gidsas chotani, 2003 part v: infection control. gidsas chotani, 2003 who is at risks? healthcare...

GIDSAS

Chotani, 2003Chotani, 2003

PART V: Infection ControlPART V: Infection Control

GIDSAS


Who is at Risks?Who is at Risks?

Healthcare professionalsHealthcare professionals

Close Family Members Close Family Members (care-takers/attendants)(care-takers/attendants)

OthersOthersAll in-patients admitted to a hospital where All in-patients admitted to a hospital where SARS has been recognizedSARS has been recognized• Especially patients with underlying conditionsEspecially patients with underlying conditions

People who visit hospitals where SARS has People who visit hospitals where SARS has been recognizedbeen recognized

In the event an employee is suspected of having contracted the disease, In the event an employee is suspected of having contracted the disease,

he/she must take steps not to expose colleagues and customers to risk.he/she must take steps not to expose colleagues and customers to risk.

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Infection ControlInfection ControlPatients with SARS pose a risk of Patients with SARS pose a risk of transmission to close household transmission to close household contacts and health care personnel in contacts and health care personnel in close contactclose contactThe duration of time before or after The duration of time before or after onset of symptoms during which a onset of symptoms during which a patient with SARS can transmit the patient with SARS can transmit the disease to others is unknowndisease to others is unknownThe following infection control measures The following infection control measures are recommended for patients with are recommended for patients with suspected SARS in households or suspected SARS in households or residential settingsresidential settings

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Hospital Infection Control Hospital Infection Control Guidance Guidance

Outpatient/triage settingOutpatient/triage setting Those presenting to health care facilities who Those presenting to health care facilities who require assessment for SARS should be rapidly require assessment for SARS should be rapidly diverted by triage nurses to a separate area to diverted by triage nurses to a separate area to minimize transmission to others minimize transmission to others Those patients should be given a N 95 mask to Those patients should be given a N 95 mask to wear wear Staff involved in the triage process should wear a Staff involved in the triage process should wear a N 95 mask and wash hands before and after N 95 mask and wash hands before and after contact with any patient, after activities likely to contact with any patient, after activities likely to cause contamination and after removing gloves cause contamination and after removing gloves Wherever possible, patients under investigation Wherever possible, patients under investigation for SARS should be separated from the probable for SARS should be separated from the probable cases – cohort patientscases – cohort patients

WHO: Revised 28 March 2003

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Jeff Stahler, The Cincinnati Post, 4/24/03

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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases Probable SARS cases should be isolated Probable SARS cases should be isolated and accommodated as follows in and accommodated as follows in descending order of preference: descending order of preference:

negative pressure rooms with the door closed negative pressure rooms with the door closed single rooms with their own bathroom facilities single rooms with their own bathroom facilities cohort placement in an area with an cohort placement in an area with an independent air supply, exhaust system and independent air supply, exhaust system and bathroom facilities bathroom facilities


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases Turning off air conditioning and opening Turning off air conditioning and opening windows for good ventilation is windows for good ventilation is recommended if an independent air supply recommended if an independent air supply is unfeasible. Please ensure that if is unfeasible. Please ensure that if windows are opened they are away from windows are opened they are away from public places public places


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases WHO advises strict adherence to the barrier WHO advises strict adherence to the barrier nursing of patients with SARS, using nursing of patients with SARS, using precautions for airborne, droplet and precautions for airborne, droplet and contact transmission contact transmission All staff, including ancilliary staff should be All staff, including ancilliary staff should be trained in the infection control measures trained in the infection control measures required for the care of such a patient required for the care of such a patient If possible, identify a member of the staff If possible, identify a member of the staff who will have the sole role of observing the who will have the sole role of observing the practice of others and provide feedback on practice of others and provide feedback on infection control infection control


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases

Disposable equipment should be used Disposable equipment should be used wherever possible in the treatment and care wherever possible in the treatment and care of patients with SARS and disposed of of patients with SARS and disposed of appropriately. If devices are to be reused, appropriately. If devices are to be reused, they should be sterilized in accordance with they should be sterilized in accordance with manufacturers’ instructions. Surfaces manufacturers’ instructions. Surfaces should be cleaned with broad spectrum should be cleaned with broad spectrum disinfectants of proven antiviral activity disinfectants of proven antiviral activity


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases Movement of patients outside of the Movement of patients outside of the isolation unit should be avoided. If moved isolation unit should be avoided. If moved the patients should wear a N 95 mask the patients should wear a N 95 mask

Visitors, if allowed by the health care facility Visitors, if allowed by the health care facility should be kept to a minimum. They should should be kept to a minimum. They should be issued with personal protective be issued with personal protective equipment (PPE) and supervised equipment (PPE) and supervised


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS cases

All non-essential staff (including students) All non-essential staff (including students) should not be allowed on the unit/ward should not be allowed on the unit/ward

Handwashing is crucial: therefore access to Handwashing is crucial: therefore access to clean water is essential clean water is essential Hands should be washed before and after Hands should be washed before and after contact with any patient, after activities contact with any patient, after activities likely to cause contamination and after likely to cause contamination and after removing gloves removing gloves


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Handwashing RecommendationsHandwashing Recommendations

When hands are soiled, including after sneezing, coughing, or blowing of noseWhen hands are soiled, including after sneezing, coughing, or blowing of nose

After personal use of toiletAfter personal use of toilet

Before and after eatingBefore and after eating

Before medication preparationBefore medication preparation

After taking care of an infected patient or one who is likely to be colonized with micro After taking care of an infected patient or one who is likely to be colonized with micro organisms of special clinical or epidemiological significance, e.g. MRSAorganisms of special clinical or epidemiological significance, e.g. MRSA

After touching inanimate sources likely to be contaminated, e.g. urine measuring devices.After touching inanimate sources likely to be contaminated, e.g. urine measuring devices.

After contact with blood, mucus membranes or bodily fluids, secretions or excretionsAfter contact with blood, mucus membranes or bodily fluids, secretions or excretions

After removal of glovesAfter removal of gloves

Before and after touching woundBefore and after touching wound

Before taking care of a particularly susceptible patient, e.g. immunocompromisedBefore taking care of a particularly susceptible patient, e.g. immunocompromised

Before doing invasive proceduresBefore doing invasive procedures

Before all patient contactBefore all patient contact

When coming on dutyWhen coming on duty

Hand washing is the Cornerstone of Infection ControlHand washing is the Cornerstone of Infection Control

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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS casesHands should be washed before and after contact Hands should be washed before and after contact with any patient, after activities likely to cause with any patient, after activities likely to cause contamination and after removing gloves contamination and after removing gloves Alcohol-based skin disinfectants could be used if Alcohol-based skin disinfectants could be used if there is no obvious organic material contamination there is no obvious organic material contamination Particular attention should be paid to interventions Particular attention should be paid to interventions such as the use of nebulisers, chest such as the use of nebulisers, chest physiotherapy, bronchoscopy or gastroscopy; any physiotherapy, bronchoscopy or gastroscopy; any intervention which may disrupt the respiratory tractintervention which may disrupt the respiratory tract


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS casesPPE should be worn by all staff and visitors PPE should be worn by all staff and visitors accessing the isolation unit accessing the isolation unit The PPE worn in this situation should be: The PPE worn in this situation should be: N95 mask as a minimum N95 mask as a minimum Single pair of gloves Single pair of gloves Goggles Goggles Disposable gown Disposable gown Apron Apron Footwear that can be decontaminated Footwear that can be decontaminated


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Inpatient settingInpatient settingCare for probable SARS casesCare for probable SARS casesAll sharps should be dealt with promptly and All sharps should be dealt with promptly and safely safely Linen from the patients should be prepared on Linen from the patients should be prepared on site for the laundry staff. Appropriate PPE should site for the laundry staff. Appropriate PPE should be worn in this preparation and the linen should be worn in this preparation and the linen should be put into biohazard bags be put into biohazard bags The room should be cleaned by staff wearing The room should be cleaned by staff wearing PPE using a broad spectrum disinfectant of PPE using a broad spectrum disinfectant of proven antiviral activity proven antiviral activity


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Infection Control Guidelines Infection Control Guidelines for SARS patientsfor SARS patients

SARS patients should limit interactions SARS patients should limit interactions outside the home and should not go to outside the home and should not go to work, school, out-of-home child care, or work, school, out-of-home child care, or other public areas until 10 days after the other public areas until 10 days after the resolution of fever, provided respiratory resolution of fever, provided respiratory symptoms are absent or improving. symptoms are absent or improving. During this time, infection control During this time, infection control precautions should be used, as precautions should be used, as described in the following slides, to described in the following slides, to minimize the potential for transmission. minimize the potential for transmission.

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Use of disposable gloves should be Use of disposable gloves should be considered for any direct contact with considered for any direct contact with body fluids of a SARS patient. body fluids of a SARS patient.

However, gloves are not intended toHowever, gloves are not intended toreplace proper hand hygienereplace proper hand hygiene

Immediately after activities involving Immediately after activities involving contact with body fluids, gloves should contact with body fluids, gloves should be removed and discarded and hands be removed and discarded and hands should be cleaned. should be cleaned. Gloves must Gloves must NEVERNEVER be washed or be washed or reused. reused.

Infection Control for SARS Infection Control for SARS patientspatients

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All members of a household with a All members of a household with a SARS patient should carefully follow SARS patient should carefully follow recommendations for hand hygiene recommendations for hand hygiene (e.g., frequent hand washing or use (e.g., frequent hand washing or use of alcohol-based hand rubs), of alcohol-based hand rubs), particularly after contact with body particularly after contact with body fluids (e.g., respiratory secretions, fluids (e.g., respiratory secretions, urine, or feces). urine, or feces).


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Each patient with SARS should be advised to cover their mouth and nose with a facial tissue when coughing or sneezing. If possible, a SARS patient should wear a surgical mask during close contact with uninfected persons to prevent spread of infectious droplets. When a SARS patient is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient.


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Sharing of eating utensils, towels, and bedding between SARS patients and others should be avoided, although such items can be used by others after routine cleaning (e.g., washing with soap and hot water). Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity.


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Household waste soiled with body fluids Household waste soiled with body fluids of SARS patients, including facial tissues of SARS patients, including facial tissues and surgical masks, may be discarded as and surgical masks, may be discarded as normal waste. normal waste. Household members and other close Household members and other close contacts of SARS patients should be contacts of SARS patients should be actively monitored by the local health actively monitored by the local health department for illness. department for illness.


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Household members or other close contacts of Household members or other close contacts of SARS patients should be vigilant for the SARS patients should be vigilant for the development of fever or respiratory symptoms development of fever or respiratory symptoms and, if these develop, should seek healthcare and, if these develop, should seek healthcare evaluation. evaluation. In advance of evaluation, healthcare providers In advance of evaluation, healthcare providers should be informed that the individual is a close should be informed that the individual is a close contact of a SARS patient. contact of a SARS patient. Household members or other close contacts Household members or other close contacts with symptoms of SARS should follow the same with symptoms of SARS should follow the same precautions recommended for SARS patients. precautions recommended for SARS patients.


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At this time, in the absence of fever or At this time, in the absence of fever or respiratory symptoms, household respiratory symptoms, household members or other close contacts of members or other close contacts of SARS patients need not limit their SARS patients need not limit their activities outside the home. activities outside the home.


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Infection Control Guidelines for Infection Control Guidelines for Hospital Visitors Hospital Visitors

Special precautions must be taken when Special precautions must be taken when entering all ICU, MICU, CCU, SICU and entering all ICU, MICU, CCU, SICU and respiratory therapy units, regardless of respiratory therapy units, regardless of whether the hospital/unit is known to have whether the hospital/unit is known to have SARS cases.SARS cases.

Hospital that have been identified of Hospital that have been identified of exposure to SARS must be visited only exposure to SARS must be visited only where absolutely necessary, and where absolutely necessary, and specialized safety procedures must be in specialized safety procedures must be in place which must be strictly followed.place which must be strictly followed.

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Precautions To Take When Visiting Precautions To Take When Visiting ICUs – For HCW & VisitorsICUs – For HCW & Visitors

Use strict Universal Precautions Use strict Universal Precautions GuidelinesGuidelinesUse N95 or FFP-1grade mask Use N95 or FFP-1grade mask No personal belongings to be No personal belongings to be allowedallowedBefore entering the unit, put on the Before entering the unit, put on the mask as per instructions, and check mask as per instructions, and check for leakagefor leakageAfter entering the unit, ask for a pair After entering the unit, ask for a pair of surgical gloves before handling of surgical gloves before handling equipmentequipment

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Precautions To Take When Visiting Precautions To Take When Visiting ICUs – For HCW & VisitorsICUs – For HCW & Visitors

Do not place belongings, tools etc. Do not place belongings, tools etc. on the floor or on exposed surfaceson the floor or on exposed surfacesRequest a paper towel from the staff Request a paper towel from the staff to spread on the surface.to spread on the surface.If you need to bring equipment/parts If you need to bring equipment/parts back from the ICU have them back from the ICU have them sterilized according to hospital sterilized according to hospital procedure by a member of the ICU procedure by a member of the ICU staff.staff.

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When Leaving The ICU…When Leaving The ICU…

After exiting the unit, remove After exiting the unit, remove the mask first and discard it, the mask first and discard it, then remove the glovesthen remove the glovesGloves must be discardedGloves must be discardedWash hands thoroughly with Wash hands thoroughly with alcohol or chlorhexidine alcohol or chlorhexidine scrub solutionscrub solutionDo not re-use a mask.Do not re-use a mask.Do not touch a used mask Do not touch a used mask without wearing gloves.without wearing gloves.

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Guidelines Guidelines What To Do If You What To Do If You Think You Have SARSThink You Have SARS

If you develop fever, cough and If you develop fever, cough and muscle pain:muscle pain:

Inform your supervisorInform your supervisorConsult your physician immediatelyConsult your physician immediatelyInform local health departmentInform local health department

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If you are If you are quarantined by quarantined by health authorities:health authorities:

Inform your Inform your supervisorsupervisor

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If you are quarantined by health If you are quarantined by health authorities:authorities:

Compile a list of colleagues (including friends Compile a list of colleagues (including friends and family members), co-workers and and family members), co-workers and customers (patients, clients, etc.) you have customers (patients, clients, etc.) you have had contact with for the last 3 days and had contact with for the last 3 days and forward it via e-mail to the identified forward it via e-mail to the identified authoritiesauthoritiesDo not leave your house for any reason, or Do not leave your house for any reason, or entertain visitors during the quarantine periodentertain visitors during the quarantine periodIf you develop any of the symptoms during the If you develop any of the symptoms during the quarantine period, inform relevant health quarantine period, inform relevant health authorities immediatelyauthorities immediately

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REVISED LIST OF QUARANTINABLE COMMUNICABLE DISEASES

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 361(b) of the Public Health Service Act (42 U.S.C. 264(b)), it is hereby ordered as follows: Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the "Secretary"), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361(b) of the Public Health Service Act:

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Patrick Chappatte, International Herald Tribune, 4/28/03

gidsas chotani, 2003 part v: infection control. gidsas chotani, 2003 who is at risks? healthcare...

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