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7/28/2019 Rapid Response Module 6 IC
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Hospital Infection Control and
Personal Protective Equipment
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Learning Objectives
Demonstrate knowledge of the principles of
infection control
Recognize gaps in infection control infrastructure
Recognize ways to address gaps in infectioncontrol infrastructure in different situations
Demonstrate proper selection and use of personalprotective equipment
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Session Overview
Introduction to personal protective equipment (PPE)
How to use PPE Demonstration
Infection control precautions In health care facilities
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Transmission of Influenza Viruses
Yes
(bird to human)
YesContact
UnknownLikelyAirborne
Probable
(human to human)
YesDroplet
Avian Influenza in
Humans
Seasonal Influenza
in Humans
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Infection Control Methods
andPersonal Protective Equipment
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Hand Washing
Method
Wet hands with clean water
Apply soap
Rub hands together for at least 20seconds
Rinse with clean water
Dry with disposable towel or air dry Use towel to turn off faucet
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Alcohol-based Hand Rubs
Effective if hands not visibly soiled
More costly than soap & water
Method
Apply coin-sized amount to palms
Rub hands together, covering all surfaces until dry
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Personal Protective Equipment (PPE)
When used properly canprotect you from
exposure to infectious
agents
Know what type of PPE is
necessary for the dutiesyou perform and use it
correctly
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Personal Protective Equipment
Gloves
Gowns
Masks
Boots & Shoe covers
Eye protection
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PPE Materials
Gloves
Different kinds of gloves Housekeeper gloves Clean gloves
Sterile glove
Work from clean to dirty
Avoid touch contamination Eyes, mouth, nose, surfaces
Change gloves between patients
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PPE Materials
Gowns
Fully cover torso
Have long sleeves
Fit snuggly at the wrist
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PPE Materials
Masks and Respirators: Barriers andFiltration
Surgical masks
Cotton, paper
Particulate respirators (N95)
Fit testing essential
Alternative materials (barrier)
Tissues, cloth
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PPE Materials
Boots Eye Protection
Face shields Goggles
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PPE Supplies
Maintain adequate, accessible supplies
Use locally produced PPE when possible
Creative alternatives
Mask: tissue, scarf
Boots: plastic bags
Gown: laboratory coat, scrubs
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Working with Limited Resources
Avoid reuse of disposable PPE items
Consider reuse of some disposable items only as anurgent, temporarysolution
Reuse only if no obvious soiling or damage
When prioritizing PPE purchase Masks
Gloves
Eye protection
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Infection Control Precautions
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Precaution Levels
All levels require hand hygiene
Standard Precautions
Transmission based precautions:
Contact Precautions
Droplet Precautions
Airborne Precautions
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Standard Precautions
Prevent the transmission of
common infectious agents
Hand washing key
Assume infectious agent could bepresent in the patients
Blood
Body fluids, secretions,excretions
Non-intact skin
Mucous membranes
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PPE for Standard Precautions
1. Gloves
2. Gowns3. Eye Protection
When touching: Blood & body fluids
Secretions, excretions
Contaminated items Mucous membranes
Non-intact skin
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Contact Precautions
Prevent infection through direct or
indirect contact with patients or patientcare environment
Examples Avian influenza Ebola hemorrhagic fever Methicillin Resistant S. Aureus
Shigellosis
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Contact Precautions
Taken in addition to Standard Precautions
Limit patient movement
Isolate or cohort patients
Gown + gloves for patient / room contact Remove immediately after contact
Do not touch eyes, nose, mouth with hands
Avoid contaminating environmental surfaces
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Contact Precautions
Wash hands immediately after patient contact
Use dedicated equipment if possible If not, clean and disinfect between uses
Clean, then disinfect patient room daily Bed rails Bedside tables Lavatory surfaces Blood pressure cuff, equipment surfaces
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Cleaning and Disinfection for
Contact Precautions Detergents
Remove dirt, soiling Mechanical force essential
Flush with clean water
Disinfectants
Kill viruses, bacteria
Decontaminate surfaces
Type depends on infectious agent
Use afterdetergent
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Droplet Precautions
Prevent infection by largedroplets from
Sneezing
Coughing
Talking
Examples
Neisseria meningitidis
Pertussis
Influenza
Avian influenza (probable)
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Droplet PrecautionsTaken in addition to Standard Precautions
Wear surgical mask within 1 meter of patient
Wear face shield or goggles within 1 meter of patient
Place patients in single rooms or cohort 1 meter apart
Limit patient movement within facility Patient wears mask when outside of room
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Airborne Precautions
Taken in addition to Standard Precautions
Prevent spread of infection through very small (< 5microns) airborne particles
Examples
Tuberculosis
Measles
Varicella
Variola
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Negative Pressure Isolation Room
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Natural Ventilation
Cohorting Room
1 meter
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Aerosol-generating Procedures
(Example; Endotracheal intubation)
N95 particulate respirator
If not available, wear tight fitting surgical mask andface shield
Eye protection
Gloves and hand washing
Gown and waterproof apron
Isolation room with negative pressure
Hair cover optional
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How to Put on and Remove
Personal Protective Equipment
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Personal Protective
Equipment (PPE)Recommended
Mask: N-95/FFP2 respiratorOR surgical mask
Gloves
Disposable long sleeved
cuffed gown Protective eyewear: goggles,
faceshield
Optional Cap
Plastic apron (splashing ofblood, secretions, excretions)
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Principles for Using PPEPersonal Protective Equipment (PPE) is used
to protect personnel byPreventing potentially infectiousmicroorganisms from:
Contaminating their hands, eyes andclothing;
and
Being transmitted to other people.
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Principles for Using PPE PPE reduces but does not completely eliminate
the possibility of infection. PPE is only effective if used correctly.
The use of PPE does not replace basic hygienemeasures such as hand washing - hand
washing is still essential to prevent
transmission of infection.
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Gown
A new gown should be worn for every patient contact.Discard immediately if visibly contaminated.
Purpose
protect skin and/or clothing
Material Natural or man-made
Reusable or disposable
Resistance to fluid penetration
Clean
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A new gown should be worn for every patient contact.
Discard immediately if visibly contaminated.
Gown
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Gown
Disposable Gowns
Use a new gown for
each patient contact.
Discard immediately if
visibly contaminated.
Dispose as per policy
for waste disposal
Reusable Gowns
If necessary, gowns may be
reused during one shift forthe same patient, e.g. whenshort of supplies.
Discard immediately if
visibly contaminated.
Discard at the end of the
shift.
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Removing Gown
Unfasten ties
Peel gown away from neck and shoulder
Turn contaminated outside toward the inside
Fold or roll into a bundle Discard
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Surgical Mask
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with ties or elastic
Adjust to fit
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Prevent
Inhalation / ingestion of infected particles (< 5 m) Contamination of the face, including the nose and mouth
Wear only one N-95/FFP2 respirator no need for additional
respiratory protection
DO NOT touch the front of the respirator once the it has been
fitted
Use correct size, fit over nose and mouth, perform seal check
Dispose of with medical waste
N-95 / FFP2 Particulate Respirators
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N95 Particulate Respirator
Pay attention to size (S, M, L)
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic
Adjust to fit and check for fit:
Inhale respirator should collapse
Exhale check for leakage around face
W i M k
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Wearing a Mask
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Respirator Fit testing
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Respirator Fit-testing
Four qualitative methods and three
quantitative your choice.
Quantitative methods are more
accurate but more expensive.
Both methods require specific
training, are time-consuming, and
imply costs.
Checking fit of respirator on individual employees
qualitative
quantitative
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Removing a Particulate Respirator or a
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Removing a Particulate Respirator or a
Surgical Mask
Lift the bottom elastic over your head first
Then lift off the top elastic
Discard
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Eye and Face Protection
Remove Goggle or Face Shield
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Remove Goggle or Face Shield
Grasp ear or head pieces
Lift away from face
Place in designated receptacle for reprocessing
or disposal
Gloves
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Purpose:- protect hands- patient care, environmental services,
other
9 Before all patient contact
9 Before all cleaning
9Before handling soiled linen & waste
9 Remove after contact with patients or labspecimens
9 Do not wear gloves outside of the patients
room / anteroom9 Do not re-use gloves
9 Hand hygiene after removing gloves
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Gloves
Don gloves last
Select correct type and size
Insert hands into gloves
Extend gloves over gown cuffs
Dos and Donts of Glove Use
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Do s and Don ts of Glove Use
Protect yourself, others, and the environment
Limit opportunities for touch contamination
Avoid touching:
your face or adjusting PPE with contaminated gloves
environmental surfaces except as necessary during patient care
Removing Gloves
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Removing Gloves
Grasp outside edge near wrist
Peel away from hand, turning glove inside-out
Hold in opposite gloved hand
Slide ungloved finger under the wrist of the remaining glove
Peel off from inside, creating a bag for both gloves
Discard
How to put on PPE
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Hand hygiene
Long sleeved, cuffed disposable gown
Apron is optional, if splashes are expected (e.g., cleaning)
Caps are optional to protect hair from aerosols that may
occur from high risk procedures (e.g., intubation)
Particulate respirators: completely seal mouth and nose,
perform seal check
Protective eyewear: goggles (upper edge of mask under
goggles), faceshield
Gloves, with gown sleeve tucked into gloves
Put onPutting on personal protective equipment (PPE)
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trousers
Put on boots
Put on shoe
covers
Put on gown
and apron
Put on hood or
head cover
Tie sleeves at wrist
Put on mask and
goggle or face shield
Tuck in sleeve inside
gloves
Put on gloves
*Tuck in trouser cuffs
inside the boots
Tie shoe covering over
trouser leg
Hood or hair cover mustcompletely cover the
hair
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Before remove your PPE remember !
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Contaminated Area
outside front
contact with
body sites,
materials,
environment
al surfaces
Clean area
Inside
outside back
ties on head
and back
y
Who should wear PPE?
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Anyone who enters the isolation area:
All health care workers
Radiographers
Physiotherapists, etc.
Laboratory staff handling HPAI
All support staff
Family members and visitors
How to reprocess the goggle?
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p g gg
1. Cleaning: water + plain liquid soap. Protect yourself!
2. Disinfect.
Duration of PPE Use
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Surgical Masks (if N95 not available)
Wear once and discard
Discard if moist
N95 Particulate Respirators
May use just one with cohorted patients
Eye Protection
May wash, disinfect, reuse
Instructor Demonstration
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Instructor Demonstration
Put on and Remove PPE
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PPE Practice
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PPE Practice
Put on, remove, and dispose of PPE
1. Practice once alone
2. Pair up with someone and critique:
Sequence
Technique / contamination prevention
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Hand Hygiene
The Role of Hand Hygiene and
Standard Precautions in Avian
Influenza (AI) Preparedness
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It is the single most important and effectivecomponent for preventing the transmission of
infection It is designed to remove transient
microorganisms that may have been picked up
from the environment Prevent the transfer of these microorganisms toself and other patients, staff and equipment.
It is best performed using soap (preferably liquid)and warm running water.
Infection Control for Human cases of
Influenza A (H5N1) in Health Care
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Standard precautions
plus
Contact precautions
plus
Droplet precautions*
or
Airborne precautions*
*depends on resource/procedure
= Hand Hygiene + PPE accordingto risk assessment
= glove + gown
= surgical mask + googles/faceshield + (single room)
= particulate masks (N95/FFP2) +goggles/face shield + negativepressure room
Influenza A (H5N1) in Health Care
Settings
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Attitude and habit
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Hand hygiene is an element of
process qualityNot to do hand hygiene at the
defined moments using a
standardized quality (technique)
represents a medical error.
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1. Before patient
contact
2. Before aseptic
task3. After body fluid
exposure task
4. After patient
contact
5. After contact
with patient
surroundings
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What to use?
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Hand rub (alcohol)
Hand wash (soap)
Alcohol based hand rubs are the gold
standard for hand hygiene in health care(unless hands are visibly soiled)
?
Hand rubbing blocks spread of AI
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Host defenses
Transmissible
microbe
contact
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Alcohol based hand
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Rub hands for hand
hygiene.Wash hands only
when visibly soiled.
A good technique is
important
20-30 seconds and
hands are safe
(WHO training
materials, 2006)
rub
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Tool to instruct onlocal production of
alcohol hand rub
Tool to estimate
local cost and usage
of alcohol
Hand washing blocks spread of AI
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Host defenses
Transmissible
microbe
contact
Soap and water
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Wash hands only
when visibly soiled.Rub hands for hand
hygiene.
A good technique is
important
40-60 seconds and
hands are safe
(WHO training
materials, 2006)
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A i I f ti C t l N d D i
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Avian Influenza
Infection Control in
Health Care Facilities
Assessing Infection Control Needs During anInvestigation
Influenza Transmission
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Effective Infection Control PreventsTransmission From. . .
Patients to health care workers
Patients to patients
Patients to family membersproviding care
Precautions for Suspected or
C fi d C
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Confirmed Cases
Duration
Adults and adolescents > 12 years
Continue for 7 days after resolution of fever
Infants and children
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Confirmed Cases
Place patient in a negative air pressure room
To create a negative air pressure room: Install exhaust fan and direct air from inside to an
outside area with no person movement
If no air conditioning, open windows in isolation areasbut keep doors closed
Place patients in rooms alone Alternative: cohort patients away from other patient
care areas with beds > 1 meter apart
Precautions for Suspected or
C fi d C
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Confirmed Cases
Limit number of health care workers, family members
and visitors
Designate experienced staff to provide care
Limit designated staff to avian influenza patient care
Teach family and visitors to use PPE
Precautions for Collecting
Specimens
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Specimens Notify laboratory in advance
Health care worker collecting specimen should wear fullbarrier PPE
Place specimen in leak-proof bag
Hand deliver, if possible
Label specimen clearly as suspected avian influenza
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Environmental Decontamination
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Cleaning MUST precede decontamination
Disinfectant ineffective if organic matter is present
Use mechanical force
Scrubbing
Brushing
Flush with water
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Household Bleach Safety
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Use mask, goggles, rubber gloves,waterproof apron
Mix in well-ventilated area
Do not use or mix with other detergents
Using Bleach Solutions
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First clean organic material from surfaces or items
Wipe nonporous surfaces with sponge or wet cloth Allow to dry
Immerse items for 30 minutes
Make fresh diluted bleach daily!
Waste Disposal
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Use Standard Precautions
Gloves and hand washing
Gown + Eye protection
Avoid aerosolization
Prevent spills and leaks
Double bag if outside of bag is contaminated
Incineration is usually the preferred method
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ADDITIONAL PRECAUTIONS for handling dead bodies
with infectious diseases, cat,2&3
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Identify the body and attach to the body the appropriate
identity label. The body should be placed in a robust,
plastic bag of not less than 150 mm thick, which shouldbe zippered or closed tightly with tapes and bandage
strips.
The outside of the plastic bag should be wiped with 0.1%household bleach ( 1:50 dilution ) if soiled.
The body is then wrapped with mortuary sheet, placed
on mortuary trolley and transported to the mortuary.
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Use minimal amount of equipment
Avoid using instruments with pointed ends
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g p use disposable instruments and equipment
staff -- minimum
Cleaning ---thoroughly , followed by disinfection
pour1% sodium hypochlorite first.,leave for 10-15min.
followed by cleaning and usual disinfection-
0.1% hypochlorite
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Avian Influenza Infection Control
in the Community
Preventing Transmission
in the Community
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Respiratoryetiquette Cover nose / mouth
when coughing orsneezing
Hand washing!
Avian Influenza and Food
H t t > 70C t kill th i i fl i
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Heat to > 70C to kill the avian influenza virus
Consumption of any raw / undercookedpoultry ingredients is risky Runny eggs Meat with red juice
Separate raw meat from cooked or ready-to-eat foods to avoid cross-contamination
Wash hands before and after preparing food
Patients Cared for at Home
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Potential for transmission!
Must educate family caregivers
Fever / symptom monitoring
Infection control measures
Hand washing
Use of available material as PPE
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Application of Infection Control
Activities during anInvestigation
Location Influences Actions
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Medical facilities
Homes
Farms
Markets
Rural versus Urban areas
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Assess Existing Infection
Control Infrastructure
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Policies and procedures
Authority
Human resources
Financial resources
Engineering resources
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Summary
Influenza transmission occurs mainly through respiratorydroplets
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droplets
Contact can be prevented using PPE
Virus can be inactivated with infection controlprocedures
Hand washing is key
PPE must be donned and removed appropriately toprevent contamination of wearers and environments
Guidelines for using PPE and infection control measuresfor avian influenza in humans should be practiced untilthey are routine
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Questions?
Glossary
Decontamination - The removal of harmful substancessuch as chemicals harmful bacteria or other organisms
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such as chemicals, harmful bacteria, or other organisms,from exposed individuals, rooms, and furnishings in
buildings or in the outside environment.
Disease transmission - The process of the spread of adisease agent through a population
Infection control - Measures practiced by health carepersonnel in health care facilities to prevent the spreadof infectious agents
Personal protective equipment - Specialized clothing orequipment worn by a worker for protect from a hazard
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