Protecting Health Care Workers: Infection Control in a

Report
Protecting Health
Care Workers: Infection
Control in a Pandemic
Brian Schwartz MD
Director, Sunnybrook Osler Centre for Prehospital Care
Scientific Advisor, Emergency Management Unit
MOHLTC
OAML June 16, 2005
Objectives
1.
2.
3.
4.
5.
Definitions
Infection control
Infection control in a pandemic
Personal Protective Equipment
What now?
1. Definitions (CPIP):
“Clinical” Influenza:
 Acute onset of fever (usually >38o C)
and cough
 Sore throat, rhinorrhea, malaise, chills,
myalgia & headache may be present
 Higher predictive value when ‘flu is
present in the community
Definitions (CPIP):
“Confirmed” Influenza:
 Laboratory confirmation
or
 Clinical case with epi link to a lab
confirmed case
Definitions (CPIP):
“Influenza-Like-Illness”:
 Acute onset of respiratory illness with
fever (>38 C) and cough and with one
or more of:
 Sore
throat, arthralgia, myalgia or
prostration which could be due to
influenza virus (no other cause identified)
2. Infection Control
A mighty creature is the germ,
Though smaller than the
pachyderm
His strange delight he often
pleases
By giving people strange
diseases
Ogden Nash
Influenza A virus
Transmission in droplets > 5 microns
 Incubation period 1-3 days
 Infectious from day before symptoms
for 3-5 days after (7 in children)
 Virus survives 5 minutes on hands, 12
hours on cloth, 1-2 days on surfaces

Infection Control

Health care settings are encouraged to
implement policies to limit unprotected
contact with infected patients
including:
Infection Control
Minimizing crowding and maintaining
one metre separation between patients
 Accommodating patients with
symptoms in a separate area away from
other patients
 Cohorting influenza patients in areas
with other influenza patients

Routine &Droplet Precautions
Accessible hand hygiene stations and
signage
 Encouraging “cough etiquette” [cover
mouth with hand (then wash)] or tissue

3. Infection Control in a
Pandemic




Cohorting patients will be a priority
Patients who have ILI should be segregated
from others
Ideally ILI patients should be cared for by
immune or prophyllaxed HCW’s
HCWs should wear PPE (unless they have
seroconverted or are on prophylaxis)
Routine &Droplet Precautions

Hand hygiene (i.e., washing hands or
using alcohol based hand rub or
sanitizer: before seeing the patient,
after seeing the patient and before
touching the face, and after removing
and disposing of personal protective
equipment)
Personal Protective
Equipment
What is a person to do?
OAML June 16, 2005
This?
This?
This?
These?
Or This?
Personal Protective
Equipment
Health care workers (HCWs)
use routine & droplet
precautions with patients
presenting with FRI/ILI:
OAML June 16, 2005
Droplet Precautions
A surgical mask covering the user’s
nose and mouth when providing direct
care
 Eye protection when providing direct
care

Droplet Precautions

Interaction with patient that minimize
contact with droplets (e.g., sitting next
to rather than in front of a coughing
patient when taking a history or
conducting an examination)
Routine &Droplet Precautions

Hand hygiene (i.e., washing hands or
using alcohol based hand rub or
sanitizer: before seeing the patient,
after seeing the patient and before
touching the face, and after removing
and disposing of personal protective
equipment)
Contact & Droplet Precautions
Appropriate gloves when they are likely
to have contact with body fluids or to
touch contaminated surfaces
 Gowns during procedures when
clothing might be contaminated

PPE Removal
1.
2.
3.
4.
Remove gloves
Remove gown (if applicable)
Hand hygiene for 15 seconds
Exit room
PPE Removal
5.
6.
7.
8.
Hand hygiene for 15 seconds
Remove protective eyewear
Remove mask
Hand hygiene for 15 seconds
Don’t Forget….

Contact precautions (gloves, gowns if
appropriate and hand hygiene) for
managing/disposing of equipment and
cleaning/disinfecting the environment
What about a mask
for the patient?
We may not have enough and
masks for HCWs are more
important if patients are cohorted
OAML June 16, 2005
Key points about protecting
patients:
The same precautions used to protect
health care workers will also protect
patients
 Hand hygiene is essential in preventing
the spread of influenza

Key points about protecting
patients:
Health care workers should encourage
all patients to practice hand hygiene
and use a “cough etiquette”- mask or
tissue to cover their mouth when
coughing
 If patients see health care workers
using such precautions consistently,
they are more likely to do the same

So what do we do now?
Practice excellent infection control day
to day
 Get your ‘flu shot
 Read the relevant sections of OHPIP
on the beach during your vacation

Questions: Thank You

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