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Click to edit Master title style • • • • •
Severe Respiratory Click to edit Acute Master text styles (SARS) SecondSyndrome level Third level Fourth level Fifth level Dr. Tjatur Winarsanto SpPD 2012 1
Overview Click to edit Master title style •• •• • • •• •
Epidemiology andtext Clinical Click to edit Master styles Management Infection Control Precautions Second level Laboratory Third level Safety Fourth level Safety Mortuary Fifth level Linen, Laundry, Waste Management Environmental Cleaning 2
Background Click to edit Master title style • Approximately 8098 cases in 29 countries • Click to edit Master text styles as of 31 July 2003 • Second level • Third level • At least 774 deaths • Fourth level • Fifth level • 1707 Cases (21%) have been health care workers
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Chronology Click to edit Master title style • •SARS, Click to anedit atypical Master pneumonia text styles of unknown was recognized at the end of •etiology, Second level February 2003 • Third level • Fourth level • •The World Health Organization (WHO) coFifth level ordinated the international responses to provide epidemiological, clinical and logistical as required 4
Chronology Click to edit Master title style 11 February • Chinese Click to health edit Master textreported styles officials “atypical • pneumonia” Second levelin Guangdong Province, China; 305 cases/5 deaths (Nov 02–Feb 03) • Third level • Fourth level 19 February • Fifth level Hong Kong confirms human infection of Influenza H5N1 5
Chronology Click to edit Master title style 5 March in Hanoi recognized • Outbreak Click to edit Master text styles 11 • March Second level Hong Kong reports SARS outbreak
• Third level • March Fourth level 13 • Singapore Fifth level reports 3 SARS cases
15 March The disease spread to outside Asia (Canada, )
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Chronology Click to edit Master title style WHO initiates : • Global Alert (12 March)
• Click to edit Master text styles • • Travel Advisory Second level (15 March; 2, 23 & 29 April) Third level • • Enhanced global surveillance • Fourth level • Global Outbreak Alert and Response Network • Fifth level • Specific Global Networks (Lab, Case Management, Epidemiology) 7
Chronology Click to edit Master title style Forward planning of Activities since then : • Infection Guidelines – bi-regional • Click toControl edit Master text styles guidelines will now cover all issues for • Second level Infection Control practice in a Health Care • Third level Facility – due out soon • Fourth level • Infection Control Programme – will member states in how to set up an IC • Fifth level programme • IC Audit tool – for self evaluation of HCF 8
Click toEpidemiology edit Master title style • Cause : SARS CoV • Click to edit Master text styles • Highly infectious • Second level • Mainly affects adults • Third level • Superspreading events important in •transmission Fourth level process • Fifth level • No reports of transmission occurring before onset of symptoms 9
Click toEpidemiology edit Master title style • •Means of edit transmission Click to Master text styles • Second level Evidence of person to person transmission • Third level • Close Fourth level with body fluids (especially respiratory • Fifth level droplets ) Contaminated hands, clothes, equipment; environment may also be important 10
Click toEpidemiology edit Master title style • •Risk factors transmission Click to editfor Master text styles • Second level • •High medical procedures: Thirdrisk level • Intubation • Fourth level • Bronchoscopy • Fifth level
• Cough-inducing procedures (sputum induction, istration of nebulised medications, suctioning) 11
Click toEpidemiology edit Master title style • •Incubation period Click to edit Master text styles
– 2 –10 days and up to 13 days in exceptional • Second cases level Onsetlevel and duration of infectivity unknown • –Third
• Fourth level • Fifth level • Organism survival in environment – Duration unknown – Data has shown SARS CoV may survive for 2-3 days 12
Case Definitions Developed forto public health purposes in the interClick edit Master title style outbreak period
Clickwith to edit Master A •person a history of:text styles • Second •Fever (> 38oC)level •AND one orlevel more of the symptoms of lower respiratory tract • Third illness (cough, difficulty breathing, shortness of breath)
• Fourth level •AND Radiographic evidence of lung infiltrates consistent with • Fifth or level pneumonia RDS or autopsy finding consistent with the pathology of pneumonia or RDS without an identifiable cause •AND No alternative diagnosis can fully explain the illness 13
Case Definitions Clickcase to definition edit Master Laboratory of SARStitle style •A person with symptoms and signs that are clinically • ClickoftoSARS editAND Master styles suggestive with text positive laboratory findings for SARS-CoV based on one or more of the following diagnostic • Second level criteria:
• Third level a) PCR for SARS-CoV – using a validated method from: • Fourth level •At least 2 different clinical specimens (eg nasopharyngeal or stool) OR level • Fifth •The same clinical specimen collected on 2 or more occasions during the course of the illness
•Two different assays or repeat PCR using a new RNA extract from the original clinical sample on each occasion of testing14
Case Definitions b) Seroconversion by ELISA or IFAtitle style Click to edit Master • Negative antibody test on acute serum followed by positive antibody testto onedit convalescent • Click Masterphase text serum stylestested in parallel OR • Fourfold or greater • Second level rise in antibody titre between acute and convalescent phase sera tested in parallel
• Third level c) Virus Isolation • Fourth level •Isolation in cell culture of SARS-CoV from any specimen AND • Fifth level using a validated method PCR confirmation •Testing should only be undertaken in a national or regional reference laboratory as per WHO guidelines. 15
s Click to edit Master title style Definition • Click to edit Master text styles Close level : having cared for, lived with, or had • Second direct with the respiratory secretions or body • Third fluids of alevel suspect or probable case of SARS.
• Fourth level s persons under investigation for SARS • Fifthoflevel
should be traced and quarantined until SARS has been ruled out as the cause of the illness
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Clinical picture in SARS patients Exposure to SARS Fever, myalgia, dry non-productive cough cough, headache shortness of breath Incubation period ~2 to 10 days up to 13 days reported
Prodrome ~ 1- to 2 days
Lower respiratory phase From day 4 onwards
Infectivity None /very low
Low
Recovery approx 90%
Very high
Acute respiratory distress syndrome approx 10%
Clinical Picture Onset / Presentation Click to edit Master title style • •Sudden of high Click to onset edit Master textfever styles with chills, rigors and a non•myalgia, Second level •productive Third level cough • Fourth level • •Most Fifth cases level have bilateral pneumonia
• ~ 90% begin to recover from day 6 or 7 18
Clinical Picture ClickOnset to edit Master title style / Presentation • Rapid deterioration in 10% (+/-) of cases • Click to edit Master text styles • Second level Acute RDS • Third level Require ICU ission & • Fourth level mechanical ventilation • Fifth level • Case fatality rate: ~ 6% • No specific treatment available
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Clinical Picture – Management
Click to edit Master title style IVE TREATMENT • Click to edit Master text styles • Antibiotic Therapy: •toSecond level cover causative organisms • Third level • •Prophylactic Fourth level Antibiotic Therapy: prevent • toFifth level secondary bacterial infection • Maintain oxygenation: intubate and ventilate as necessary 20
Clinical Picture – Management
Click to edit Master title style IVE TREATMENT
• Click to edit Master text styles Avoid interventions which may cause • Second level aerosolisation of respiratory secretions: • Third level Bronchoscopy •Fourth levelbronchodilators Nebulised Chest physiotherapy •Fifth level
Gastroscopy Any procedure / intervention that may release respiratory secretions 21
Clinical – Management Click toPicture edit Master title style • Click IVE to edit MasterTREATMENT text styles • Second level • Third level In severe cases corticosteroids and ribavirin • Fourth level have been used, however there • is Fifth level no evidence to their general or routine use at this stage. 22
Summary – SARS • Multi - Country Outbreak Click to edit Master
title style
• New Pathogen: • Click to edit Master text styles CoronaVirus family – SARS CoV
• Second level • • Clinical Picture: Third level Fever and respiratory symptoms • Fourth level ~ case fatality rate currently 4% • Fifth level
• Transmission: Close with symptomatic case(s) Contaminated hands and objects 23
Summary – SARS
Click to&edit Master title style • Prevention Control: Identification Isolation suspect and probable cases •Click to editofMaster text styles Tracing & quarantine of close s •Second level Infection control precautions for all • Third level suspect and probable cases •Fourth Publiclevel Education • Fifth level • Health care workers are currently at greatest risk therefore: Infection control precautions are 24 essential
Infection Control Precautions Click to edit Master title style Infection Control precautions (previously Barrier nursing techniques) are • known Click toasedit Master text styles to prevent infection from the patient • designed Second level to the staff/visitor or the staff/visitors to other • Third level patients. • Fourth level • Fifth level Strict precautions must be used for all SARS patients. 25
Patient Management Click to edit Master title style SARS : Infection Control Goals
• Click to edit Master text styles • SARS Secondissions level - Triage • Third level • Components Fourth level of SARS Isolation • Fifth level SARS : Infection Control Practices 26
SARS : Infection Control Goals Click to edit Master title style In addition to providing the best possible • clinical Click tocare: edit Master text styles • Second level • Third level Detect early any suspect cases. • Fourth level Implement appropriate isolation measures. • Fifth level Protect health care personnel. Protect other patients. Protect family and community . 27
Triage for SARS issions Clickthere to edit title style If possible, shouldMaster be separate wards/areas for each of the following categories :
• Click to edit Master text styles • Patients Secondwith levelcolds, sniffles and runny noses should be isolated in a single room / area Third level • Suspect cases • -Fourth Place inlevel a single room • Probable cases Fifth level - If cohort nursing, keep probable and suspect cases apart - May share room with other probable cases; where possible use a single room for all patients 28
Components of SARS Isolation Click to edit Master title style •• Facility Click to edit Master text styles •• istrative Controls Second level Third level •• Clinical Surveillance of Staff Fourth level •• Organization of Isolation Area Fifth level Equipment •• Protective • Standard Precautions 29
Facility Clickfrom toother editpatient Master style Isolated / stafftitle movement
• • Good ventilation
• –Click to edit Master styles Air movement: corridor text to room to outdoors Turn off level central air-conditioning systems unless the • –Second room can be isolated from the system. • Third level • Sinks and running water Fourth level • •Adequate bathroom facilities Fifth level • •Capacity to handle waste and laundry • Sufficient rooms for expected number of patients • Contingency plans for converting other areas to isolation facilities 30
ISOLATION WASH/TOILET
General Principles of isolation unit
Click to edit Master title style A F
• ISOLATION Click to ROOM edit Master text styles CHANGE Negative pressure/ ROOM (e.g. blow air out of • Second level E window with fan) D • Third level A D B C • Fourth level E A •A. Fifth level Disinfection station
GENERAL ACCESS AREA
B. Container for disinfection of reusable items e.g. goggles C. Biohazard bag for used (personal protective equipment) disposal D. Wall-mounted alcohol handwash dispensers E. External windows only. Keep clear of public. F. Storage for general ward clothes, new PPE 31
ISOLATION WASH/TOILET
General Principles of Isolation Unit
Click to edit Master title style A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM • Click to edit Master CHANGE text styles • Second level A D • Third level B C E A B • Fourth level A. Disinfection station Fifth level B.• Container for disinfection of reusable items C. D. E.
F.
GENERAL ACCESS AREA
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE 32
Facility Click to edit Master title style Isolation Area – Full IC Precautions required Colour codes
• Click to edit Master text styles • Green • Second level[reduced] staff movement (GO) : General • Third level •• Yellow Fourth level (CAUTION) • Fifth level: Limited staff movement
• Red (RESTRICTED) : Assigned staff only 33
istrative Controls Click to edit Master title style
• Limit and control points of entry to SARS ward(s) • Click to edit Master text styles • • • •
Second level – One entrance Third level – “Guard” to control entrance –Fourth Log oflevel permitted visitors (staff & visitors) levelmust be restricted or preferably –Fifth Visitors forbidden with NO EXCEPTIONS – Limit patient travel/transport outside unit – Minimize the number of staff exposure to cases 34
istrative Controls Click to edit Master title style • Assignment of responsibility • Click to edit Master text styles • Second level – Determining patient placement • –Third level implementation and enforcement Overseeing of infection • Fourth level control measures Enforcing • –Fifth level access restrictions –
Supply acquisition and distribution – Surveillance of Health Care Workers (HCWs) 35
Clinical Surveillance of Staff Click to edit Master title style
• Maintain list of all staff who worked with SARS patients or on the SARS ward;
• –Click to edit Master text styles Systematically monitor for fever; and • –Second level Twice daily temperature for staff working in the area (baseline Chest X-Ray may be needed ) • Third level • Screen for symptoms of SARS-like illness among •staff Fourth level for duty. reporting • •List Fifth levelinformation for: –
–
Persons visiting or caring for SARS patients; and s of HCWs in close with SARS patients. 36
Organization of SARS Isolation Area
Click to edit Master title style
• Put Up Signs: eg. SARS Isolation Area • Designated for cleantext protective • Click to area edit Master styles equipment –
Instructions for using protective equipment Second level Accessible to personnel Third level Sufficient inventory to meet daily needs
–
Color-coded bags and containers for contaminated waste and laundry Containers for laundry and all waste should have footoperated lids
• – •– • Separation of clean and dirty supplies including an • Fourth level area for level containment of waste and soiled linen • Fifth –
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ISOLATION WASH/TOILET
General Principles of Isolation Unit
Click to edit Master title style A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM • Click to edit Master CHANGE text styles • Second level A D • Third level B C E A B • Fourth level A. Disinfection station Fifth level B.• Container for disinfection of reusable items C. D. E.
F.
GENERAL ACCESS AREA
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE 38
Infection Control Click to edit Master title style • • • • •
“Youtocan Click edit minimize Master text YOUR styles risk of catching Second level Third level SARS Fourth level Fifth level by following Infection Control Precautions.” 39
Infection Control Precautions Click to edit forMaster SARS title style • • • • •
Click to edit Master text styles Standard Precautions Second level + Third level Fourth level Respiratory Precautions Fifth level +
Precaution 40
Exposure Risks Click to edit Master title style • Patient: • Health Care Staff: Respiratory – Respiratory secretions • –Click to edit Master text styles secretions – Blood • Second level – Blood – Body fluids including • Third level – Body fluids excreta • Fourth level including excreta – Mucous membranes • –Fifth Skin level lesions – Skin lesions –
Staff – Visitors
–
Sharps – Visitors 41
Click to edit Master title style
Hand Washing
• Click to edit Master text styles • Second level • Third level An essential Infection Control • Fourth level precaution to prevent the • Fifth level
transmission of SARS
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Principles of Hand Washing Click to edit Master title style
Hand Washing : • •IsClick the single important and effective to editmost Master text styles component for preventing the transmission of •infection. Second level levelto remove transient • •IsThird designed that may have been picked •microorganisms Fourth level from the environment. •up Fifth level • Prevents the transfer of these microorganisms to other patients, staff and equipment. • Is best performed using soap (preferably liquid) and warm running water. 43
Handwashing – When? – After removing gloves Click to edit Master title style – Before and after patient –• After with blood ortext Click to edit Master body fluids from any • patient Second level – After taking blood • pressure Third level or vital signs any level patient • from Fourth
styles
Other times:
•– After Fifthusing levelbathroom – After blowing or wiping nose – Before eating – Before preparing food
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Handwashing – How? Click to edit Master title style Handwashing procedure : • Click to edit Master text styles • Second level Running water • Third level Soap (preferably liquid) • Fourth level • Fifth level Friction Or use Alcohol-based hand rub
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Handwashing Steps Click to edit Master title style Step 1 • Click to edit Master text styles • Second Wet hands level and wrists. • Third level Apply soaplevel • Fourth • Fifth level
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Handwashing Steps Click to edit Master title style Step 2
• Click to edit Master text styles • Second Right palmlevel over left. • Third level • Fourth level Left over right. • Fifth level
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Handwashing Steps Click to edit Master title style • Click Step 3 to edit Master text styles • Second level Palm to palm • Third level • Fourth level with fingers • Fifth level interlaced. 48
Handwashing Steps
Click to edit Master title style Step 4 • Click to edit Master text styles Back of thelevel • Second fingers the • Thirdtolevel opposing fingers • Fourth level and interlocked. • Fifth level
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Handwashing Steps Click to edit Master title style Step 5 • Click to edit Master text styles
Rotational rubbing of • Second level • Third the right level thumb by • Fourth level clasping it in the left • Fifth level palm. And vice versa.
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Handwashing Steps
Click to edit Master title style Step 6 • Click to edit Master text styles Rotational rubbing • Second level backwards and forwards with tops of • Third level fingers and thumb of • Fourth level right hand in left. • Fifth level And vice versa. 51
Drying Your Hands Click toto edit Master title style It is important dry your hands thoroughly after washing them because :
• Click to edit Master text styles • Damp hands collect microorganisms • Second level • Damp hands spread potentially infectious •microorgansims Third level • •Damp hands Fourth levelmay become colonised with potentially infectious microorganisms • Fifth level Therefore it is important to “pat dry” your hands thoroughly. “Pat drying” also helps to prevent damage to skin. 52
Handwashing Tips Click to edit Master title style : • Click to edit Master text styles • Second level Wash hands for a minimum of 15 to 20 • Third level seconds. • Fourth level •Ensure you have washed all areas properly. Fifth level
Dry hands thoroughly. 53
Handwashing Tips Click to edit Master title style Alcohol based hand gels/ lotions • Click to edit Master text styles Use on clean (unsoiled) hands • Second level Use enough of the product to cover hands Third levelrub hands using the same steps as •Vigorously • Fourth Step 1 – 6 level (do not wet hands prior to applying the solution/gel) • Fifth level
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Handwashing in Difficult Situations
Click to edit Master title style
If running water is not immediately available, • Click to edit what should youMaster do? text styles • Second level Use a basin • Third levelof clean water and wash hands. Use a clean basin each time. • Fourth level Use fresh water each time. • Fifth level DO NOT contaminate sources of fresh / clean water by handling ladles or dippers. 55
Handwashing in Difficult Situations
Click to edit Master title style If water is not immediately available, what should you do? • Click to edit Master–text styles Use an 70% alcohol based hand rub solution. • Second levelamount to completely cover Use sufficient your hands. • Third level Wash your hands using running water • Fourth level and soaplevel as soon as they become soiled • Fifth NB: Alcohol is very effective when hands are clean (i.e.. not soiled with blood, body fluids etc) 56
Infection Control Precautions
Click to edit Master title style Precautions
Other Infection Control • Click to edit Master text styles Factors
• Standard Precautions • Second level • Respiratory • Precautions Third level Fourth Precautions level • • • • Hand FifthWashing level • PPE • Exposure Risks • Patient transport
• Patient and family education • Laboratories / Specimens • Mortuary Care • Waste and Linen Handling • Cleaning & Disinfection 57
Personal Protective Equipment (PPE)
Click to edit Master title style • N-95 Respirator Mask must be worn
• •• • •• •
Click to edit Master text styles Goggles (protective glasses) Second level Third level Disposable Fourth levelor Reusable Gowns Fifth level
• Disposable Gloves
• Cap and shoe covers are optional 58
Personal Protective Equipment for SARS
Click to edit Master title style • • • • •
Click to edit Master text styles Second level Third level Fourth level Fifth level
59
Personal Protective Equipment Click to edit(PPE) Master title style • • • • •
N-95 Respirator Mask Click to edit Master text styles Gloves Second level Gown Third level Goggles Fourth level Fifth level Optional Cap Shoe covers 60
Principles for Using PPE Click to edit Master title style Personal Protective Equipment (PPE) is used to• protect care workers Click tohealth edit Master text stylesby preventing potentially infectious microorganisms from: • Second level • Third level •• Contaminating their hands, eyes and Fourth level clothing; • Fifth level and • Being transmitted to other patients and staff. 61
Principles for Using PPE Click to edit Master title style • PPE reduces but does not completely •eliminate Click to edit Master text styles the possibility of infection. • Second level • Third level • PPE is only effective if used correctly. • Fourth level • Fifth level • The use of PPE does not replace basic
hygiene measures such as hand washing – hand washing is still essential to prevent transmission of infection. 62
N-95 Click to Respirator edit Master Masks title style • • • • •
Click to edit Master text styles types of Different Second level N-95 Respirator Masks Third level Fourth level Fifth level
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Principles for Using the N-95 Respirator Click to edit Master Mask title style • Click edit Master styles The N-95 to respirator masktext is used to protect health care workers, other patients, staff or visitors by • Second level preventing potentially infectious microorganisms • Third level such as respiratory secretions from:
• Fourth level Fifth level their face including the nose and • • Contaminating mouth. • Being inhaled or ingested. 64
N-95 Respirator Mask Click to edit Master title style • Click to edit Master text styles For respiratory • Second level protection wear • Third level an N-95 • Fourth level respirator mask • Fifth level during all patient 65
Proper use of N-95 Respirator Click to edit Master title style Mask •• DO Click NOT to edit touch Master the front text styles of the mask once masklevel has been fitted • the Second • Third level •• Wear one N-95 mask – no need for Fourthonly level additional respiratory protection • Fifth level • REMOVE the N-95 respirator mask before leaving the isolation unit / area 66
WHY antoN-95 Respirator Mask? Click edit Master title style • • • • •
Click to edit Master text styles N-95 masks offer a Second respirator level higher Third level level of filtration for Fourth level respiratory secretions than a Fifth level surgical mask
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HOW to use an N-95 Respirator Click to editMask Master title style • Use for single shift unless excess moisture •necessitates Click to edit Master text styles replacement during each shift or it has by touching or soiling •become Secondcontaminated level Label with • –Third levelthe wearer‟s name • Fourth level • Dispose of with medical waste • Fifth level
NB: You must fit the mask securely over both your nose and mouth 68
HOW to use an N-95 Respirator Click to editMask Master title style •• Always correct Click to use editthe Master textsized stylesmask. • Second level •• The size will not fit properly and Thirdincorrect level will fail the „fit test‟. • Fourth level • Fifth level NB: You must fit the mask securely over both your nose and mouth so size is important. 69
N-95 Respirator Mask Click to edit Master title style • This only oneMaster text styles Clickis to edit example (brand) of an • Second level N95 respirator mask.
• •• •
Third level Fourth level Other types of N95 masks must be fitted Fifth level according to the manufacturers instructions 70
N-95 Respirator Masks Click- Fitting to edit Master title style Instructions Step 1 • Click to edit Master text styles Cup the respirator Second level in• your hand with the nosepiece • Third level at your fingertips • Fourth level allowing the • Fifth levelto hang headbands freely below your hand. 71
N-95 Respirator Masks Click to edit Master title style - Fitting Instructions • Click Step 2 to edit Master text styles • Second level Position the • Third level respirator under your chinlevel with the • Fourth nosepiece up. • Fifth level
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N-95 Respirator Masks Click- Fitting to edit Master title style Instructions
Step 3 Pull the top strap • Click to edit Master text styles over your head • Second level resting it high at the • Third top backlevel of your head. Pulllevel the • Fourth bottom strap over • Fifth level your head and position it around the neck below the ears.
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N-95 Respirator Masks Fitting Instructions Click to edit Master title style Step 4 Place the fingertips of both hands at the the • Click totop editofMaster text metal nosepiece. Mould the • Second level nosepiece to the shape of your nose by pushing • Third level inward while moving your fingertips • Fourthdown levelboth sides of the • Fifth level nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.
styles
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N-95 Respirator Masks - Fitting Instructions Click to edit Master title style
Step 5.1
The seal of the respirator • the Click edit Master on facetoshould be fit- text styles • Second level checked prior to wearing in• the work area. Third level
• Fourth level Cover the front of the • Fifth level respirator with both hands, being careful not to disturb the position of respirator. 75
N-95 Respirator Masks - Fitting Instructions Click to edit Master title style Step 5.2
Positive Fit Test
Exhale sharply. positive • Click to editA Master pressure should be felt • Second level inside the respirator. If • Third level any leakage is detected, adjust the position • Fourth level of the respirator and/or tension • Fifth level of straps. Retest the seal. Repeat the steps until the respirator is sealed properly.
text styles
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N-95 Respirator Masks Click- to edit Master title style Fitting Instructions Step 5.3 Negative Fit Test • Click to edit Inhale deeply. If Master there is text styles no negative • leakage, Second the level pressure make the • Thirdwill level mask cling to your face. • Fourth level A poor seal will result in • Fifthloss level prompt of negative pressure in the mask due to air entering through gaps in the seal. 77
When to change your N-95 ClickRespirator to edit Master title style Mask? If you the front of the mask • Click to touch edit Master text styles • Second level • Third If it islevel grossly contaminated • Fourth level • Fifth level
If it becomes wet
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Principles for Using Goggles, Gowns, Click to edit title style Gloves, CapsMaster and Overshoes • Click to edit Master text styles Goggles, gowns, gloves, caps and overshoes are • Second level used to protect health care workers, by preventing • Third level potentially infectious microorganisms from : • Fourth level Fifth level their eyes, clothing, hands, hair and • • Contaminating shoes and • Being transmitted to other patients and staff. 79
Goggles Click to edit Master title style • Assign one pair to each worker at the • beginning Click to edit of aMaster shift text styles • Second level Third goggles level in room with SARS patients •• Wear • Fourth level •• Fifth Leavelevel in the container in the anteroom at the end of the shift to be cleaned and disinfected 80
Goggles Click to edit Master title style • Click to edit Master text styles • Second level You should use • Third level goggles to cover • Fourth level all of the eye area. • Fifth level
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Gowns
Click to edit Master title style
• Long sleeved gowns must be worn when in direct • Clickwith to edit the Master patient text styles Second • •Wear gownlevel at all times in patient’s •the Third levelroom • Gowns must be removed • Fourth level before leaving the patient’s •room Fifthorlevel dedicated anteroom • Remove used gowns as soon as possible particularly when grossly contaminated
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Gowns AClick new Gown be worn fortitle everystyle patient to should edit Master
• Click to edit MasterReusable text styles Gowns Disposable Gowns If necessary, gowns may be • Second level reused during one shift for • Third level for Use a new gown the same patient, e.g. when each patientlevel . short of supplies. • Fourth Discard immediately if • Fifth level Visibly contaminated. Discard immediately if visibly contaminated.
Hang gown with outside facing in when not in use. Discard at the end of the shift. 83
Gloves Click to edit Master title style • Before all patient • Click to edit Master text styles
• •• • ••
Second level Third level Before all cleaning Fourth level Before handling Fifth level soiled linen & waste
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•
Gloves Clickafterto edit with Master title style Remove patients or lab specimens
• Click to edit Master text styles • • Do not wear gloves outside Second level of the patient‟s room / • anteroom Third level • Fourth level • • Do not re-use Fifth level gloves • Wash hands after removing your gloves 85
Plastic Disposable Aprons Click to edit Master title style
• Plastic disposable aprons must be worn is atext likelihood • whenever Click to editthere Master styles of other PPE such as gowns becoming wet. • Second level • Third level • They are worn to reduce the risk of • Fourth level breakthrough and contamination of • clothing Fifth level worn underneath the PPE. • They must be disposed of after use.
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Plastic Disposable Aprons Click to edit Master title style Aprons must be worn when : • Performing patient care activities where • soiling Click to edit Master text styles or increased moisture is likely; Second level •• Cleaning and disinfecting the patient • environment. Third level •• Cleaning and disinfecting medical; other Fourth level patient care equipment. • Fifth level • Laundering used linen. • Cleaning and disinfecting the cleaning equipment. 87
Caps Click to edit Master title style Caps are optional and worn to protect hair text styles • Click to editthe Master from aerosols that may • Second level occur from high risk • Third level procedures such as intubation • Fourth or level bronchoscopy
• Fifth level
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Overshoes Click to edit Master title style Overshoes are •optional Click toand editworn Master to text styles • Second level protect the health care worker’s • Third level shoes and feet from being • Fourth level splashed by spills • Fifth level such as blood or other body fluids or aerosols 89
•
Key Points Click edit Master titledisposable style Wear N-95 to respirator mask, goggles,
gowns, gloves (and hats, overshoes – optional in high risk situations) for all patient & •aprons Click when to edit Master text styles necessary
• Second level • •Wash Thirdhands levelusing soap (preferably liquid) and water when leaving the anteroom • Fourth level Fifth levelalcohol-based hand rub solution after • •Use an 70% hand washing • Wash hands when leaving the unit 90
Personal Protective Equipment for SARS
Click to edit Master title style • • • • •
Click to edit Master text styles Second level Third level Fourth level Fifth level
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Patient Transport Click to edit Master title style It is essential to avoid all unnecessary • Click to edit Master text styles transport of isolated SARS patients to •control Secondand level prevent the potential spread of •SARS Thirdinfection. level • Fourth level • Fifth level
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Patient Transport If the patient needs to be out of their room for an Click to edit Master title style essential procedure, e.g. X-Ray • • • • •
Transport route must avoid Click to edit Master textpopulated styles areas. levelwear an N-95 respirator mask (standard –Second Patient must surgical masks can be used by patients if N-95 Third levelmasks are not tolerated or are in insufficient respirator supply)level and an isolation gown. Fourth –Fifth Accompanying level staff must wear : –
•
N-95 respirator mask • Gloves • Gown • Goggles 93
•
Patient Transport Click to edit Master title style Transport –Ambulance –
No dedicated ambulance needed edit (N-95 Master text styles –Click Maskto patient respirator mask) – Transporters wear personal protective equipment Second level
• • N-95 respirator mask, disposable gown, goggles, gloves Thirdand level • • Clean disinfect ambulance after transport • –Fourth level Standard cleaning and disinfecting or • Fifth level
1:100 dilution of bleach; after 10 minute time, clean and disinfect using standard procedures. DO NOT use spray cleaners 94
Patient, Family & Community Click to edit Master title style Education • •Education forMaster the patient, their family and Click to edit text styles community •the Second level is essential in the control and prevention of the SARS Virus. • Third level • Fourth level • It is particularly essential for those persons • Fifth level requiring hospital or home isolation to understand the necessary restrictions. 95
Patient, Family & Community Click to edit Master title style Education Explain: • Click to edit Master text styles • What SARS is (to date) • • • • • •
Second level Third level Why isolation is required. Fourth level Fifth level Precautions required including PPE
• Hand washing procedures 96
Patient and Family Education Click to edit Master title style • Teach the patient and family :
• Click to edit Master text styles – about the SARS illness • Second level and the reason • –Third levelfor the precautions being used • Fourth level • Teach the patient and visiting family : • Fifth level – –
how to perform hand hygiene how to wear an N-95 respirator mask, gown, gloves and goggles (if available) 97
Patient and Family Education Click to edit Master title style Explain to the patient and family why • Click to edit Master text styles disposable equipment is being used • Second level such as: • Third level • Fourth level • Eating utensils • Fifth level • Medical equipment • Patient gowns 98
Laboratories Click to edit Master title style • Laboratory staff must ensure that their • practices Click to edit Master text styles are meticulous. • Second level • Third level • Fourth level • Fifth level
99
Click to edit Master title style Laboratories • Click to edit Master text styles • Second level • •Advance Third levelplanning in each • designated Fourth levellaboratory is essential to ensure that specimen handling, • Fifth level transportation and storage is managed according to the guidelines. 100
Bio Safety for SARS in Click toLaboratories edit Master title style The following activities may be performed in biosafety •level Click to edit facilities Master text 2 (BSL-2) withstyles appropriate work •practices Second level • •Routine tests Third diagnostic level • •Manipulations Fourth level involving known inactivated viru and/or incomplete, non-infectious portions of the • Fifth level viral genome • Routine examination of mycotic and bacterial cultures • Final packing of specimens for transport
101
Bio Safety for SARS in Click toLaboratories edit Master title style Precautions for BSL-2 labs
• Click edit Master text styles biological safetyto cabinet for any procedure that may generate aerosols • Second level • PPE•toThird be worn: level
•disposable gloves
• Fourth level • solid-front or wrap-around gowns with cuffed sleeves • Fifth level • eye protection • surgical mask, or full-face shield, according to the risk of aerosols and exposure • When working at a biological safety cabinet, a full face shield is not necessary.
102
Bio Safety for SARS in Click toLaboratories edit Master title style Precautions for BSL-2 labs
• Click to edit Master text styles •Use sealed centrifuge cups – unload in a safety cabinet • Secondwork level •Decontaminate surfaces and equipment • Third level •Biological waste should be treated as outlined in the WHO Laboratory Biosafety Manual – 2nd Edition (Revised), 2003 • Fourth level • Fifth level
103
Bio Safety for SARS in Click toLaboratories edit Master title style BSL-3 facilities & BSL-3 work practices are required • Click to edit Master text styles for:
••Viral Second level cell culture of the etiologic agent ••Manipulations Third level involving growth or concentration of the •etiologic Fourthagent. level When a procedure • Fifth level or process cannot be conducted within a
biological safety cabinet, then appropriate combinations of personal protective equipment (e.g., respirators, face shields) and physical containment devices (e.g., centrifuge safety cups or sealed rotors) must be used. 104
Specimen Collection Click to edit Master title style • • • • •• •• •• •
Wear full PPE Click to edit Master text styles Write clinical details on the request form Second level Samples should be collected by clinical staff Third level Label clinical samples clearly Fourththe level Change PPE between patients Fifth level Discard all disposable materials in a biohazard bag 105
Storage of Specimens Click to edit Master title style • • • • • • •
Respiratory samples and frozen tissues: Click to edit Master text styles o – store at –70 C Second level Third level Serum: Fourth level o – store at 4 - 8 C for 24-48 hours Fifth level or –
at -20oC for longer periods 106
Patient Specimens Click to edit Master title style • Treat all • •patient Click to edit Master text styles specimens as • Second level highly •infectious Third level •
• Fourth level Fifth • •Use leaklevel proof containers for collection
Do not contaminate outside of container
Transport specimens in leak-proof outer containers e.g. a sealed plastic bag 107
Mortuary Precautions Click to edit Master title style Health care workers must wear full PPE:
(N-95 respirator mask, Goggles, Gown, Gloves) • Click to edit Master text styles
• Second level Health Care Workers must: level • Third Prepare the body level • Fourth Place in a body-bag or leak-resistant bag • Fifth level or Place in plastic sheeting, wrap the body and tape/seal with waterproof adhesive tape 108
Mortuary Precautions tobeedit Master title (3°C style: The Click body must placed in cold storage +/- 2°C ) as soon as possible after the body is • Click to Masterintext styles prepared andedit wrapped a bag or plastic sheeting.
• Second level The need for a post mortem must be discussed • Third level with the designated • Fourth level national laboratory as there are potential infection risks for personnel during a • Fifth level post mortem.
Post mortems must be performed wearing full PPE 109
Mortuary Care Click to deference edit Master titletostyle Although all due must be given local cultural and religious customs associated with the death of a to member of the community, • Click edit Master text stylesthe following must be considered • Second level to minimize the potential risk of spread of the SARS Virus. • Third level • The body must not be embalmed, to reduce • Fourth level exposure risk. •• Fifth The need levelfor cremation with minimal delay. • The delaying of a „wake‟ to celebrate the life of the individual until all close s and possible secondary s are cleared. 110
Linen & Laundry ClickWaste to editManagement Master title style • Health care and laundry workers must the Master importance handling linen • understand Click to edit textofstyles correctly to prevent the spread of potentially • infectious Second level microorganisms
• •• •
Third level Linen canlevel be washed using routine laundry Fourth practices. Fifth level
• The health care facility should follow routine waste management practices but all waste must be incinerated. 111
Linen
Click to edit Master title style All contaminated or soiled linen is potentially • Click to edit Master infectious therefore:
text styles
• Second level • • Wear fulllevel PPE when handling Third linen. • Fourth level Fifth level • • Separate grossly contaminated linen from non- contaminated linen in the patient‟s room for ease of handling in the laundry. 112
•
Laundry Click to edit Master title style Place in color-coded bags and double bag for
transport. Click to edit text styles • •Do not sort linenMaster in the laundry to avoid the aerosols. •creation Secondoflevel • •Staff handling Third level linen should wear full PPE as per standard procedures for SARS. • Fourth level • Use routine detergents.
• Fifth level
Bleach may be added if desired, and compatible with the detergent being used. 113
Waste Click to edit Master title style • • • • • • •
Wear full PPE when handling waste. Click to edit Master text styles Second level Clinical waste: all items from treatment Third level areas Fourth level – Soiled surgical dressings Fifth level – Swabs –
Masks – Gowns – Other contaminated waste
114
•
Waste Sharps ClickContainers. to edit Master title style
Click towaste edit Master text styles •• Collect in designated color-coded • plastic Secondbags levelfor incineration. • Third level Fourth level •• Double bag for transport. • Fifth level • the local authorities for assistance if the health care facility does not have incineration facilities. 115
Sharps Disposal Click to edit Master title style
Disposal containers should be puncture-resistant and leak- proof.
• • • • • • ••
Click to edit Master text styles Second level Do not overfill container Third level Do not reach into Fourth level container Dispose of used sharps Fifth level into the sharps container
116
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • Cleaning is usually sufficient for prevention and • control Click to Master styles infection the use of edit infection, buttext for SARS a disinfectant • ofSecond level following cleaning is recommended level to clean thoroughly before • • ItThird is essential the environment or equipment. • disinfecting Fourth level • Cleaning and disinfection must be carried out at • least Fifthdaily level and particularly when gross contamination occurs. • In some instances it may be necessary to disinfect to render the item safe to handle. 117
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • • • • •
Click to edit Master text styles Cleaning and disinfecting patient Second level rooms and equipment is one of the best ways Third level to reduce transmission of infection Fourth level Fifth level Wear full PPE when cleaning and disinfecting 118
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • To communicate infection risk, use signs.
• Click to edit Master text styles eg. SARS Isolation • Second level Third patients level & staff by: • •Protect • Fourth level and disinfecting •- Cleaning Fifth level equipment.
- Cleaning and disinfecting the room and anteroom. 119
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style Click to edit Master text styles •• The immediate area around patients
must be
heavily contaminated. • considered Second level • Third level • Bedside table, bed stand, and accessible areas of • bed Fourth level must be cleaned with detergent and floors warm • and Fifth levelwater at least daily (preferably twice a
day). •
In addition, disinfect all surfaces after cleaning. 120
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style • Contain and dispose of infectious materials in : • waste Clickcontainers to edit Master text styles – Put waste containers near entrance / exit to • Second patientlevel room.
• Third level • • Provide patient equipment when Fourth dedicated level possible. • Fifth level • Clean and disinfect patient care equipment immediately after use depending on the type of equipment. 121
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment Use standard procedures and agents • Click to edit Master text styles for cleaning And disinfecting environmental surfaces and • Second level patient care equipment.
• Third level Fourth level and warm water, rinse in hot • • Use detergent • water Fifth and level dry. • Use disinfectant afterwards.
122
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • When areas and inanimate objects are • grossly Click tocontaminated edit Master text styles use: • –Second level hypochlorite (bleach) solution 1:100 sodium to disinfect • Third level (before cleaning) – it will reduce the viral load and the potential • Fourth level to spread. for infection • Fifth level • Then use the standard cleaning and disinfecting procedures mentioned previously. 123
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment •
All reusable patient items such as basins and • bedpans Click toshould edit Master be: text styles
• • • •
Second level Cleaned and disinfected before being used on another Third level patient Fourth level Taken to the dirty utility room for cleaning Fifth level Staff should wear full PPE when handling contaminated equipment. 124
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style •
DO NOT spray clean the room / area.
• Click to edit Master text styles Why? • Second level Because it: • Third level – Spreads droplets • Fourth level • –Fifth level aerosols Spreads –
Is not effective as a surface disinfectant 125
Severe Respiratory Click to edit Acute Master text styles (SARS) SecondSyndrome level Third level Fourth level Fifth level Dr. Tjatur Winarsanto SpPD 2012 1
Overview Click to edit Master title style •• •• • • •• •
Epidemiology andtext Clinical Click to edit Master styles Management Infection Control Precautions Second level Laboratory Third level Safety Fourth level Safety Mortuary Fifth level Linen, Laundry, Waste Management Environmental Cleaning 2
Background Click to edit Master title style • Approximately 8098 cases in 29 countries • Click to edit Master text styles as of 31 July 2003 • Second level • Third level • At least 774 deaths • Fourth level • Fifth level • 1707 Cases (21%) have been health care workers
3
Chronology Click to edit Master title style • •SARS, Click to anedit atypical Master pneumonia text styles of unknown was recognized at the end of •etiology, Second level February 2003 • Third level • Fourth level • •The World Health Organization (WHO) coFifth level ordinated the international responses to provide epidemiological, clinical and logistical as required 4
Chronology Click to edit Master title style 11 February • Chinese Click to health edit Master textreported styles officials “atypical • pneumonia” Second levelin Guangdong Province, China; 305 cases/5 deaths (Nov 02–Feb 03) • Third level • Fourth level 19 February • Fifth level Hong Kong confirms human infection of Influenza H5N1 5
Chronology Click to edit Master title style 5 March in Hanoi recognized • Outbreak Click to edit Master text styles 11 • March Second level Hong Kong reports SARS outbreak
• Third level • March Fourth level 13 • Singapore Fifth level reports 3 SARS cases
15 March The disease spread to outside Asia (Canada, )
6
Chronology Click to edit Master title style WHO initiates : • Global Alert (12 March)
• Click to edit Master text styles • • Travel Advisory Second level (15 March; 2, 23 & 29 April) Third level • • Enhanced global surveillance • Fourth level • Global Outbreak Alert and Response Network • Fifth level • Specific Global Networks (Lab, Case Management, Epidemiology) 7
Chronology Click to edit Master title style Forward planning of Activities since then : • Infection Guidelines – bi-regional • Click toControl edit Master text styles guidelines will now cover all issues for • Second level Infection Control practice in a Health Care • Third level Facility – due out soon • Fourth level • Infection Control Programme – will member states in how to set up an IC • Fifth level programme • IC Audit tool – for self evaluation of HCF 8
Click toEpidemiology edit Master title style • Cause : SARS CoV • Click to edit Master text styles • Highly infectious • Second level • Mainly affects adults • Third level • Superspreading events important in •transmission Fourth level process • Fifth level • No reports of transmission occurring before onset of symptoms 9
Click toEpidemiology edit Master title style • •Means of edit transmission Click to Master text styles • Second level Evidence of person to person transmission • Third level • Close Fourth level with body fluids (especially respiratory • Fifth level droplets ) Contaminated hands, clothes, equipment; environment may also be important 10
Click toEpidemiology edit Master title style • •Risk factors transmission Click to editfor Master text styles • Second level • •High medical procedures: Thirdrisk level • Intubation • Fourth level • Bronchoscopy • Fifth level
• Cough-inducing procedures (sputum induction, istration of nebulised medications, suctioning) 11
Click toEpidemiology edit Master title style • •Incubation period Click to edit Master text styles
– 2 –10 days and up to 13 days in exceptional • Second cases level Onsetlevel and duration of infectivity unknown • –Third
• Fourth level • Fifth level • Organism survival in environment – Duration unknown – Data has shown SARS CoV may survive for 2-3 days 12
Case Definitions Developed forto public health purposes in the interClick edit Master title style outbreak period
Clickwith to edit Master A •person a history of:text styles • Second •Fever (> 38oC)level •AND one orlevel more of the symptoms of lower respiratory tract • Third illness (cough, difficulty breathing, shortness of breath)
• Fourth level •AND Radiographic evidence of lung infiltrates consistent with • Fifth or level pneumonia RDS or autopsy finding consistent with the pathology of pneumonia or RDS without an identifiable cause •AND No alternative diagnosis can fully explain the illness 13
Case Definitions Clickcase to definition edit Master Laboratory of SARStitle style •A person with symptoms and signs that are clinically • ClickoftoSARS editAND Master styles suggestive with text positive laboratory findings for SARS-CoV based on one or more of the following diagnostic • Second level criteria:
• Third level a) PCR for SARS-CoV – using a validated method from: • Fourth level •At least 2 different clinical specimens (eg nasopharyngeal or stool) OR level • Fifth •The same clinical specimen collected on 2 or more occasions during the course of the illness
•Two different assays or repeat PCR using a new RNA extract from the original clinical sample on each occasion of testing14
Case Definitions b) Seroconversion by ELISA or IFAtitle style Click to edit Master • Negative antibody test on acute serum followed by positive antibody testto onedit convalescent • Click Masterphase text serum stylestested in parallel OR • Fourfold or greater • Second level rise in antibody titre between acute and convalescent phase sera tested in parallel
• Third level c) Virus Isolation • Fourth level •Isolation in cell culture of SARS-CoV from any specimen AND • Fifth level using a validated method PCR confirmation •Testing should only be undertaken in a national or regional reference laboratory as per WHO guidelines. 15
s Click to edit Master title style Definition • Click to edit Master text styles Close level : having cared for, lived with, or had • Second direct with the respiratory secretions or body • Third fluids of alevel suspect or probable case of SARS.
• Fourth level s persons under investigation for SARS • Fifthoflevel
should be traced and quarantined until SARS has been ruled out as the cause of the illness
16
Clinical picture in SARS patients Exposure to SARS Fever, myalgia, dry non-productive cough cough, headache shortness of breath Incubation period ~2 to 10 days up to 13 days reported
Prodrome ~ 1- to 2 days
Lower respiratory phase From day 4 onwards
Infectivity None /very low
Low
Recovery approx 90%
Very high
Acute respiratory distress syndrome approx 10%
Clinical Picture Onset / Presentation Click to edit Master title style • •Sudden of high Click to onset edit Master textfever styles with chills, rigors and a non•myalgia, Second level •productive Third level cough • Fourth level • •Most Fifth cases level have bilateral pneumonia
• ~ 90% begin to recover from day 6 or 7 18
Clinical Picture ClickOnset to edit Master title style / Presentation • Rapid deterioration in 10% (+/-) of cases • Click to edit Master text styles • Second level Acute RDS • Third level Require ICU ission & • Fourth level mechanical ventilation • Fifth level • Case fatality rate: ~ 6% • No specific treatment available
19
Clinical Picture – Management
Click to edit Master title style IVE TREATMENT • Click to edit Master text styles • Antibiotic Therapy: •toSecond level cover causative organisms • Third level • •Prophylactic Fourth level Antibiotic Therapy: prevent • toFifth level secondary bacterial infection • Maintain oxygenation: intubate and ventilate as necessary 20
Clinical Picture – Management
Click to edit Master title style IVE TREATMENT
• Click to edit Master text styles Avoid interventions which may cause • Second level aerosolisation of respiratory secretions: • Third level Bronchoscopy •Fourth levelbronchodilators Nebulised Chest physiotherapy •Fifth level
Gastroscopy Any procedure / intervention that may release respiratory secretions 21
Clinical – Management Click toPicture edit Master title style • Click IVE to edit MasterTREATMENT text styles • Second level • Third level In severe cases corticosteroids and ribavirin • Fourth level have been used, however there • is Fifth level no evidence to their general or routine use at this stage. 22
Summary – SARS • Multi - Country Outbreak Click to edit Master
title style
• New Pathogen: • Click to edit Master text styles CoronaVirus family – SARS CoV
• Second level • • Clinical Picture: Third level Fever and respiratory symptoms • Fourth level ~ case fatality rate currently 4% • Fifth level
• Transmission: Close with symptomatic case(s) Contaminated hands and objects 23
Summary – SARS
Click to&edit Master title style • Prevention Control: Identification Isolation suspect and probable cases •Click to editofMaster text styles Tracing & quarantine of close s •Second level Infection control precautions for all • Third level suspect and probable cases •Fourth Publiclevel Education • Fifth level • Health care workers are currently at greatest risk therefore: Infection control precautions are 24 essential
Infection Control Precautions Click to edit Master title style Infection Control precautions (previously Barrier nursing techniques) are • known Click toasedit Master text styles to prevent infection from the patient • designed Second level to the staff/visitor or the staff/visitors to other • Third level patients. • Fourth level • Fifth level Strict precautions must be used for all SARS patients. 25
Patient Management Click to edit Master title style SARS : Infection Control Goals
• Click to edit Master text styles • SARS Secondissions level - Triage • Third level • Components Fourth level of SARS Isolation • Fifth level SARS : Infection Control Practices 26
SARS : Infection Control Goals Click to edit Master title style In addition to providing the best possible • clinical Click tocare: edit Master text styles • Second level • Third level Detect early any suspect cases. • Fourth level Implement appropriate isolation measures. • Fifth level Protect health care personnel. Protect other patients. Protect family and community . 27
Triage for SARS issions Clickthere to edit title style If possible, shouldMaster be separate wards/areas for each of the following categories :
• Click to edit Master text styles • Patients Secondwith levelcolds, sniffles and runny noses should be isolated in a single room / area Third level • Suspect cases • -Fourth Place inlevel a single room • Probable cases Fifth level - If cohort nursing, keep probable and suspect cases apart - May share room with other probable cases; where possible use a single room for all patients 28
Components of SARS Isolation Click to edit Master title style •• Facility Click to edit Master text styles •• istrative Controls Second level Third level •• Clinical Surveillance of Staff Fourth level •• Organization of Isolation Area Fifth level Equipment •• Protective • Standard Precautions 29
Facility Clickfrom toother editpatient Master style Isolated / stafftitle movement
• • Good ventilation
• –Click to edit Master styles Air movement: corridor text to room to outdoors Turn off level central air-conditioning systems unless the • –Second room can be isolated from the system. • Third level • Sinks and running water Fourth level • •Adequate bathroom facilities Fifth level • •Capacity to handle waste and laundry • Sufficient rooms for expected number of patients • Contingency plans for converting other areas to isolation facilities 30
ISOLATION WASH/TOILET
General Principles of isolation unit
Click to edit Master title style A F
• ISOLATION Click to ROOM edit Master text styles CHANGE Negative pressure/ ROOM (e.g. blow air out of • Second level E window with fan) D • Third level A D B C • Fourth level E A •A. Fifth level Disinfection station
GENERAL ACCESS AREA
B. Container for disinfection of reusable items e.g. goggles C. Biohazard bag for used (personal protective equipment) disposal D. Wall-mounted alcohol handwash dispensers E. External windows only. Keep clear of public. F. Storage for general ward clothes, new PPE 31
ISOLATION WASH/TOILET
General Principles of Isolation Unit
Click to edit Master title style A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM • Click to edit Master CHANGE text styles • Second level A D • Third level B C E A B • Fourth level A. Disinfection station Fifth level B.• Container for disinfection of reusable items C. D. E.
F.
GENERAL ACCESS AREA
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE 32
Facility Click to edit Master title style Isolation Area – Full IC Precautions required Colour codes
• Click to edit Master text styles • Green • Second level[reduced] staff movement (GO) : General • Third level •• Yellow Fourth level (CAUTION) • Fifth level: Limited staff movement
• Red (RESTRICTED) : Assigned staff only 33
istrative Controls Click to edit Master title style
• Limit and control points of entry to SARS ward(s) • Click to edit Master text styles • • • •
Second level – One entrance Third level – “Guard” to control entrance –Fourth Log oflevel permitted visitors (staff & visitors) levelmust be restricted or preferably –Fifth Visitors forbidden with NO EXCEPTIONS – Limit patient travel/transport outside unit – Minimize the number of staff exposure to cases 34
istrative Controls Click to edit Master title style • Assignment of responsibility • Click to edit Master text styles • Second level – Determining patient placement • –Third level implementation and enforcement Overseeing of infection • Fourth level control measures Enforcing • –Fifth level access restrictions –
Supply acquisition and distribution – Surveillance of Health Care Workers (HCWs) 35
Clinical Surveillance of Staff Click to edit Master title style
• Maintain list of all staff who worked with SARS patients or on the SARS ward;
• –Click to edit Master text styles Systematically monitor for fever; and • –Second level Twice daily temperature for staff working in the area (baseline Chest X-Ray may be needed ) • Third level • Screen for symptoms of SARS-like illness among •staff Fourth level for duty. reporting • •List Fifth levelinformation for: –
–
Persons visiting or caring for SARS patients; and s of HCWs in close with SARS patients. 36
Organization of SARS Isolation Area
Click to edit Master title style
• Put Up Signs: eg. SARS Isolation Area • Designated for cleantext protective • Click to area edit Master styles equipment –
Instructions for using protective equipment Second level Accessible to personnel Third level Sufficient inventory to meet daily needs
–
Color-coded bags and containers for contaminated waste and laundry Containers for laundry and all waste should have footoperated lids
• – •– • Separation of clean and dirty supplies including an • Fourth level area for level containment of waste and soiled linen • Fifth –
37
ISOLATION WASH/TOILET
General Principles of Isolation Unit
Click to edit Master title style A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM • Click to edit Master CHANGE text styles • Second level A D • Third level B C E A B • Fourth level A. Disinfection station Fifth level B.• Container for disinfection of reusable items C. D. E.
F.
GENERAL ACCESS AREA
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE 38
Infection Control Click to edit Master title style • • • • •
“Youtocan Click edit minimize Master text YOUR styles risk of catching Second level Third level SARS Fourth level Fifth level by following Infection Control Precautions.” 39
Infection Control Precautions Click to edit forMaster SARS title style • • • • •
Click to edit Master text styles Standard Precautions Second level + Third level Fourth level Respiratory Precautions Fifth level +
Precaution 40
Exposure Risks Click to edit Master title style • Patient: • Health Care Staff: Respiratory – Respiratory secretions • –Click to edit Master text styles secretions – Blood • Second level – Blood – Body fluids including • Third level – Body fluids excreta • Fourth level including excreta – Mucous membranes • –Fifth Skin level lesions – Skin lesions –
Staff – Visitors
–
Sharps – Visitors 41
Click to edit Master title style
Hand Washing
• Click to edit Master text styles • Second level • Third level An essential Infection Control • Fourth level precaution to prevent the • Fifth level
transmission of SARS
42
Principles of Hand Washing Click to edit Master title style
Hand Washing : • •IsClick the single important and effective to editmost Master text styles component for preventing the transmission of •infection. Second level levelto remove transient • •IsThird designed that may have been picked •microorganisms Fourth level from the environment. •up Fifth level • Prevents the transfer of these microorganisms to other patients, staff and equipment. • Is best performed using soap (preferably liquid) and warm running water. 43
Handwashing – When? – After removing gloves Click to edit Master title style – Before and after patient –• After with blood ortext Click to edit Master body fluids from any • patient Second level – After taking blood • pressure Third level or vital signs any level patient • from Fourth
styles
Other times:
•– After Fifthusing levelbathroom – After blowing or wiping nose – Before eating – Before preparing food
44
Handwashing – How? Click to edit Master title style Handwashing procedure : • Click to edit Master text styles • Second level Running water • Third level Soap (preferably liquid) • Fourth level • Fifth level Friction Or use Alcohol-based hand rub
45
Handwashing Steps Click to edit Master title style Step 1 • Click to edit Master text styles • Second Wet hands level and wrists. • Third level Apply soaplevel • Fourth • Fifth level
46
Handwashing Steps Click to edit Master title style Step 2
• Click to edit Master text styles • Second Right palmlevel over left. • Third level • Fourth level Left over right. • Fifth level
47
Handwashing Steps Click to edit Master title style • Click Step 3 to edit Master text styles • Second level Palm to palm • Third level • Fourth level with fingers • Fifth level interlaced. 48
Handwashing Steps
Click to edit Master title style Step 4 • Click to edit Master text styles Back of thelevel • Second fingers the • Thirdtolevel opposing fingers • Fourth level and interlocked. • Fifth level
49
Handwashing Steps Click to edit Master title style Step 5 • Click to edit Master text styles
Rotational rubbing of • Second level • Third the right level thumb by • Fourth level clasping it in the left • Fifth level palm. And vice versa.
50
Handwashing Steps
Click to edit Master title style Step 6 • Click to edit Master text styles Rotational rubbing • Second level backwards and forwards with tops of • Third level fingers and thumb of • Fourth level right hand in left. • Fifth level And vice versa. 51
Drying Your Hands Click toto edit Master title style It is important dry your hands thoroughly after washing them because :
• Click to edit Master text styles • Damp hands collect microorganisms • Second level • Damp hands spread potentially infectious •microorgansims Third level • •Damp hands Fourth levelmay become colonised with potentially infectious microorganisms • Fifth level Therefore it is important to “pat dry” your hands thoroughly. “Pat drying” also helps to prevent damage to skin. 52
Handwashing Tips Click to edit Master title style : • Click to edit Master text styles • Second level Wash hands for a minimum of 15 to 20 • Third level seconds. • Fourth level •Ensure you have washed all areas properly. Fifth level
Dry hands thoroughly. 53
Handwashing Tips Click to edit Master title style Alcohol based hand gels/ lotions • Click to edit Master text styles Use on clean (unsoiled) hands • Second level Use enough of the product to cover hands Third levelrub hands using the same steps as •Vigorously • Fourth Step 1 – 6 level (do not wet hands prior to applying the solution/gel) • Fifth level
54
Handwashing in Difficult Situations
Click to edit Master title style
If running water is not immediately available, • Click to edit what should youMaster do? text styles • Second level Use a basin • Third levelof clean water and wash hands. Use a clean basin each time. • Fourth level Use fresh water each time. • Fifth level DO NOT contaminate sources of fresh / clean water by handling ladles or dippers. 55
Handwashing in Difficult Situations
Click to edit Master title style If water is not immediately available, what should you do? • Click to edit Master–text styles Use an 70% alcohol based hand rub solution. • Second levelamount to completely cover Use sufficient your hands. • Third level Wash your hands using running water • Fourth level and soaplevel as soon as they become soiled • Fifth NB: Alcohol is very effective when hands are clean (i.e.. not soiled with blood, body fluids etc) 56
Infection Control Precautions
Click to edit Master title style Precautions
Other Infection Control • Click to edit Master text styles Factors
• Standard Precautions • Second level • Respiratory • Precautions Third level Fourth Precautions level • • • • Hand FifthWashing level • PPE • Exposure Risks • Patient transport
• Patient and family education • Laboratories / Specimens • Mortuary Care • Waste and Linen Handling • Cleaning & Disinfection 57
Personal Protective Equipment (PPE)
Click to edit Master title style • N-95 Respirator Mask must be worn
• •• • •• •
Click to edit Master text styles Goggles (protective glasses) Second level Third level Disposable Fourth levelor Reusable Gowns Fifth level
• Disposable Gloves
• Cap and shoe covers are optional 58
Personal Protective Equipment for SARS
Click to edit Master title style • • • • •
Click to edit Master text styles Second level Third level Fourth level Fifth level
59
Personal Protective Equipment Click to edit(PPE) Master title style • • • • •
N-95 Respirator Mask Click to edit Master text styles Gloves Second level Gown Third level Goggles Fourth level Fifth level Optional Cap Shoe covers 60
Principles for Using PPE Click to edit Master title style Personal Protective Equipment (PPE) is used to• protect care workers Click tohealth edit Master text stylesby preventing potentially infectious microorganisms from: • Second level • Third level •• Contaminating their hands, eyes and Fourth level clothing; • Fifth level and • Being transmitted to other patients and staff. 61
Principles for Using PPE Click to edit Master title style • PPE reduces but does not completely •eliminate Click to edit Master text styles the possibility of infection. • Second level • Third level • PPE is only effective if used correctly. • Fourth level • Fifth level • The use of PPE does not replace basic
hygiene measures such as hand washing – hand washing is still essential to prevent transmission of infection. 62
N-95 Click to Respirator edit Master Masks title style • • • • •
Click to edit Master text styles types of Different Second level N-95 Respirator Masks Third level Fourth level Fifth level
63
Principles for Using the N-95 Respirator Click to edit Master Mask title style • Click edit Master styles The N-95 to respirator masktext is used to protect health care workers, other patients, staff or visitors by • Second level preventing potentially infectious microorganisms • Third level such as respiratory secretions from:
• Fourth level Fifth level their face including the nose and • • Contaminating mouth. • Being inhaled or ingested. 64
N-95 Respirator Mask Click to edit Master title style • Click to edit Master text styles For respiratory • Second level protection wear • Third level an N-95 • Fourth level respirator mask • Fifth level during all patient 65
Proper use of N-95 Respirator Click to edit Master title style Mask •• DO Click NOT to edit touch Master the front text styles of the mask once masklevel has been fitted • the Second • Third level •• Wear one N-95 mask – no need for Fourthonly level additional respiratory protection • Fifth level • REMOVE the N-95 respirator mask before leaving the isolation unit / area 66
WHY antoN-95 Respirator Mask? Click edit Master title style • • • • •
Click to edit Master text styles N-95 masks offer a Second respirator level higher Third level level of filtration for Fourth level respiratory secretions than a Fifth level surgical mask
67
HOW to use an N-95 Respirator Click to editMask Master title style • Use for single shift unless excess moisture •necessitates Click to edit Master text styles replacement during each shift or it has by touching or soiling •become Secondcontaminated level Label with • –Third levelthe wearer‟s name • Fourth level • Dispose of with medical waste • Fifth level
NB: You must fit the mask securely over both your nose and mouth 68
HOW to use an N-95 Respirator Click to editMask Master title style •• Always correct Click to use editthe Master textsized stylesmask. • Second level •• The size will not fit properly and Thirdincorrect level will fail the „fit test‟. • Fourth level • Fifth level NB: You must fit the mask securely over both your nose and mouth so size is important. 69
N-95 Respirator Mask Click to edit Master title style • This only oneMaster text styles Clickis to edit example (brand) of an • Second level N95 respirator mask.
• •• •
Third level Fourth level Other types of N95 masks must be fitted Fifth level according to the manufacturers instructions 70
N-95 Respirator Masks Click- Fitting to edit Master title style Instructions Step 1 • Click to edit Master text styles Cup the respirator Second level in• your hand with the nosepiece • Third level at your fingertips • Fourth level allowing the • Fifth levelto hang headbands freely below your hand. 71
N-95 Respirator Masks Click to edit Master title style - Fitting Instructions • Click Step 2 to edit Master text styles • Second level Position the • Third level respirator under your chinlevel with the • Fourth nosepiece up. • Fifth level
72
N-95 Respirator Masks Click- Fitting to edit Master title style Instructions
Step 3 Pull the top strap • Click to edit Master text styles over your head • Second level resting it high at the • Third top backlevel of your head. Pulllevel the • Fourth bottom strap over • Fifth level your head and position it around the neck below the ears.
73
N-95 Respirator Masks Fitting Instructions Click to edit Master title style Step 4 Place the fingertips of both hands at the the • Click totop editofMaster text metal nosepiece. Mould the • Second level nosepiece to the shape of your nose by pushing • Third level inward while moving your fingertips • Fourthdown levelboth sides of the • Fifth level nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.
styles
74
N-95 Respirator Masks - Fitting Instructions Click to edit Master title style
Step 5.1
The seal of the respirator • the Click edit Master on facetoshould be fit- text styles • Second level checked prior to wearing in• the work area. Third level
• Fourth level Cover the front of the • Fifth level respirator with both hands, being careful not to disturb the position of respirator. 75
N-95 Respirator Masks - Fitting Instructions Click to edit Master title style Step 5.2
Positive Fit Test
Exhale sharply. positive • Click to editA Master pressure should be felt • Second level inside the respirator. If • Third level any leakage is detected, adjust the position • Fourth level of the respirator and/or tension • Fifth level of straps. Retest the seal. Repeat the steps until the respirator is sealed properly.
text styles
76
N-95 Respirator Masks Click- to edit Master title style Fitting Instructions Step 5.3 Negative Fit Test • Click to edit Inhale deeply. If Master there is text styles no negative • leakage, Second the level pressure make the • Thirdwill level mask cling to your face. • Fourth level A poor seal will result in • Fifthloss level prompt of negative pressure in the mask due to air entering through gaps in the seal. 77
When to change your N-95 ClickRespirator to edit Master title style Mask? If you the front of the mask • Click to touch edit Master text styles • Second level • Third If it islevel grossly contaminated • Fourth level • Fifth level
If it becomes wet
78
Principles for Using Goggles, Gowns, Click to edit title style Gloves, CapsMaster and Overshoes • Click to edit Master text styles Goggles, gowns, gloves, caps and overshoes are • Second level used to protect health care workers, by preventing • Third level potentially infectious microorganisms from : • Fourth level Fifth level their eyes, clothing, hands, hair and • • Contaminating shoes and • Being transmitted to other patients and staff. 79
Goggles Click to edit Master title style • Assign one pair to each worker at the • beginning Click to edit of aMaster shift text styles • Second level Third goggles level in room with SARS patients •• Wear • Fourth level •• Fifth Leavelevel in the container in the anteroom at the end of the shift to be cleaned and disinfected 80
Goggles Click to edit Master title style • Click to edit Master text styles • Second level You should use • Third level goggles to cover • Fourth level all of the eye area. • Fifth level
81
Gowns
Click to edit Master title style
• Long sleeved gowns must be worn when in direct • Clickwith to edit the Master patient text styles Second • •Wear gownlevel at all times in patient’s •the Third levelroom • Gowns must be removed • Fourth level before leaving the patient’s •room Fifthorlevel dedicated anteroom • Remove used gowns as soon as possible particularly when grossly contaminated
82
Gowns AClick new Gown be worn fortitle everystyle patient to should edit Master
• Click to edit MasterReusable text styles Gowns Disposable Gowns If necessary, gowns may be • Second level reused during one shift for • Third level for Use a new gown the same patient, e.g. when each patientlevel . short of supplies. • Fourth Discard immediately if • Fifth level Visibly contaminated. Discard immediately if visibly contaminated.
Hang gown with outside facing in when not in use. Discard at the end of the shift. 83
Gloves Click to edit Master title style • Before all patient • Click to edit Master text styles
• •• • ••
Second level Third level Before all cleaning Fourth level Before handling Fifth level soiled linen & waste
84
•
Gloves Clickafterto edit with Master title style Remove patients or lab specimens
• Click to edit Master text styles • • Do not wear gloves outside Second level of the patient‟s room / • anteroom Third level • Fourth level • • Do not re-use Fifth level gloves • Wash hands after removing your gloves 85
Plastic Disposable Aprons Click to edit Master title style
• Plastic disposable aprons must be worn is atext likelihood • whenever Click to editthere Master styles of other PPE such as gowns becoming wet. • Second level • Third level • They are worn to reduce the risk of • Fourth level breakthrough and contamination of • clothing Fifth level worn underneath the PPE. • They must be disposed of after use.
86
Plastic Disposable Aprons Click to edit Master title style Aprons must be worn when : • Performing patient care activities where • soiling Click to edit Master text styles or increased moisture is likely; Second level •• Cleaning and disinfecting the patient • environment. Third level •• Cleaning and disinfecting medical; other Fourth level patient care equipment. • Fifth level • Laundering used linen. • Cleaning and disinfecting the cleaning equipment. 87
Caps Click to edit Master title style Caps are optional and worn to protect hair text styles • Click to editthe Master from aerosols that may • Second level occur from high risk • Third level procedures such as intubation • Fourth or level bronchoscopy
• Fifth level
88
Overshoes Click to edit Master title style Overshoes are •optional Click toand editworn Master to text styles • Second level protect the health care worker’s • Third level shoes and feet from being • Fourth level splashed by spills • Fifth level such as blood or other body fluids or aerosols 89
•
Key Points Click edit Master titledisposable style Wear N-95 to respirator mask, goggles,
gowns, gloves (and hats, overshoes – optional in high risk situations) for all patient & •aprons Click when to edit Master text styles necessary
• Second level • •Wash Thirdhands levelusing soap (preferably liquid) and water when leaving the anteroom • Fourth level Fifth levelalcohol-based hand rub solution after • •Use an 70% hand washing • Wash hands when leaving the unit 90
Personal Protective Equipment for SARS
Click to edit Master title style • • • • •
Click to edit Master text styles Second level Third level Fourth level Fifth level
91
Patient Transport Click to edit Master title style It is essential to avoid all unnecessary • Click to edit Master text styles transport of isolated SARS patients to •control Secondand level prevent the potential spread of •SARS Thirdinfection. level • Fourth level • Fifth level
92
Patient Transport If the patient needs to be out of their room for an Click to edit Master title style essential procedure, e.g. X-Ray • • • • •
Transport route must avoid Click to edit Master textpopulated styles areas. levelwear an N-95 respirator mask (standard –Second Patient must surgical masks can be used by patients if N-95 Third levelmasks are not tolerated or are in insufficient respirator supply)level and an isolation gown. Fourth –Fifth Accompanying level staff must wear : –
•
N-95 respirator mask • Gloves • Gown • Goggles 93
•
Patient Transport Click to edit Master title style Transport –Ambulance –
No dedicated ambulance needed edit (N-95 Master text styles –Click Maskto patient respirator mask) – Transporters wear personal protective equipment Second level
• • N-95 respirator mask, disposable gown, goggles, gloves Thirdand level • • Clean disinfect ambulance after transport • –Fourth level Standard cleaning and disinfecting or • Fifth level
1:100 dilution of bleach; after 10 minute time, clean and disinfect using standard procedures. DO NOT use spray cleaners 94
Patient, Family & Community Click to edit Master title style Education • •Education forMaster the patient, their family and Click to edit text styles community •the Second level is essential in the control and prevention of the SARS Virus. • Third level • Fourth level • It is particularly essential for those persons • Fifth level requiring hospital or home isolation to understand the necessary restrictions. 95
Patient, Family & Community Click to edit Master title style Education Explain: • Click to edit Master text styles • What SARS is (to date) • • • • • •
Second level Third level Why isolation is required. Fourth level Fifth level Precautions required including PPE
• Hand washing procedures 96
Patient and Family Education Click to edit Master title style • Teach the patient and family :
• Click to edit Master text styles – about the SARS illness • Second level and the reason • –Third levelfor the precautions being used • Fourth level • Teach the patient and visiting family : • Fifth level – –
how to perform hand hygiene how to wear an N-95 respirator mask, gown, gloves and goggles (if available) 97
Patient and Family Education Click to edit Master title style Explain to the patient and family why • Click to edit Master text styles disposable equipment is being used • Second level such as: • Third level • Fourth level • Eating utensils • Fifth level • Medical equipment • Patient gowns 98
Laboratories Click to edit Master title style • Laboratory staff must ensure that their • practices Click to edit Master text styles are meticulous. • Second level • Third level • Fourth level • Fifth level
99
Click to edit Master title style Laboratories • Click to edit Master text styles • Second level • •Advance Third levelplanning in each • designated Fourth levellaboratory is essential to ensure that specimen handling, • Fifth level transportation and storage is managed according to the guidelines. 100
Bio Safety for SARS in Click toLaboratories edit Master title style The following activities may be performed in biosafety •level Click to edit facilities Master text 2 (BSL-2) withstyles appropriate work •practices Second level • •Routine tests Third diagnostic level • •Manipulations Fourth level involving known inactivated viru and/or incomplete, non-infectious portions of the • Fifth level viral genome • Routine examination of mycotic and bacterial cultures • Final packing of specimens for transport
101
Bio Safety for SARS in Click toLaboratories edit Master title style Precautions for BSL-2 labs
• Click edit Master text styles biological safetyto cabinet for any procedure that may generate aerosols • Second level • PPE•toThird be worn: level
•disposable gloves
• Fourth level • solid-front or wrap-around gowns with cuffed sleeves • Fifth level • eye protection • surgical mask, or full-face shield, according to the risk of aerosols and exposure • When working at a biological safety cabinet, a full face shield is not necessary.
102
Bio Safety for SARS in Click toLaboratories edit Master title style Precautions for BSL-2 labs
• Click to edit Master text styles •Use sealed centrifuge cups – unload in a safety cabinet • Secondwork level •Decontaminate surfaces and equipment • Third level •Biological waste should be treated as outlined in the WHO Laboratory Biosafety Manual – 2nd Edition (Revised), 2003 • Fourth level • Fifth level
103
Bio Safety for SARS in Click toLaboratories edit Master title style BSL-3 facilities & BSL-3 work practices are required • Click to edit Master text styles for:
••Viral Second level cell culture of the etiologic agent ••Manipulations Third level involving growth or concentration of the •etiologic Fourthagent. level When a procedure • Fifth level or process cannot be conducted within a
biological safety cabinet, then appropriate combinations of personal protective equipment (e.g., respirators, face shields) and physical containment devices (e.g., centrifuge safety cups or sealed rotors) must be used. 104
Specimen Collection Click to edit Master title style • • • • •• •• •• •
Wear full PPE Click to edit Master text styles Write clinical details on the request form Second level Samples should be collected by clinical staff Third level Label clinical samples clearly Fourththe level Change PPE between patients Fifth level Discard all disposable materials in a biohazard bag 105
Storage of Specimens Click to edit Master title style • • • • • • •
Respiratory samples and frozen tissues: Click to edit Master text styles o – store at –70 C Second level Third level Serum: Fourth level o – store at 4 - 8 C for 24-48 hours Fifth level or –
at -20oC for longer periods 106
Patient Specimens Click to edit Master title style • Treat all • •patient Click to edit Master text styles specimens as • Second level highly •infectious Third level •
• Fourth level Fifth • •Use leaklevel proof containers for collection
Do not contaminate outside of container
Transport specimens in leak-proof outer containers e.g. a sealed plastic bag 107
Mortuary Precautions Click to edit Master title style Health care workers must wear full PPE:
(N-95 respirator mask, Goggles, Gown, Gloves) • Click to edit Master text styles
• Second level Health Care Workers must: level • Third Prepare the body level • Fourth Place in a body-bag or leak-resistant bag • Fifth level or Place in plastic sheeting, wrap the body and tape/seal with waterproof adhesive tape 108
Mortuary Precautions tobeedit Master title (3°C style: The Click body must placed in cold storage +/- 2°C ) as soon as possible after the body is • Click to Masterintext styles prepared andedit wrapped a bag or plastic sheeting.
• Second level The need for a post mortem must be discussed • Third level with the designated • Fourth level national laboratory as there are potential infection risks for personnel during a • Fifth level post mortem.
Post mortems must be performed wearing full PPE 109
Mortuary Care Click to deference edit Master titletostyle Although all due must be given local cultural and religious customs associated with the death of a to member of the community, • Click edit Master text stylesthe following must be considered • Second level to minimize the potential risk of spread of the SARS Virus. • Third level • The body must not be embalmed, to reduce • Fourth level exposure risk. •• Fifth The need levelfor cremation with minimal delay. • The delaying of a „wake‟ to celebrate the life of the individual until all close s and possible secondary s are cleared. 110
Linen & Laundry ClickWaste to editManagement Master title style • Health care and laundry workers must the Master importance handling linen • understand Click to edit textofstyles correctly to prevent the spread of potentially • infectious Second level microorganisms
• •• •
Third level Linen canlevel be washed using routine laundry Fourth practices. Fifth level
• The health care facility should follow routine waste management practices but all waste must be incinerated. 111
Linen
Click to edit Master title style All contaminated or soiled linen is potentially • Click to edit Master infectious therefore:
text styles
• Second level • • Wear fulllevel PPE when handling Third linen. • Fourth level Fifth level • • Separate grossly contaminated linen from non- contaminated linen in the patient‟s room for ease of handling in the laundry. 112
•
Laundry Click to edit Master title style Place in color-coded bags and double bag for
transport. Click to edit text styles • •Do not sort linenMaster in the laundry to avoid the aerosols. •creation Secondoflevel • •Staff handling Third level linen should wear full PPE as per standard procedures for SARS. • Fourth level • Use routine detergents.
• Fifth level
Bleach may be added if desired, and compatible with the detergent being used. 113
Waste Click to edit Master title style • • • • • • •
Wear full PPE when handling waste. Click to edit Master text styles Second level Clinical waste: all items from treatment Third level areas Fourth level – Soiled surgical dressings Fifth level – Swabs –
Masks – Gowns – Other contaminated waste
114
•
Waste Sharps ClickContainers. to edit Master title style
Click towaste edit Master text styles •• Collect in designated color-coded • plastic Secondbags levelfor incineration. • Third level Fourth level •• Double bag for transport. • Fifth level • the local authorities for assistance if the health care facility does not have incineration facilities. 115
Sharps Disposal Click to edit Master title style
Disposal containers should be puncture-resistant and leak- proof.
• • • • • • ••
Click to edit Master text styles Second level Do not overfill container Third level Do not reach into Fourth level container Dispose of used sharps Fifth level into the sharps container
116
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • Cleaning is usually sufficient for prevention and • control Click to Master styles infection the use of edit infection, buttext for SARS a disinfectant • ofSecond level following cleaning is recommended level to clean thoroughly before • • ItThird is essential the environment or equipment. • disinfecting Fourth level • Cleaning and disinfection must be carried out at • least Fifthdaily level and particularly when gross contamination occurs. • In some instances it may be necessary to disinfect to render the item safe to handle. 117
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • • • • •
Click to edit Master text styles Cleaning and disinfecting patient Second level rooms and equipment is one of the best ways Third level to reduce transmission of infection Fourth level Fifth level Wear full PPE when cleaning and disinfecting 118
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • To communicate infection risk, use signs.
• Click to edit Master text styles eg. SARS Isolation • Second level Third patients level & staff by: • •Protect • Fourth level and disinfecting •- Cleaning Fifth level equipment.
- Cleaning and disinfecting the room and anteroom. 119
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style Click to edit Master text styles •• The immediate area around patients
must be
heavily contaminated. • considered Second level • Third level • Bedside table, bed stand, and accessible areas of • bed Fourth level must be cleaned with detergent and floors warm • and Fifth levelwater at least daily (preferably twice a
day). •
In addition, disinfect all surfaces after cleaning. 120
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style • Contain and dispose of infectious materials in : • waste Clickcontainers to edit Master text styles – Put waste containers near entrance / exit to • Second patientlevel room.
• Third level • • Provide patient equipment when Fourth dedicated level possible. • Fifth level • Clean and disinfect patient care equipment immediately after use depending on the type of equipment. 121
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment Use standard procedures and agents • Click to edit Master text styles for cleaning And disinfecting environmental surfaces and • Second level patient care equipment.
• Third level Fourth level and warm water, rinse in hot • • Use detergent • water Fifth and level dry. • Use disinfectant afterwards.
122
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment • When areas and inanimate objects are • grossly Click tocontaminated edit Master text styles use: • –Second level hypochlorite (bleach) solution 1:100 sodium to disinfect • Third level (before cleaning) – it will reduce the viral load and the potential • Fourth level to spread. for infection • Fifth level • Then use the standard cleaning and disinfecting procedures mentioned previously. 123
Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment •
All reusable patient items such as basins and • bedpans Click toshould edit Master be: text styles
• • • •
Second level Cleaned and disinfected before being used on another Third level patient Fourth level Taken to the dirty utility room for cleaning Fifth level Staff should wear full PPE when handling contaminated equipment. 124
Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style •
DO NOT spray clean the room / area.
• Click to edit Master text styles Why? • Second level Because it: • Third level – Spreads droplets • Fourth level • –Fifth level aerosols Spreads –
Is not effective as a surface disinfectant 125
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