11

Pandemic Influenza Pandemic Influenza PreparednessPreparedness

Response Guidance forResponse Guidance forHealthcare Workers Healthcare Workers

and Healthcare and Healthcare EmployersEmployers

Educational material developed through funding from OSHA Susan Harwood Grant #SH-16624-07-60-F-54

22

IntroductionIntroduction

Any Pandemic DiseaseAny Pandemic Disease is a global disease outbreakis a global disease outbreak occurs when a new virus emerges occurs when a new virus emerges spreads where people have no immunityspreads where people have no immunity is a disease for which there is no vaccineis a disease for which there is no vaccine spreads easily person-to-personspreads easily person-to-person causes serious illnesscauses serious illness sweeps around the world in a short timesweeps around the world in a short time

33

Initial Control MeasuresInitial Control Measures

After a pandemic disease starts, After a pandemic disease starts, everyone in the world is at riskeveryone in the world is at risk

Countries might try to delay or stop Countries might try to delay or stop the arrival of the virus throughthe arrival of the virus through border closuresborder closures travel restrictionstravel restrictions quarantinesquarantines

44

Effects of A Severe Effects of A Severe PandemicPandemic

Everyday life would come to a standstill due to high levels of illness, death, social

disruption, and economic loss everyone being ill at the same time interruptions of basic services such as

public transportation and food delivery

55

History of Flu PandemicsHistory of Flu Pandemics

Deaths in USA from past influenza Deaths in USA from past influenza pandemicspandemics 1918 – 500,000 1918 – 500,000 1957 – 70,0001957 – 70,000 1968 – 34,0001968 – 34,000

66

The Public Health ServiceThe Public Health Service

By 1918, most PHS By 1918, most PHS officers understood officers understood how diseases how diseases spreadspread

Without antibiotics, Without antibiotics, PHS officers were PHS officers were limited in their limited in their ability to fight ability to fight diseasedisease

77

Devastation of 1918 Avian Devastation of 1918 Avian FluFlu

The Influenza The Influenza Pandemic Pandemic occurred in occurred in three waves three waves in the United in the United States States throughout throughout 1918 and 1918 and 1919. 1919.

http://www.pandemicflu.gov/

88

1918 – Rapid-paced 1918 – Rapid-paced OutbreaksOutbreaks

The 1918 influenza pandemic The 1918 influenza pandemic occurred too rapidly for the PHS to occurred too rapidly for the PHS to develop a detailed study of the develop a detailed study of the pandemicpandemic

After the pandemic, they developed a After the pandemic, they developed a map with approximate dates of the map with approximate dates of the outbreakoutbreak

99[Credit: Office of the Public Health Service Historian] [Credit: Office of the Public Health Service Historian]

1010

Effects on Healthcare Effects on Healthcare SystemSystem

Healthcare facilities would be Healthcare facilities would be overwhelmed including shortage ofoverwhelmed including shortage of hospital staffhospital staff bedsbeds ventilatorsventilators suppliessupplies

1111

Healthcare Worker Healthcare Worker DemandsDemands

Healthcare will be affected since Healthcare will be affected since healthcare workers will be ill, too healthcare workers will be ill, too ((including first responders, nurses,

physicians, pharmacists, technicians and aides, building maintenance, security and administrative personnel, social workers, laboratory employees, food service, housekeeping, and mortuary personnel)

1212

Healthcare Facility Healthcare Facility Demands Demands

Healthcare will be affected since Healthcare will be affected since healthcare resources will be expected to healthcare resources will be expected to meet non-pandemic associated meet non-pandemic associated healthcare needs in a variety of healthcare needs in a variety of workplace settings workplace settings

(including medical and dental offices, schools, physical and rehabilitation therapy centers, health departments, occupational health clinics, and prisons, free-standing ambulatory care and surgical facilities, and emergency response settings)

1313

Cornerstones of Cornerstones of PreparednessPreparedness

Cornerstones of effective pandemic Cornerstones of effective pandemic influenza preparedness and response influenza preparedness and response Risk AssessmentRisk Assessment Policy DevelopmentPolicy Development Procedure ExecutionProcedure Execution

1414

Each Facility is UniqueEach Facility is Unique

To insure adequate To insure adequate preparation of healthcare preparation of healthcare workersworkers make preparations for each make preparations for each

facility facility collaborate with local, state, collaborate with local, state,

and federal partnersand federal partners follow related standards and follow related standards and

guidelines guidelines

1515

Specific Areas for PlanningSpecific Areas for Planning

Infection Control Plans Risk Communication Tools Self-triage Instructions for Home Care of Flu Patients Diagnosis and Treatment of Staff During a

Pandemic Technical Information Available Through

Internet Sources Supply Checklists

1616Permission of Gary Brookins and the Richmond Times-Dispatch

1717

Summit for Pandemic Summit for Pandemic PlanningPlanning

January 12, 2006January 12, 2006 Pandemic planning Pandemic planning summitsummit The state of West The state of West

VirginiaVirginia HHS and other federal HHS and other federal

agenciesagencies Public health officialsPublic health officials Emergency Emergency

management and management and response leaders response leaders

1818

North AmericaNorth America

The United States Northern Command has The United States Northern Command has a role in protecting our healtha role in protecting our health

Resources are available at their websiteResources are available at their website Information SheetInformation Sheet Personal Training BriefPersonal Training Brief Readiness GuideReadiness Guide NewsletterNewsletter Department of Defense Influenza WatchboardDepartment of Defense Influenza Watchboard

http://www.northcom.mil/Avian%20Flu/http://www.northcom.mil/Avian%20Flu/index.htmlindex.html

1919

PandemicFlu.govPandemicFlu.gov

State Pandemic PlansState Pandemic Plans

http://www.pandemicflu.gov/plan/stathttp://www.pandemicflu.gov/plan/states/stateplans.htmles/stateplans.html

Site contains list of pandemic plans Site contains list of pandemic plans that are currently available on state that are currently available on state websiteswebsites

2020

WV Pandemic PlanningWV Pandemic Planning

Agreement - WV & Agreement - WV & U.S. Dept. of Health U.S. Dept. of Health and Human Servicesand Human Services January 12, 2006January 12, 2006

HHS Secretary Mike HHS Secretary Mike Leavitt and Governor Joe Leavitt and Governor Joe Manchin III signed a Manchin III signed a Planning Resolution Planning Resolution detailing HHS‘s and detailing HHS‘s and West Virginia's shared West Virginia's shared and independent and independent responsibilities for responsibilities for pandemic planningpandemic planning

2121

WV for Pandemic WV for Pandemic PlanningPlanning

WV Federal Funding - 2006WV Federal Funding - 2006 $940,502$940,502 - Phase One funding from U. S. - Phase One funding from U. S.

Dept. of Health and Human Services (HHS) Dept. of Health and Human Services (HHS) for pandemic planning activitiesfor pandemic planning activities

$1,688,192$1,688,192 - revised Phase Two of Health - revised Phase Two of Health and Human Services’ local and state and Human Services’ local and state allocationsallocations

$620,408$620,408 - awarded to help strengthen the - awarded to help strengthen the state's capacity to respond to a pandemic state's capacity to respond to a pandemic influenza outbreak. influenza outbreak.

2222

WV Agencies Involved in WV Agencies Involved in PlanningPlanning

Bureau for Bureau for Public HealthPublic Health

Health and Health and Human Human ResourcesResources

WV WV Department Department of Military of Military Affairs and Affairs and Public Public

2323

WV Pandemic Flu WebsiteWV Pandemic Flu Website http://www.wvflu.org/http://www.wvflu.org/ West Virginia Bureau for Public West Virginia Bureau for Public

Health - Threat PreparednessHealth - Threat Preparedness505 Capitol Street • Suite 200 • 505 Capitol Street • Suite 200 • Charleston, WV 25301Charleston, WV 25301Phone: (304) 558-6900 ext. 2005 Phone: (304) 558-6900 ext. 2005 Fax: (304) 558-0464Fax: (304) 558-0464

2424

2525

WV Pandemic Flu BrochureWV Pandemic Flu Brochure

2626

InfluenzaInfluenza

2727

Influenza - HistoryInfluenza - History

Clinical Background Clinical Background Three pandemics in the 20Three pandemics in the 20thth Century Century Three types: A, B, & CThree types: A, B, & C Only Type A influenza viruses cause pandemicsOnly Type A influenza viruses cause pandemics

Influenza A virus variationsInfluenza A virus variations VirulenceVirulence Infectivity to specific hostsInfectivity to specific hosts Modes of transmissionModes of transmission Clinical presentation of infectionClinical presentation of infection

2828

Influenza Type A: SubtypesInfluenza Type A: Subtypes

Only Type A is divided into subtypesOnly Type A is divided into subtypes Based on presence of two viral surface Based on presence of two viral surface

proteins (antigens)proteins (antigens) Hemagglutin (H) Hemagglutin (H) Neuraminidase (N)Neuraminidase (N)

Number of surface proteins identified in Number of surface proteins identified in influenza A virusesinfluenza A viruses

16 hemagglutinin16 hemagglutinin 9 neuraminidase 9 neuraminidase

2929

Pandemic SubtypesPandemic Subtypes

In the 20In the 20thth Century, 3 different Century, 3 different subtypes have caused pandemicssubtypes have caused pandemics H1N1H1N1 H2N2H2N2 H3N2H3N2

Subtypes are designated as H protein Subtypes are designated as H protein type (1-16) solely, OR followed by the type (1-16) solely, OR followed by the N protein type (1-9)N protein type (1-9)

3030

TerminologyTerminology

Avian (bird) flu is caused by influenza A Avian (bird) flu is caused by influenza A viruses that occur naturally among birdsviruses that occur naturally among birds

Different subtypes of these viruses exist Different subtypes of these viruses exist because of changes in certain proteins on the because of changes in certain proteins on the surface of the influenza A virus and the way surface of the influenza A virus and the way the proteins combinethe proteins combine hemagglutininhemagglutinin [HA][HA] neuraminidase [NA]neuraminidase [NA]

Each combination represents a different Each combination represents a different subtypesubtype

All known subtypes of influenza A viruses can All known subtypes of influenza A viruses can be found in birdsbe found in birds

The avian flu currently of concern is the H5N1 The avian flu currently of concern is the H5N1 subtypesubtype

3131

H5N1 VirusH5N1 Virus

H5N1H5N1 spreading rapidlyspreading rapidly first appeared in Asiafirst appeared in Asia epizootic (an epidemic in epizootic (an epidemic in

nonhumans) nonhumans) panzootic (affecting animals panzootic (affecting animals

of many species, especially of many species, especially over a wide area)over a wide area)

killing tens of millions of killing tens of millions of birdsbirds

spurring the culling of spurring the culling of hundreds of millions of birds hundreds of millions of birds to stem its spreadto stem its spread

Most references to Most references to "bird flu" and H5N1 in "bird flu" and H5N1 in the popular media refer the popular media refer to thisto this strainstrainhttp://en.wikipedia.org/wiki/H5n1

3232

Seasonal InfluenzaSeasonal Influenza

Refers to periodic outbreaks of acute onset viral respiratory infection caused by circulating strains of human influenza A and B viruses

Between 5–20 percent of the population may be infected annually

Most people have some immunity to the currently circulating strains of influenza virus

Thus, the severity and impact of seasonal influenza is substantially less than during pandemics

3333

Avian Influenza: Bird FluAvian Influenza: Bird Flu

Caused by type A influenza viruses that infect wild birds and domestic poultry

Some forms of the avian influenza are worse than others

Generally divided into two groups low pathogenic avian influenza highly pathogenic avian influenza

3434

Low Pathogenic Avian Low Pathogenic Avian InfluenzaInfluenza

Naturally occurs in wild birds and can spread to domestic birds

In general, poses little threat to human health

Has the potential to mutate into highly pathogenic avian influenza and is, therefore, closely monitored

3535

High Pathogenic Avian High Pathogenic Avian InfluenzaInfluenza

Can spread rapidly Has a high death rate in birds H5N1

now rapidly spreading in birds in some parts of the world

one of the few avian influenza viruses to have crossed the species barrier to infect humans

the most deadly of those viruses that have crossed the barrier

3636

Humans and H5N1Humans and H5N1

Most cases of H5N1 infections in humans have resulted from contact with infected poultry or surfaces contaminated with secretion/excretions from infected birds

Spread of H5N1 from person to person has been limited to rare, sporadic cases

H5N1 does not commonly infect humans In humans, there is little or no immune

protection against H5N1 (Information from November 2006)(Information from November 2006)

3737

Influenza Pandemic PatternsInfluenza Pandemic Patterns

Many scientists believe that since no pandemic has occurred since 1968, it is only a matter of time before another pandemic occurs

A pandemic may occur in waves of outbreaks with each wave in a community lasting 8 to 12 weeks

One-to-three waves may occur

3838

Critical Response ElementsCritical Response Elements

Rapid detection of unusual influenza outbreaks

Isolation of possible pandemic viruses Immediate notification of national and

international health authorities

3939

URL: http://www.who.int/en/URL: http://www.who.int/en/ WHO is the directing and coordinating WHO is the directing and coordinating

authority for health within the United Nations authority for health within the United Nations system. It is responsible for providing system. It is responsible for providing leadership on global health matters, shaping leadership on global health matters, shaping the health research agenda, setting norms the health research agenda, setting norms and standards, articulating evidence-based and standards, articulating evidence-based policy options, providing technical support to policy options, providing technical support to countries and monitoring and assessing countries and monitoring and assessing health trends.health trends.

WHO URL for Avian Influenza WHO URL for Avian Influenza http://www.who.int/topics/avian_influenza/en/http://www.who.int/topics/avian_influenza/en/

4040

Public Health Map/GIS Map Public Health Map/GIS Map LibraryLibrary

World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry and wild birds between January and June 2007

4141

Public Health Map/GIS Map Public Health Map/GIS Map LibraryLibrary

World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry

and wild birds Since 2003, status as of Dec. 7, 2007 (latest available update)

4242

WHO Pandemic Alert & WHO Pandemic Alert & Response SystemResponse System

URL: http://www.who.int/csr/en/URL: http://www.who.int/csr/en/ Purpose: The world requires a global Purpose: The world requires a global

system that can rapidly identify and system that can rapidly identify and contain public health emergencies contain public health emergencies and reduce unneeded panic and and reduce unneeded panic and disruption of trade, travel and society disruption of trade, travel and society in generalin general

4343

WHO Pandemic Alert WHO Pandemic Alert SystemSystem

Phase 1 & 2Phase 1 & 2 The “Inter-Pandemic Period” There is a novel influenza A virus in

animals but no human cases have been observed

Phase 2 indicates that an animal influenza subtype that poses a risk to humans has been detected

4444

WHO Pandemic Alert WHO Pandemic Alert SystemSystem

Phase 3, 4 & 5Phase 3, 4 & 5 The “Pandemic Alert Period” A novel influenza virus causes human

infection with a new subtype, but does not exhibit efficient and sustained human-to-human transmission

4545

WHO Pandemic Alert WHO Pandemic Alert SystemSystem

Phase 6Phase 6 The “Pandemic Period” A new influenza A virus develops the

capacity for efficient and sustained human-to-human transmission in the general population

The WHO declares that an influenza pandemic is in progress

4646

Sentinel Provider NetworkSentinel Provider Network

Operated by the CDC Operated by the CDC (Centers for Disease Control and (Centers for Disease Control and PreventionPrevention

URL: http://www.cdc.gov/URL: http://www.cdc.gov/

4747

CLINICALCLINICALDIAGNOSISDIAGNOSIS

4848

Clinical Presentation of Clinical Presentation of InfluenzaInfluenza

Varies from “no symptoms” at all in seasonal influenza to “ “fulminant” (fully symptomatic) disease in pandemic strains that result in severe illness and death (even among previously healthy adults and children)No Symptoms --------------------- > Fulminant

4949

Clinical DiagnosisClinical Diagnosis

Clinical Diagnosis of Seasonal Influenza sudden onset of fever respiratory illness muscle aches headaches nonproductive cough sore throat runny nose ear infections gastrointestinal symptoms

5050

Accuracy of DiagnosisAccuracy of Diagnosis

It has been reported that the use of the influenza-like case definition is 63 to 78% accurate in identifying

culture-confirmed cases of influenza (a sensitivity of 63 to 78%)

55 to 71% accurate in excluding influenza (specificity of 55 to 71%)

5151

Clinical Signs & SymptomsClinical Signs & Symptoms

Sensitivity - Sensitivity - The likelihood of a clinical sign or symptom to accurately detect influenza infection in a group of patients

Specificity - TSpecificity - The likelihood of a clinical sign or symptom to exclude influenza infection in a group of patients who do not have influenza

5252

Laboratory DiagnosisLaboratory DiagnosisSeasonal InfluenzaSeasonal Influenza

Seasonal Influenza Commercial rapid testing can detect seasonal

influenza virus in less than 30 minutes Some tests not very sensitive False negative results are common Not all of these tests can distinguish between

influenza A and B virusesHHS/CDC Influenza Laboratory Diagnostic Procedureshttp://www.cdc.gov/flu/professionals/

labdiagnosis.htm

5353

Clinical DiagnosisPandemic Influenza

Patients will likely have clinical signs and symptoms similar to seasonal influenza

Clinical presentation and course of illness may be severe in a higher percentage of the cases of pandemic influenza

5454

Laboratory Diagnosis Avian Influenza

HHS/CDC developed a 4-hour RT-PCR assay to detect gene coding for H5 surface protein of Asian lineage of the highly pathogenic H5N1 avian influenza virus

RT-PCR reagents distributed to approximately 140 designated laboratories of the Laboratory Response Network (LRN)

Laboratories located in all 50 states

5555

Modes of TransmissionSeasonal Influenza

1- Droplet Transmission coughing, sneezing, or talking therapeutic manipulations i. e. suctioning or

bronchoscopy 2 - Airborne Transmission

disseminated by air currents to susceptible individuals can travel significant distances penetrate deep into the lung to the alveoli can establish an infection

3 - Contact Transmission Direct contact - touching skin-to- skin

5656

Modes of TransmissionPandemic Influenza

Transmission - Past Pandemics Person-to-person Airborne

Transmission - Future Pandemics May be possible by

contact with blood CSF (cerebrospinal fluid) feces respiratory secretions mucous membranes of the eye

5757

Treatment and PreventionSeasonal Influenza

Antiviral medications

Vaccinations Intranasal live

attenuated vaccine Injectable,

inactivated trivalent vaccine

5858

Treatment and PreventionPandemic Influenza

Antiviral medications HHS recommends

use of neuraminidase inhibitors zanamivir and oseltamivir because of influenza resistance to amantadine and rimantadine

5959

PosterPoster

A printable poster on A printable poster on the sequences for the sequences for putting on and putting on and taking off PPE, which taking off PPE, which can be used for can be used for employee training employee training and can be posted and can be posted outside respiratory outside respiratory isolation rooms, is isolation rooms, is available at available at http://www.cdc.gov/http://www.cdc.gov/ncidod/sars/ic.htmncidod/sars/ic.htm

6060

Patient Patient Screening Screening

PlanPlan

Screen all patients for influenza-like illness

Routinely implement strategies

6161

Surveillance ActivitiesHealthcare Workers

Keep a register of healthcare workers who have provided care for pandemic influenza-infected

patients recovered from pandemic influenza

Encourage self-reporting by symptomatic healthcare workers

Exclude symptomatic healthcare workers from duty

6262

EpidemicRespiratory

Infection Six levels of alert

corresponding to the type of transmission, the location of the cases, and the presence and type of cases at a particular medical center

6363

Alert Levels

Determined by Readiness Committee use matrix and data collected through

surveillance activities Can be upgraded (or downgraded) by the

committee depending on number of cases other compelling circumstances

At each level of alert Readiness Committee will consider implementing certain actions

As level of alert becomes higher, additional actions are added to actions initiated at lower level

6464

Level: READY

Baseline activities to ensure preparedness in the absence of known active epidemic of ERI in the world

ERI = Epidemic Respiratory Infection

6565

Level: GREEN

Confirmed efficient human-to-human transmission of potentially epidemic contagious respiratory infection present outside the U.S. and bordering countries (Canada and Mexico)

6666

Level: YELLOW

Confirmed human-to-human transmission of potentially epidemic contagious respiratory infection (ERI) documented in the U.S. or bordering countries (Canada or Mexico)

6767

Level: CONTROLLED ORANGE

A case of ERI has been diagnosed at a particular medical center or in an inpatient at a medical center but there has been no documented nosocomial or community spread from this person to others

6868

Level: ORANGE

There is evidence of nosocomial transmission of ERI from known infected patients to other patients, employees, or visitors at a particular medical center, OR there is human-to-human transmission in specified region, or nearby

6969

Level: RED

There is evidence of untraceable or uncontrolled nosocomial transmission of ERI

OR there is widespread human-to-human transmission in a particular region or nearby

7070

Epidemic Respiratory Infections

Patient Flow This chart

shows possible patient responses to risk factor screening questions

7171

ERI Outpatient Management Protocol

For patients with new cough and risk factors associated with epidemic respiratory infection (ERI)

Key points Give patient a mask Require PPE for

anyone visiting patient Evaluate risk factors

Consult with physician

Move patient to room with negative air pressure

Administer tests Coordinate medical

followup if patient is released

Activate ERI plan if patient is admitted

7272

PrinciplesCare of ERI Patients

Minimize Health Care Workers (HCW) contact with the patient

Protect HCWs during contact with patient

Minimize opportunities for exposure to other patients or visitors

7373

ERI Inpatient Management Protocol

This plan will be put into effect when a patient is believed to meet the criteria for an Epidemic

Respiratory Infection by one of the Infectious Disease Physicians, and

needs hospitalization

7474

Self-Triage

Question: You may have influenza

When should you seek additional help from a healthcare provider?

7575

Home Care Guide for Influenza Common

symptoms Supplies to

have on hand Caring for a

person with influenza

When to seek additional medical advice

7676

Symptom and Care Log

for Home Care

Copy, fill out, and bring log sheets to healthcare provider visits

7777

Influenza Diagnostic Table

This table contains references for diagnosis and treatment of staff during an influenza pandemic

Please refer to www.pandemicflu.gov or http://www.pandemicflu.gov/vaccine/#testing for current information and recommendations

7878

Planning Checklists

and Example Plans

Many government and private organizations have developed viable resources including planning checklists example plans communication

plans

7979

Assistance Available fromAssistance Available from

Safety and Health Program Management Guidelines Management leadership and employee

involvement Worksite analysis Hazard prevention and control Safety and health training

8080

INFECTIONINFECTIONCONTROLCONTROL

8181

Infection Control

Use same strategies implemented for any infectious agent facility and environmental controls

engineering controls standard operating procedures

administrative controls personal protective clothing and equipment safe work practices

8282

Standard Precautions

Apply to blood all body fluids, secretions, and excretions

except sweat, regardless of whether or not they contain visible blood

non-intact skin mucous membranes

8383

First, Conduct Risk First, Conduct Risk AssessmentAssessment

Conduct to determine necessary PPE and work practices to avoid contact with blood, body fluids, excretions, and secretions

Will help to customize standard precautions to the healthcare setting of interest

8484

Next, Implement ProceduresNext, Implement Procedures

IncludeInclude Gloves and facial (nose, mouth, and eye)

protection Hand hygiene before and after patient

contact, and after removing gloves or other PPE

Handling and disinfection of patient care equipment, patient rooms, and soiled linen

8585

Then, Use PrecautionsThen, Use Precautions

Contact Precautions Use PPE, dedicated patient care

equipment, limitation of patient movement, private rooms

Droplet Precautions Use surgical masks within 3 feet of a

patient Airborne Precautions

Place patient in a negative pressure room and follow associated precautions

8686

Compliance with Infection Control

“Weak Links” Adherence to hand hygiene Consistent and proper use of PPE Influenza vaccination of healthcare

workers Perform serologic and other testing for

pandemic influenza on healthcare workers with influenza-like illness and who have had likely exposures to pandemic influenza-infected patients

8787

Personal Protective Equipment

Gloves HHS recommends the use of gloves

when there is contact with blood and bodily fluids, including respiratory secretions latex vinyl nitrile other synthetic materials

8888

Personal Protective Equipment

Gowns Healthcare workers should wear an

isolation gown when clothes will come into contact with blood or other bodily fluids (respiratory secretions) during procedures such as intubation when closely holding a pediatric patient

Isolation gowns can be disposable and made of synthetic material reusable and made of washable cloth

8989

Personal Protective Equipment

Goggles/Face Shields Wear goggles and/or face shields if

sprays or splatters of infectious material are likely

if a pandemic influenza patient is coughing

For additional information about eye For additional information about eye protection for infection control, visit protection for infection control, visit NIOSH’s website at NIOSH’s website at http://www.cdc.gov/niosh/topics/eye/eyeinfectious.http://www.cdc.gov/niosh/topics/eye/eyeinfectious.htmlhtml

9090

Personal Protective Equipment

Respiratory Protection Comply with OSHA’s Respiratory

Protection standard (29 CFR 1910.134) to achieve high levels of protection

All respirators used by employees are required to be tested and certified by NIOSH

For a list of all NIOSH-certified respirators (the Certified Equipment List), see http://www.cdc.gov/niosh/celintro.html

9191

Personal Protective Equipment

NIOSH-Certified Respirators NIOSH-certified respirators are marked with theNIOSH-certified respirators are marked with the

manufacturer’s namemanufacturer’s name part numberpart number protection provided by the filter (e.g., N95)protection provided by the filter (e.g., N95) ““NIOSH” NIOSH”

This information is printed on the This information is printed on the facepiecefacepiece exhalation valve cover, orexhalation valve cover, or head strapshead straps

If a respirator does not have these markings If a respirator does not have these markings and does not appear on the Certified and does not appear on the Certified Equipment List, it has not been certified by Equipment List, it has not been certified by NIOSHNIOSH

9292

Required Elements of an Required Elements of an OSHA Respirator ProgramOSHA Respirator Program

1. Selection1. Selection

2. Medical evaluation2. Medical evaluation

3. Fit testing3. Fit testing

4. Use4. Use

5. Maintenance and care5. Maintenance and care

6. Breathing air quality and use6. Breathing air quality and use

7. Training7. Training

8. Program evaluation8. Program evaluation

9393

Filtering FacepieceFiltering Facepiece

A negative pressure particulate respirator with a filter as an integral part of the facepiece OR with the entire facepiece composed of the filtering medium.

3M 1870 - P2 / N95 Flat Fold Respirator Health Care Mask

9494

Medical EvaluationMedical Evaluation

If these masks are required, then:If these masks are required, then: Provide a medical evaluation according to the Provide a medical evaluation according to the

OSHA standardOSHA standard Required to determine employee’s ability to use a Required to determine employee’s ability to use a

respirator before fit testing and userespirator before fit testing and use Identify a PLHCP Identify a PLHCP

Required to perform medical evaluations using a Required to perform medical evaluations using a medical questionnaire medical questionnaire OROR an initial medical an initial medical examination that obtains the same informationexamination that obtains the same information

9595

PLHCPPLHCP

Physician or Other Licensed Health Care Professional

An individual whose legally permitted scope of practice (i.e., license, registration, or certification) allows him / her to independently provide, or be delegated the responsibility to provide, some or all of the health care services required by paragraph (e) Medical evaluation

9696

Medical EvaluationMedical Evaluation Medical EvaluationMedical Evaluation

Must obtain information requested by Must obtain information requested by questionnaire in Sections 1 and 2, questionnaire in Sections 1 and 2, Part A of Appendix CPart A of Appendix C

Follow-up medical examinationFollow-up medical examination Required for employee who gives a positive Required for employee who gives a positive

response to any question among questions response to any question among questions #1 through #8 in Section 2, Part A of App. C #1 through #8 in Section 2, Part A of App. C OROR whose initial medical examination whose initial medical examination demonstrates the need for a follow-up demonstrates the need for a follow-up medical examinationmedical examination

9797

OSHA OSHA Respirator Respirator

Medical Medical Evaluation Evaluation

QuestionnairQuestionnairee

Page 1 of 10Page 1 of 10

9898

Medical EvaluationMedical Evaluation Annual review of medical status is not Annual review of medical status is not

requiredrequired At a minimum, employer must provide At a minimum, employer must provide

additional medical evaluations if:additional medical evaluations if: Employee reports medical signs or Employee reports medical signs or

symptomssymptoms PLHCP, supervisor, or program PLHCP, supervisor, or program

administrator indicates an employee needs administrator indicates an employee needs to be reevaluatedto be reevaluated

Change occurs in workplace conditions that Change occurs in workplace conditions that may increase the burden on an employeemay increase the burden on an employee

9999

Fit TestingFit Testing Employees using tight-fitting facepiece Employees using tight-fitting facepiece

respirators must pass an appropriate respirators must pass an appropriate qualitative fit test (QLFT)qualitative fit test (QLFT) or or quantitative fit test (QNFT)quantitative fit test (QNFT) prior to initial useprior to initial use whenever a different respirator whenever a different respirator

facepiece (size, style, model or make) facepiece (size, style, model or make) is used, andis used, and

at least annually thereafterat least annually thereafter

100100

The respirator used for fit testing MUST be the

same make, model, style, and size of

respirator that will be used by the employee.

Fit Testing

101101

QQuantitative uantitative FFit it TTest - est - QNFTQNFT

An assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator.

QNFT Protocols–Generated Aerosol (corn oil, salt, DEHP)–Condensation Nuclei Counter (PortaCount)–Controlled Negative Pressure (Dynatech FitTester 3000)

102102

QQualiitative ualiitative FFit it TTestest -- QLFTQLFT

A pass/fail fit test to assess A pass/fail fit test to assess the adequacy of respirator the adequacy of respirator fit that relies on the fit that relies on the individual’s response to the individual’s response to the test agent.test agent.

Isoamyl acetateIsoamyl acetate SaccharinSaccharin BitrexBitrex Irritant smokeIrritant smoke

Saccharin Fit Test Kit

103103

Employees who are required to use Employees who are required to use respirators must be trained such that respirators must be trained such that they can demonstrate knowledge of they can demonstrate knowledge of at leastat least why the respirator is necessary why the respirator is necessary limitations and capabilities of the limitations and capabilities of the

respiratorrespirator effective use in emergency situationseffective use in emergency situations how to don the respiratorhow to don the respirator How to perform user seal check How to perform user seal check

(each time)(each time) recognition of medical signs and recognition of medical signs and

symptomssymptoms Proper disposal of the respiratorProper disposal of the respirator

Training and InformationTraining and Information

104104

HHS/CDC recommends that personal protective equipment be put on in the following order Gown Respirator (or mask, when appropriate) Face shield or goggles Gloves

Upon leaving the room, HHS/CDC recommends that PPE be removed in a way to avoid self-contamination, as follows Gloves Faceshield or goggles Gown Respirator or mask

Personal Protective Equipment

Putting on and Removing PPE

User Seal CheckUser Seal Check

Check the seal each timeCheck the seal each timeyou don the respiratoryou don the respirator

Place one or both hands completelyPlace one or both hands completely

over the middle panelover the middle panel Inhale and exhale sharplyInhale and exhale sharply

If air leaks around your nose, If air leaks around your nose, readjust the readjust the nosepiece nosepiece

If air leaks between the face and face seal of the If air leaks between the face and face seal of the respirator, reposition it and adjust strapsrespirator, reposition it and adjust straps

If you cannot achieve a proper seal, doIf you cannot achieve a proper seal, do not not enter the contaminated areaenter the contaminated area

See your supervisorSee your supervisor

Time / Use LimitationTime / Use Limitation If the respirator becomes If the respirator becomes

damaged, soiled, or damaged, soiled, or breathing becomes difficult, breathing becomes difficult, leave the contaminated area leave the contaminated area and replace the respiratorand replace the respirator

Wear a respirator only onceWear a respirator only once Remove and dispose of a Remove and dispose of a

respirator in an appropriate respirator in an appropriate trash receptacletrash receptacle

Upon re-entry, don a new Upon re-entry, don a new respiratorrespirator

3M #1860 N95 HEALTH CARE RESPIRATOR

Healthcare Healthcare RespiratorRespirator

NIOSH approved as an N95 particulate filter NIOSH approved as an N95 particulate filter respirator respirator

Designed to be fluid resistant to splash and Designed to be fluid resistant to splash and spatter of blood and other infectious materialsspatter of blood and other infectious materials

Intended for use against both mechanically Intended for use against both mechanically generated particulates and thermally generated particulates and thermally generated fumes, plumes and smokesgenerated fumes, plumes and smokes

Applications includeApplications include OR Laser SurgeryOR Laser Surgery ElectrocauteryElectrocautery Other powered medical instrumentsOther powered medical instruments Exposure to Mycobacterium tuberculosisExposure to Mycobacterium tuberculosis Aerosol droplet transfer, e.g. working with Aerosol droplet transfer, e.g. working with SARS patients SARS patients Dental care where aerosol and particleDental care where aerosol and particle exposures are possibleexposures are possible Aerosols created during use and Aerosols created during use and

manipulation of chemotherapy solutionsmanipulation of chemotherapy solutions Removal of casts or other dust producing Removal of casts or other dust producing

activityactivity 107107

3M™ Health Care Particulate Respirator

and Surgical Mask 1870

Healthcare RespiratorHealthcare Respirator Filter efficiency level 95% or Filter efficiency level 95% or

greater against particulate greater against particulate aerosols free of oilaerosols free of oil

Fluid resistantFluid resistant DisposableDisposable May be worn in surgeryMay be worn in surgery Fits a wide range of face sizesFits a wide range of face sizes Meets CDC guidelines for Meets CDC guidelines for

Mycobacterium tuberculosis Mycobacterium tuberculosis exposure controlexposure control

108108

3M™ Health Care Particulate Respirator

and Surgical Mask 1860

Healthcare RespiratorHealthcare Respirator

NIOSH approved as an N95 NIOSH approved as an N95 particulate filter respiratorparticulate filter respirator

Intended for use by operating Intended for use by operating room personnel and health care room personnel and health care workersworkers

Meets CDC guidelines for TB Meets CDC guidelines for TB controlcontrol

Helps protect patients and Helps protect patients and health care workers from the health care workers from the transfer of microorganisms, transfer of microorganisms, blood and bodily fluidsblood and bodily fluids

109109

Kimberly-Clark Fluidshield PFR95

N95 Particulate Filter Respirator and Surgical Mask

Healthcare RespiratorHealthcare Respirator

Moldex 3200 Series N95 Moldex 3200 Series N95 Particulate RespiratorsParticulate Respirators Both an N95 respirator and Both an N95 respirator and

surgical masksurgical mask Latex freeLatex free First and only NIOSH-First and only NIOSH-

approved single strap N95 approved single strap N95 respiratorrespirator

Meets CDC guidelines for TB Meets CDC guidelines for TB exposure control standardsexposure control standards

110110

Moldex 3200 SeriesN95 Particulate

Respirator

111111

SUMMARYSUMMARY

This course has coveredThis course has covered Definition of Pandemic InfluenzaDefinition of Pandemic Influenza Transmission RoutesTransmission Routes Clinical DiagnosisClinical Diagnosis ControlControl PreventionPrevention

112112

Questions?Questions?