Transcript Brief Infection Control/PPE Overview (Powerpoint).

Principles of Infection Control
and
Personal Protective Equipment
A Brief Overview
Why Should I Care?
Because if you become sick or injured,
you become part of the problem instead
of being part of the solution.
Why Should I Care?
We would never intentionally send you
into a situation requiring extensive PPE.
However, basic PPE would be prudent if
dealing with the general public during a
pandemic or other situation where
exposure to harmful substances could
occur.
Why Should I Care?
You could find yourself in a situation
where PPE would reduce your chances
of being harmed. For example, think
about the chemical fire in Marietta in
May, 2014. Basic PPE could prevent
inhalation of particulates, eye exposure.
But know what PPE can’t do!
Why Should I Care?
Lives will be saved if bystanders
can provide initial care to survivors of an
incident: manage bleeding, blocked
airways, burns, hypothermia, drowning.
All MRC members should strive to be
able to help in this way. Some basic PPE
could protect you.
Transmission of Influenza
Virus Among Humans
Droplet
Most likely route.
Airborne
Possible at close distances.
Contact
Possible
Types of PPE
• Gloves
• Gowns/coveralls
• Masks/respirators
• Footwear Covers
• Eye protection
Types of PPE
Gloves
•
Different kinds of gloves
–
–
–
Housekeeper gloves
Clean gloves
Sterile glove
•
Work from clean to dirty
•
Avoid “touch contamination”
–
•
Eyes, mouth, nose, surfaces
Change gloves between patients
Types of PPE
Coveralls
• Cover torso, legs, arms
• May include attached foot
coverings, hood, and/or
gloves
Types of PPE
Masks and Respirators: Barriers and Filtration
•
Surgical masks
–
–
•
Cotton, paper
Protect against body fluids and large
particles
Particulate respirators (N95)
–
–
•
Fit testing essential
Protect against small droplets and
other airborne particles
Alternative materials (barrier)
–
Tissues, cloth
PPE for Standard Precautions
Wear:
If:
•
Gloves
•
Touching respiratory secretions,
contaminated items or surfaces, blood,
other body fluids
•
Gown or
coverall
•
Handling soiled clothes, linens, other
items with patient body fluids,
secretions, or excretions
•
Eye
Protection
and Mask
•
Procedures are likely to generate
splashes / sprays of blood, body fluids,
secretions, excretions
•
ALL
•
IF IN DOUBT.
Sequence for Donning PPE
1. STOP! Assess the situation. Should I even
be here???
2. Determine what level of PPE is needed.
3. Engage trained observer or buddy.
4. Carefully inspect all items. Look for rips,
tears, any other sign of damage.
5. Don’t forget gravity!
6. Remove jewelry, trim nails if longer than ¼”
Sequence for Donning PPE
7. Hand hygiene
8. Shoe covers if not part of coverall
9. Inner gloves (inside gown/coverall cuffs)
10. Gown/coverall and hood
11. N95 Particulate respirator
12. If needed, outer gloves (outside cuffs)
13. Goggles or face shield
14. Verify
Hand Washing
Method
• Wet hands with clean (not hot)
water
• Apply soap
• Rub hands together for about
20 seconds
• Rinse with clean water
• Dry with disposable towel or
air dry
• Use towel to turn off faucet
Alcohol-based Hand Rubs
• Effective if hands not visibly soiled
• More costly than soap & water
Method
• Apply appropriate (3ml) amount to
palms
• Rub hands together, covering all
surfaces until dry
Gloves
• Select correct type and size
• Insert hands into gloves
• Pull up so no wrinkles or sagging
Coverall
• Select appropriate type and size.
If no attached hood or foot
covering, consider whether they
are needed
• This is not a fashion statement –
choose a size that fits loosely and
allows you to move freely.
• If separate, don foot covering
before gloves, hood after
respirator
Coverall
• Sit down to pull on legs, then
put on arms and hood
• If too large, roll sleeves
and/or legs under (so they
won’t catch and retain any
contaminant)
• Tape cuffs to gloves (fold
tape end under)
• If separate foot covering, tape
cuffs
N95 Particulate Respirator
•
•
•
•
•
Pay attention to size (S, M, L)
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic (inside hood)
Adjust to fit and check for fit:
Inhale – respirator should collapse
Exhale – check for leakage around face
Facial hair a problem? Use PAPR.
Goggles
• Position goggles over eyes
and secure to the head
using the ear pieces or
headband
• Adjust to fit comfortably
Gloves
• Don outer gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over gown cuffs and tape
Key Infection Control
Points
• Minimize exposures
– Plan before entering room
• Avoid adjusting PPE after
patient contact
– Do not touch eyes, nose or mouth!
• Avoid spreading infection
– Limit surfaces and items touched
• Change torn gloves
– Wash hands before donning new
gloves
Duration of PPE Use
Gloves
–Never reuse
Surgical Masks/N95
Respirators
–Wear once and discard
–Discard if moist
Eye Protection
–May wash, disinfect, reuse indefinitely
Sequence for Removing PPE
Remove in anteroom when possible
1.
2.
3.
4.
5.
6.
7.
Engage trained observer or buddy.
Disinfect outer gloves, remove, discard
Inspect and disinfect inner gloves
Remove goggles
Disinfect inner gloves
Remove coverall (hood first if separate)
Disinfect inner gloves (replace if attached
to coverall
Sequence for Removing PPE
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Remove foot covering (if separate)
Change inner gloves
Remove N95 respirator
Disinfect new inner gloves
Disinfect shoes
Disinfect inner gloves
Remove and discard inner gloves
Perform hand hygiene
Review self for contaminants
Exit the doffing area.
Removing Gloves (1)
• Grasp outside edge near wrist
• Peel away from hand, turning
glove inside-out
• Hold in opposite gloved hand
Removing Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for both
gloves
• Discard
Removing Goggles
• Grasp where elastic band
joins to goggle
• Pull gently away from face
• Lift up over hood and back;
don’t let elastic snap!
• Discard properly
Removing Coveralls
1.
2.
3.
4.
5.
6.
7.
8.
If particulate contamination, rinse or wipe coverall
with damp towels
Gently pull any zipper cover away from zipper
Use mirror to make sure you don’t touch bare skin
Grasp zipper tab with two fingers of one hand and
gently unzip
Disinfect gloves
Peel away from neck and shoulder, rolling inside of
coverall over outside
Once rolled down as far as practical while
standing, sit down on clean chair
Remove one leg at a time, discard coverall
Removing The N95 Respirator
• Don’t touch front of
mask!
• Lift the bottom elastic
over your head first
• Gently lift the top
elastic over your head,
allowing the mask to
fall forward
• Discard
Hand Washing
• Wash thoroughly immediately after
removing all PPE
• Use soap and water. An alcoholbased hand rub may be used only if
soap and water are not available
Environmental Decontamination
• Cleaning MUST precede decontamination
• Disinfectant ineffective if organic matter is
present
• Use mechanical force
– Scrubbing
– Brushing
– Flush with water
Environmental Decontamination:
Disinfecting
• Household bleach
(diluted)
• Quaternary ammonia
compounds
• Chlorine compounds
(Chloramin B, Presept)
• Alcohol
– Isopropyl 70% or
ethyl alcohol 60%
• Peroxygen compounds
• Phenolic disinfectants
• Germicides with a
tuberculocidal claim on
label
• Others
Using Bleach Solutions 1
• First, clean organic material from
surfaces or items – wash with soap or
detergent and water, rinse, dry.
• The CDC recommends using 5
tablespoons of liquid bleach per gallon
of water.
• Leave nonporous surfaces (tile, metal,
hard plastics, etc.) wet at least 10
minutes and allow to air dry.
Using Bleach Solutions 2
• Leave porous surfaces (wood, rubber,
soft plastics, etc.) wet for 2 minutes.
Rinse and air dry.
• Use household chlorine bleach (5.25 6% sodium hypochlorite); do not use
scented or color safe bleaches.
• Use fresh diluted bleach daily!
• Wear gloves and eye protection!
Waste Disposal
• Use Standard Precautions
– Gloves and hand washing
– Gown + Eye protection
• Avoid aerosolization
• Prevent spills and leaks
– Double bag if outside of bag is contaminated
• Incineration is usually the preferred method
Managing Linens and Laundry
• Use Standard Precautions
– Gloves and hand hygiene
– Gown
– Mask
• Avoid aerosolization – do not shake
• Fold or roll heavily soiled laundry
– Remove large amounts of solid waste first
• Place soiled laundry into bag in patient room
• Wash with normal detergent
Summary
• Contact with contaminants can be prevented
using correct PPE
• Viruses can be inactivated with infection
control procedures
• Hand washing is key
• PPE must be donned and removed
appropriately to prevent contamination of
wearers and environments
• Guidelines for using PPE and infection
control measures should be practiced until
they are routine
For Emergencies,
you should keep on hand
• A fresh (no more than six months old) bottle
of household chlorine bleach
• Several N95 particulate respirators
• Several pairs of disposable gloves
• At least one disposable coverall or one you
can discard.
Remember…
Your first obligation is to protect
yourself!
If you have any doubt about your safety
in any situation, avoid that situation!
For more information
Standard Precautions
http://www.cdc.gov/HAI/settings/outpatie
nt/outpatient-care-gl-standaredprecautions.html
For more information
Donning/Doffing PPE
• http://www.cdc.gov/vhf/ebola/hcp/ppetraining/n95Respirator_Coveralls/donni
ng_01.html
• http://www.cdc.gov/vhf/ebola/hcp/ppetraining/n95Respirator_Coveralls/doffin
g_01.html