PART V: Infection Control

1
PART V Infection Control
2
Who is at Risks?

• Healthcare professionals
• Close Family Members (care-takers/attendants)
• Others
• All in-patients admitted to a hospital where SARS
  has been recognized
• Especially patients with underlying conditions
• People who visit hospitals where SARS has been
  recognized

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.
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Infection Control

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

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Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
5
Jeff Stahler, The Cincinnati Post, 4/24/03
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Hospital Infection Control Guidance

• Inpatient settingCare for probable SARS cases
• Probable SARS cases should be isolated and
  accommodated as follows in descending order of
  preference
• negative pressure rooms with the door closed
• single rooms with their own bathroom facilities
• cohort placement in an area with an independent
  air supply, exhaust system and bathroom
  facilities

WHO Revised 28 March 2003
7
Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
8
Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
9
Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
10
Hospital Infection Control Guidance

• Inpatient settingCare for probable SARS cases
• Movement of patients outside of the isolation
  unit should be avoided. If moved the patients
  should wear a N 95 mask
• Visitors, if allowed by the health care facility
  should be kept to a minimum. They should be
  issued with personal protective equipment (PPE)
  and supervised

WHO Revised 28 March 2003
11
Hospital Infection Control Guidance

• Inpatient settingCare for probable SARS cases
• All non-essential staff (including students)
  should not be allowed on the unit/ward
• Handwashing is crucial therefore access to clean
  water is essential Hands should be washed before
  and after contact with any patient, after
  activities likely to cause contamination and
  after removing gloves

WHO Revised 28 March 2003
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Handwashing Recommendations
Hand washing is the Cornerstone of Infection
Control
When coming on duty
Before all patient contact
Before doing invasive procedures
Before taking care of a particularly susceptible
patient, e.g. immunocompromised
Before and after touching wound
After removal of gloves
After contact with blood, mucus membranes or
bodily fluids, secretions or excretions
After touching inanimate sources likely to be
contaminated, e.g. urine measuring devices.
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. MRSA
Before medication preparation
Before and after eating
After personal use of toilet
When hands are soiled, including after sneezing,
coughing, or blowing of nose
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Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
14
Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
15
Hospital Infection Control Guidance

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

WHO Revised 28 March 2003
16
Infection Control Guidelines for SARS patients

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

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Infection Control for SARS patients

• Use of disposable gloves should be considered for
  any direct contact with body fluids of a SARS
  patient.
• However, gloves are not intended to
• replace proper hand hygiene
• Immediately after activities involving contact
  with body fluids, gloves should be removed and
  discarded and hands should be cleaned.
• Gloves must NEVER be washed or reused.

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Infection Control for SARS patients

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

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Infection Control for SARS patients

• 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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Infection Control for SARS patients

• 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.

21
Infection Control for SARS patients

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

22
Infection Control for SARS patients

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

23
Infection Control for SARS patients

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

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Infection Control Guidelines for Hospital
Visitors

• Special precautions must be taken when entering
  all ICU, MICU, CCU, SICU and respiratory therapy
  units, regardless of whether the hospital/unit is
  known to have SARS cases.
• Hospital that have been identified of exposure to
  SARS must be visited only where absolutely
  necessary, and specialized safety procedures must
  be in place which must be strictly followed.

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Precautions To Take When Visiting ICUs For HCW
Visitors

• Use strict Universal Precautions Guidelines
• Use N95 or FFP-1grade mask
• No personal belongings to be allowed
• Before entering the unit, put on the mask as per
  instructions, and check for leakage
• After entering the unit, ask for a pair of
  surgical gloves before handling equipment

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Precautions To Take When Visiting ICUs For HCW
Visitors

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

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When Leaving The ICU

• After exiting the unit, remove the mask first and
  discard it, then remove the gloves
• Gloves must be discarded
• Wash hands thoroughly with alcohol or
  chlorhexidine scrub solution
• Do not re-use a mask.
• Do not touch a used mask without wearing gloves.

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Guidelines What To Do If You Think You Have SARS

• If you develop fever, cough and muscle pain
• Inform your supervisor
• Consult your physician immediately
• Inform local health department

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Guidelines What To Do If You Think You Have SARS

• If you are quarantined by health authorities
• Inform your supervisor

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Guidelines What To Do If You Think You Have SARS

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