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COVID-19 INFECTION PREVENTION AND CONTROL WEBINAR: YOUR QUESTIONS ANSWERED
SUMMER 2020
OBJECTIVES1 Overview of who we are and COVID-19 disease & transmission
2 Overview of the Infection Prevention and Control (IPAC) principles to be prepared for and to prevent COVID-19
3 Answer your questions
LAND ACKNOWLEDGEMENT
I wish to acknowledge that the land on which we meet has been for thousands of years, the traditional land of the Huron-Wendat and Petun First Nations, the
Seneca, and most recently, the Mississaugas of the Credit River. Today, this meeting place is still the home to many Indigenous people from across Turtle Island and I am
grateful to have the opportunity to work in the community, on this land.
» I am a settler on this land. I recognize the many treaties that the British and Canadian governments have broken and continue to break.
» As an ally, I aim to do what I can to hold the governments accountable to meet the agreements within those treaties as they are vital to all those who live here - First Peoples & settlers.
» In the spirit of reconciliation, I am requesting your permission to work together and how I can be a better guest on this land.
WCH DISCLAIMER» “Women’s College Hospital (WCH) does not make any representations or
warranties about the completeness, reliability or accuracy of any COVID-related services, information or materials it provides. Any action you take in reliance upon services, information or materials provided by WCH is strictly and entirely at your own risk, and WCH will not be liable for any damages or losses in connection with the use of the services, information or materials.”
» Please note: the content of this webinar is designed for shelter and respite settings which fall under the recommendation of the Shelter, Support and Housing Administration department at Toronto Public Health
WCH COMMUNITY SUPPORT SQUAD OUR TEAM & WHAT WE OFFERDr. Mona Loutfy
Co-lead (Infectious Diseases Specialist & Clinician Scientist)
Ms. Jessica BawdenCo-lead
(Primary Care Nurse Practitioner)
Ms. Logan KennedyProject Manager
(RN and PhD Candidate)
Ms. Christal MalcolmProject Assistant
Mr. Darryl Yates (VP of Patient Care and Ambulatory
Care Innovation)
Dr. Sacha Bhatia (Chief Medical Innovation Officer)
Ms. Lori Matthews, Ms. Sandra Smith & Dr. Michael Gardam
(IPAC advisory)
We offer education on Infection Prevention and Control material and guidance for shelters and other congregate living settings
COVID-19 BASICS» COVID-19 stands for coronavirus disease 19 & is caused by the virus, SARS-CoV-2
• It is mostly a respiratory disease with some atypical presentations also
» Main symptoms:• Cough (68%) • Fever (44%)• Fatigue (38%)• Shortness of breath (19%)
» Atypical symptoms are common: lost sense of taste or smell, headache, nausea/vomiting, diarrhea, stomach pain, chills, sore throat, difficulty swallowing, hoarse voice, runny nose, stuffy or congested nose, sputum production, muscle pain, reddening of the eye, strange desire to burp; In elderly - falling down more than usual, For young children and infants - sluggishness or lack of appetite
https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-epi-evolution-case-growth-ontario.pdf?la=en
SARS-COV-2 TRANSMISSION» Primarily by droplet = when droplets come from a person's mouth through
coughing or talking or from someone’s nose from sneezing, the droplet will fall to the ground due to gravity, it will not travel through the air• The cluster of transmissions between close contacts is the evidence that the transmission
is by droplet
» Also through contact = touching surface, items and hands that are infected • The virus lives for usually 3-5 hours on surfaces … can be up to 72 hours
INFECTION PREVENTION AND CONTROL
» IPAC stands for Infection Prevention and Control• You and your organization have already been practicing these
» There are 6 important IPAC principles: 1. Screening: passive and active2. Hand hygiene3. Personal Protective Equipment (PPE) 4. Physical distancing5. Respiratory etiquette6. Cleaning and disinfecting
IPAC PRINCIPLE 1: SCREENING
q Post signage at entrances and in locations throughout the setting where they are visible to all staff and residents on signs and symptoms
PASSIVE SCREENING
IPAC STEP 1: SCREENINGACTIVE SCREENING – SELF, FRONT DOOR & STAFF/RESIDENT SCREENING
– TWICE PER DAY
If yes to any à stay home and call your manager
ACTIVESCREENING
TORONTO.CA/COVID19
Do you have any of the following:
If you answered YES to any of these questions, go home & self-isolate right away. Call Telehealth or your health care provider, to find out if you need a test.
Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days?
Yes
No
Have you returned from travel outside Canada in the past 14 days?
Yes
No
Please complete the following questions before beginning your work today.
Name: Date: Time:
COVID-19
Yes
No
Yes
No
Fever
Runny nose
Difficulty breathing
Not feeling well
Cough
Loss of taste or smell
Sore throat, trouble swallowing
Nausea, vomiting, diarrhea
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
STAFF, VOLUNTEERS AND PEERS SHOULD BE SCREENED AT THE START OF SHIFT
CONSIDER SOMETHING SIMILAR FOR ALL FOLKS ENTERING IF YOU ARE ABLE
KEEPING A RECORD OF WHO USES YOUR DROP-IN WILL HELP WITH CONTACT TRACING IF OUTBREAK OCCURS
YOUR JOB IF SOMEONE SCREENS POSITIVE
Stay CalmHand hygiene and Mask to
Individual
Isolate (private room if
possible)
Notify Manager
Assist person to get tested • testing is available for everyone in Ontario• send staff or client to the WCH or any COVID-19 Assessment CentreIf you have a positive case – notify TPH 416 338 1521 or [email protected]
We have made 3 sheets to assist if someone at a shelter screens positive:1. QUICK GUIDE ON WHAT TO DO IF CLIENT SCREENS POSITIVE 2. SHELTER TIPS FOR TRANSFER TO THE WCH COVID-19 ASSESSMENT CENTRE3. SHELTER LETTER FOR TRANSFER TO THE WCH COVID-19 ASSESSMENT CENTRE
IPAC PRINCIPLE 2: HAND HYGIENE
HAND WASHINGHAND SANITIZINGONE OF THE MOST IMPORTANT PRINCIPLES
WHEN TO WASH YOUR HANDS
When you enter work
Prior to wearing or after removing a mask or gloves
Before, during, and after preparing
foodBefore eating food
Before and after caring for someone
who is sick
After using the toilet
After changing diapers or cleaning
a child who has used the toilet
After blowing your nose, coughing, or
sneezing
After handling pet food, pet treats or
pets
After touching garbage/
contaminated laundry
When you leave work
Anytime you feel your hands are
dirty
IPAC STEP 3: PERSONAL PROTECTIVE EQUIPMENT (PPE)
MASKSalways
RECOMMENDATIONS FOR SHELTERS
+ +
+ +
+
+ +
FULL PPE= Administering naloxone= Carrying for suspected or confirmed client with COVID19
Additional PPE= Handling items that clients have interacted with
Additional PPE= If screening with no plexi= If checking temperatures during screening
WHEN TO WEAR A MASK AT WORK
ALWAYS!
FRONTLINE STAFF PROVIDED WITH ONE TO TWO NEW MEDICAL MASKS PER SHIFT
IF NO OUTBREAK, CAN BE NON-MEDICAL MASK
MASKS DO NOT NEED TO BE CHANGED UNLESS WET, DAMAGED, OR SOILED. (DECREASES THE CHANCE OF 'SELF-CONTAMINATION’)
TORONTO BY-LAW 541-2020 (JULY 7)Shelter’s and Respite Clients are exempt from this By-Law
All others are required to do:
1. Create a mask policy for your establishment.2. Communicate new policy to staff/clients.3. Train all staff on the requirements of the policy and this bylaw.4. Ensure staff understand exceptions & do not require proof for the exceptions.5. Have a copy of your policy ready for inspection by authorized enforcement personnel.6. Download and post bylaw sign at all entrances.
Individuals who are exempt:• Children under 2 years of age.• Persons with health conditions making breathing through a mask difficult.• Persons unable to use a mask without assistance.• Employees in designated areas that are not open to the public (private office, staff room, loading dock).• Persons who are hearing impaired, or is communicating with a person who is hearing impaired.• Persons requiring accommodation under the Ontario Human Rights Code.
Operators are not permitted to request proof of exemption.
Temporary removal of the mask is permitted for the purposes of receiving services, or while actively engaging in an athletic or fitness activity (e.g. swimming).
WHY UNIVERSAL MASKS?MASKS PROTECT ME FROM YOU
IF WE ALL WEAR THEM, TRANSMISSION GOES DOWN
HOW TO REMOVE A MASK
v Do not touch the front of your mask to remove it.
1. Remove the elastic loops of the mask from around your ears or untie the strings from behind your head.
2. Hold only the loops or strings and place the mask in a garbage bin with a lid.
3. Wash your hands with soap and water for at least 15 seconds or use ABHR* after you have discarded your mask.
3 SIMPLE STEPS
*ABHR = Alcohol-based hand rub
A FACE SHIELD IS NOT A MASK
LET’S TALK ABOUT GLOVES» Gloves used in HIGH RISK situations (when hands can get dirty)
• Front door screening if not behind Plexiglass• If in contact with someone who is sick• Cleaning & disinfecting, laundry, cooking, garbage disposal• When administering naloxone
» Gloves are to be taken off immediately after the encounter• This is the highest risk time of cross-contamination (spread of
germs from gloves to skin)• Thus, not recommended to wear gloves in LOW RISK situations or
all the time
HOW TO TAKE OFF GLOVES
IPAC STEP 3: PERSONAL PROTECTIVE EQUIPMENT (PPE)
MASKSalways
RECOMMENDATIONS FOR SHELTERS
+ +
+ +
+
+ +
FULL PPE= Administering naloxone= Carrying for suspected or confirmed client with COVID19
Additional PPE= Handling items that clients have interacted with
Additional PPE= If screening with no plexi= If checking temperatures during screening
PHO DONNING & DOFFING
IPAC STEP 4: PHYSICAL DISTANCING
IPAC PRINCIPLE 4: PHYSICAL DISTANCING
PHYSICAL DISTANCING STEPS» Cancel group activities (especially with more than 5 participants) » Provide support through telephone or on-line activities where possible» Do not have unnecessary volunteers or visitors at the setting» Reduce face-to-face staff meetings» Use furniture layout to promote physical distancing (e.g. removing chairs around
tables to promote six feet distance)» Stagger eating times and set-up tables so clients are not directly facing each other» Consider having food program providers offer to-go meals to clients» Use visual markers to help promote physical distancing in high-traffic locations
throughout the setting (e.g. at intake; meal lines)» Ensure physical distancing in any elevators used at the setting
PROMOTING DISTANCINGWaiting Room/Reception Chairs: space chairs by 2 metres, consider vinyl/plastic for wiping Remove toys, magazines, remote controls, etc. Provide visual cues to maintain physical distancing (onfloor, on reception window)Have available tissues, alcohol-based hand rub and a waste basket
IN COMMON & SLEEPING AREAS
IN DINING AREAS» Serve food onto client's plates while
maintaining physical distancing » Educate clients - not to share cutlery, dishes
and other items» Use disposable cutlery as much as possible» Remove shared food containers from dining
areas (e.g. pitchers of water, shared coffee cream dispensers, salt/pepper shakers)
» Stagger eating times» Consider having food program providers offer
to-go meals to clients» If staggering is not possible, set up tables so
clients are not directly facing each other and maintain 6 feet distance à à à à
PHYSICAL DISTANCING WORKS2M BETTER THAN 1M
38
IPAC STEP 5: RESPIRATORY ETIQUETTE
IPAC PRINCIPLE 6: CLEANING & DISINFECTION
PUBLIC HEALTH ONTARIO RECOMMENDATIONS
IPAC STEP 6: CLEANING & DISINFECTIONRECOMMENDED CLEANING TECHNIQUES
» High-touch surfaces* include: door handles, elevator buttons, light switches, toilet handles, handrails, shared equipment such as keyboards, walkie-talkies, toys.
» Use damp cleaning methods such as damp clean cloths, and/or a wet mop. » Do not dust or sweep, which can distribute virus droplets into the air.» Don’t forget underside of tables and chairs
On a routine and consistent basis
•Environmental cleaning and disinfection
Increased frequency (at least twice per day and when visibly dirty)
•High-touch surfaces*•Common spaces•Washroom and shower facilities
WASHROOMS AND SHOWER FACILITIES
Frequently cleaned and disinfected, at least twice
per day, when visibly dirty, and after a sick person uses
Clean down shared shower room after COVID-19 or
symptomatic patients use it (don’t forget the walls as
well as floors & all surfaces)
DISINFECTANTS» Use cleaning and disinfectants that have been tested by credible
organizations like PHAC, PHO or CDC:
§ Public Health Agency of Canada – indicates:Ø one-part bleach to nine parts water (to make 0.5% bleach solution) is also
acceptable for use against COVID-19.
ü Bleach solutions will be effective for disinfection up to 24 hoursü Take appropriate safety precautions when using bleachü Ensure it is prepared fresh daily
GARBAGE DISPOSAL
Obtain larger garbage receptacles that are open, or foot pedal operated.
Contaminated disposable items (e.g. garbage, mop heads, cloths) of a client that has been diagnosed with COVID-19 or is suspected to have COVID-19 should be placed in a lined garbage bin before disposing of them with regular waste.
IN REVIEW» We went over the COVID-19 in general & its transmission
» The 6 SIMPLE IPAC PRINCIPLES :1. Screening: a) self-screening; b) front door; and c) resident screening2. Hand hygiene3. Personal Protective Equipment (PPE) – gloves, masks4. Physical distancing5. Respiratory etiquette6. Cleaning and disinfecting
» We’re doing great but NEED TO STAY STRONG & keep going!
REFERENCES1. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 2. Zhang, T., Wu, Q., & Zhang, Z. (2020). Probable Pangolin Origin of 2019-nCoV Associated with Outbreak of COVID-19.
SSRN Electronic Journal. doi: 10.2139/ssrn.35425863. Montgomery, D. H. (2020, March 11). COVID-19: How it compares with other diseases in 5 charts. Retrieved from
https://www.mprnews.org/story/2020/03/11/covid19-how-it-compares-with-other-diseases-in-5-charts4. https://files.ontario.ca/moh-covid-19-report-en-2020-03-31.pdf5. Lauer, S. A., Grantz, K. H., Bi, Q., Jones, F. K., Zheng, Q., Meredith, H. R., … Lessler, J. (2020). The Incubation Period of
Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Annals of Internal Medicine. doi: 10.7326/m20-0504
6. Ji, Y., Ma, Z., Peppelenbosch, M. P., & Pan, Q. (2020). Potential association between COVID-19 mortality and health-care resource availability. The Lancet Global Health, 8(4). doi: 10.1016/s2214-109x(20)30068-1
7. Liu, Y., Yan, L.-M., Wan, L., Xiang, T.-X., Le, A., Liu, J.-M., … Zhang, W. (2020). Viral dynamics in mild and severe cases of COVID-19. The Lancet Infectious Diseases. doi: 10.1016/s1473-3099(20)30232-2
8. (2020). Retrieved 24 May 2020, from https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-epi-evolution-case-growth-ontario.pdf?la=en
9. Bourouiba L. Turbulent Gas Clouds and Respiratory Pathogen Emissions. JAMA. 2020. doi:10.1001/jama.2020.475610. Brosseau, L. (2020, March 16). COMMENTARY: COVID-19 transmission messages should hinge on science. Retrieved
from http://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science
REFERENCES11. Van Doremalen N, Bushmaker T, Morris D et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-
1. New England Journal of Medicine. 2020. doi:10.1056/nejmc200497312. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with
biocidal agents. Journal of Hospital Infection. 2020;104(3):246-251. doi:10.1016/j.jhin.2020.01.02213. Ontario Agency for Health Protection and Promotion (Public Health Ontario). “What we know so far about asymptomatic
infection and asymptomatic transmission.” Toronto, ON: Queen’s Printer for Ontario; 2020. 14. Tong Z-D, Tang A, Li K-F, Li P, Wang H-L, Yi J-P, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang
Province, China, 2020. Emerg Infect Dis. 2020 Feb 24 [Epub ahead of print]. Available from: https://wwwnc.cdc.gov/eid/article/26/5/20-0198_article
15. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill 2020;25(10):2000180. Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180
16. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the risk to health care workers: a case report. Ann Intern Med. 2020 Mar 16 [Epub ahead of print]. Available from: https://dx.doi.org/10.7326/l20-0175
17. https://www.toronto.ca/home/covid-19/covid-19-protect-yourself-others/community-settings-workplaces/18. https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-
coronavirus19. http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx20. A national standard developed by Infection Prevention and Control Canada (IPAC Canada, 2016)
THANK YOU! QUESTIONS?DR. MONA LOUTFY, MD, [email protected]
MS JESSICA BAWDEN, [email protected]
MS LOGAN KENNEDY, [email protected]
50
Q&A WITH TDINSetting up physical spaces: What are people planning to do?- 5 square metres/person suggestion - Start slow with # of people in space- Hand hygiene should be easy and encouraged- Cleaning and disinfecting is everyone’s job (incl clients)- Encouraging mask use by clients (can you distribute and strongly encourage?)- Tips for client-centred approach? Encouraging behaviour change with you pop’n…
What other challenges are you facing?
