healthcare-associated infection & antimicrobial stewardship
TRANSCRIPT
Healthcare-Associated Infection & Antimicrobial Stewardship
INFECTION CONTROL AND PANDEMIC RESPONSE
Washington State Department of Health | 3
Larissa Lewis MPH, RN, CIC
Who we are
Patty Montgomery MPH, RN, CIC
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Agenda
• Infection Prevention Learnings
• Aerosol Generating Procedures
• Review Scenarios
• Discussion
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✓ 2. Symptom screening
5 Key Infection Prevention Learnings
✓ 1. Source Control
✓ 3. Social Distancing
5. Aerosol-Generating Procedures (AGP)
✓ 4. Personal Protective Equipment
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General Recommendations
DOH recommends following CDC guidance:
• Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
• Using Personal Protective Equipment (PPE)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
• Optimizing Personal Protective Equipment (PPE) Supplies
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
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Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission
We know that a significant proportion of SARS-CoV-2 infections (estimated 40-45%) occur without symptoms and that infection can be spread by people showing no symptoms.October 5, 2020
https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html
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5 Key Infection Prevention Learnings
5. Aerosol-Generating Procedures (AGP)
CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.htmlWA DOH: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVID19InfectionControlForAerosolGeneratingProcedures.pdf
Generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or breathing. These AGP potentially put healthcare personnel and others at an increased risk for pathogen exposure and infection.
Is a respirator needed during AGP even if patient is COVID-19 negative on admission?• Yes, especially in areas of
moderate to substantial community transmission!
• Eye protection too
Viruses 2019, 11 (10): https://www.mdpi.com/1999-4915/11/10/940/htm
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Aerosol Generating Procedures (AGPS)
Some procedures performed on patients with suspected or confirmed SARS-CoV-2 infection could generate infectious aerosols. Procedures that pose such risk should be performed cautiously and avoided if possible.
If performed, the following should occur:
• HCP in the room should wear an N95 or equivalent or higher-level respirator, eye protection, gloves, and a gown.
• The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.
• AGPs should ideally take place in an AIIR.
• Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
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5 Key Infection Prevention Learnings
5. Aerosol-Generating Procedures (AGP)
Viruses 2019, 11 (10): https://www.mdpi.com/1999-4915/11/10/940/htm
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Scenario 1
45 year-old female visits outpatient clinic on 10/1 for pre-procedure work-up which includes a PCR test for SARS-COV-2. Results return negative and she arrives on 10/5 for her procedure which requires intubation.
https://jamanetwork.com/journals/jama/fullarticle/2765376
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Polling Question #1
What PPE should Anesthesia Wear?
A. Gloves, Surgical Mask, and Eye protection
B. Gloves and N95 Respirator
C. Gloves, N95 Respirator, and Eye Protection
D. Surgical procedure mask and eye protection as patient tested negative.
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Anesthesia Society of America (ASA)
A patient may be infected with SARS-CoV-2 and have a negative SARS-CoV-2 test.
The diagnostic sensitivity of the SARS-CoV-2 test is dependent on sampling technique, fluid sampled, the test performed and the timing of the test relative to the infectious course.(1, 2)
Therefore, we recommend as optimal practice that all anesthesia professionals should utilize appropriate PPE during aerosol generating procedures for all patients.
https://www.asahq.org/about-asa/newsroom/news-releases/2020/06/revised-the-use-of-personal-protective-equipment-by-anesthesia-professionals-during-the-covid-19-pandemic
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Appropriate PPE Includes
• Fitted N95 masks; powered air purifying respirators (PAPRs); and may include other NIOSH or CDC approved respirator.
• PAPRs should be used by individuals who are not N95 fit-tested, have facial hair, or fail N95 fit-testing.
• Surgical face masks protect against SARS-CoV-2 droplet transmission but do not protect against aerosolized particles.
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Polling Question # 2
Limiting the number of people in a room where an aerosol generating procedure is being performed is an example of which type of control?
A. Administrative
B. Elimination
C. Engineering
D. Personal Protective Equipment
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Polling Question # 3
A respiratory therapist is rounding on patients who require nebulizing treatments. She is wearing a N95 respirator with a face shield and going room to room without removing this equipment. This is an example of:
A. Extended Use
B. Conventional use
C. Contingency use
D. Reuse
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Polling Question # 4
Is extended use acceptable in this situation?
A. Yes
B. No
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• Respirators grossly contaminated with blood, respiratory or nasal secretions, or other bodily fluids should be discarded.
• HCP can consider using a face shield or facemask over the respirator to reduce/prevent contamination of the N95 respirator.
• As long as the respirator is not contaminated by splashes or sprays or unclean hands, extended use or reuse of the respirator can happen even for AGPs.
• Extended use or reuse of an N95 respirator is acceptable, even following an aerosol-generating procedure, as long as the respirator is not visibly soiled or damaged and the user performs good hand hygiene.
5. Aerosol-Generating Procedures (AGP)
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Room Clearance
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Polling Question # 5
What PPE do screeners at your hospital wear?
A. Cloth face covering
B. Medical grade mask
C. N95 respirator
D. Eye protection
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PPE for Staff Screening Patients
• Screening staff should wear a facemask or cloth face covering (for source control) but do not need to wear PPE if they are separated from patients by a physical barrier such as a glass or plastic window.
• If a staff member must be within 6 feet of a patient, they should use appropriate PPE, including an N95 or higher-level respirator (or facemask if a respirator is not available), gloves, and, eye protection. A gown could be considered if extensive contact with the patients is anticipated.
• Cloth face coverings are not considered PPE and should not be worn by HCP when PPE is indicated.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis/screening.html#:~:text=Screening%20staff%20should%20wear%20a,a%20glass%20or%20plastic%20window.
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Resources
DOH: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVID-19-InfectionPreventionCDCGuidanceCatalog.pdf
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Resources
CDC: https://www.cdc.gov/coronavirus/2019-ncov/whats-new-all.html
