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Pandemic Influenza Preparedness

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Title: Pandemic Influenza Preparedness


1
Pandemic Influenza Preparedness
  • Response Guidance forHealthcare Workers and
    Healthcare Employers

Educational material developed through
funding from OSHA Susan Harwood Grant
SH-16624-07-60-F-54
2
Introduction
  • Any Pandemic Disease
  • is a global disease outbreak
  • occurs when a new virus emerges
  • spreads where people have no immunity
  • is a disease for which there is no vaccine
  • spreads easily person-to-person
  • causes serious illness
  • sweeps around the world in a short time

3
Initial Control Measures
  • After a pandemic disease starts, everyone in the
    world is at risk
  • Countries might try to delay or stop the arrival
    of the virus through
  • border closures
  • travel restrictions
  • quarantines

4
Effects of A Severe Pandemic
  • 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

5
History of Flu Pandemics
  • Deaths in USA from past influenza pandemics
  • 1918 500,000
  • 1957 70,000
  • 1968 34,000

6
The Public Health Service
  • By 1918, most PHS officers understood how
    diseases spread
  • Without antibiotics, PHS officers were limited in
    their ability to fight disease

7
Devastation of 1918 Avian Flu
  • The Influenza Pandemic occurred in three waves
    in the United States throughout 1918 and 1919.

http//www.pandemicflu.gov/
8
1918 Rapid-paced Outbreaks
  • The 1918 influenza pandemic occurred too rapidly
    for the PHS to develop a detailed study of the
    pandemic
  • After the pandemic, they developed a map with
    approximate dates of the outbreak

9
  • Credit Office of the Public Health Service
    Historian

10
Effects on Healthcare System
  • Healthcare facilities would be overwhelmed
    including shortage of
  • hospital staff
  • beds
  • ventilators
  • supplies

11
Healthcare Worker Demands
  • Healthcare will be affected since 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)

12
Healthcare Facility Demands
  • Healthcare will be affected since healthcare
    resources will be expected to meet non-pandemic
    associated healthcare needs in a variety of
    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)

13
Cornerstones of Preparedness
  • Cornerstones of effective pandemic influenza
    preparedness and response
  • Risk Assessment
  • Policy Development
  • Procedure Execution

14
Each Facility is Unique
  • To insure adequate preparation of healthcare
    workers
  • make preparations for each facility
  • collaborate with local, state, and federal
    partners
  • follow related standards and guidelines

15
Specific 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

16
Permission of Gary Brookins and the Richmond
Times-Dispatch
17
Summit for Pandemic Planning
  • January 12, 2006
    Pandemic planning summit
  • The state of West Virginia
  • HHS and other federal agencies
  • Public health officials
  • Emergency management and response leaders

18
North America
  • The United States Northern Command has a role in
    protecting our health
  • Resources are available at their website
  • Information Sheet
  • Personal Training Brief
  • Readiness Guide
  • Newsletter
  • Department of Defense Influenza Watchboard

http//www.northcom.mil/Avian20Flu/index.html
19
PandemicFlu.gov
  • State Pandemic Plans
  • http//www.pandemicflu.gov/plan/states/stateplans
    .html
  • Site contains list of pandemic plans that are
    currently available on state websites

20
WV Pandemic Planning
  • Agreement - WV U.S. Dept. of Health and Human
    Services
  • January 12, 2006 HHS Secretary Mike
    Leavitt and Governor Joe Manchin III signed a
    Planning Resolution detailing HHSs and West
    Virginia's shared and independent
    responsibilities for pandemic planning

21
WV for Pandemic Planning
  • WV Federal Funding - 2006
  • 940,502 - Phase One funding from U. S. Dept. of
    Health and Human Services (HHS) for pandemic
    planning activities
  • 1,688,192 - revised Phase Two of Health and
    Human Services local and state allocations
  • 620,408 - awarded to help strengthen the state's
    capacity to respond to a pandemic influenza
    outbreak.

22
WV Agencies Involved in Planning
  • Bureau for Public Health
  • Health and Human Resources
  • WV Department of Military Affairs and Public

23
  • WV Pandemic Flu Website
  • http//www.wvflu.org/
  • West Virginia Bureau for Public Health - Threat
    Preparedness505 Capitol Street Suite 200
    Charleston, WV 25301Phone (304) 558-6900 ext.
    2005 Fax (304) 558-0464

24
(No Transcript)
25
WV Pandemic Flu Brochure
26
Influenza
27
Influenza - History
  • Clinical Background
  • Three pandemics in the 20th Century
  • Three types A, B, C
  • Only Type A influenza viruses cause pandemics
  • Influenza A virus variations
  • Virulence
  • Infectivity to specific hosts
  • Modes of transmission
  • Clinical presentation of infection

28
Influenza Type A Subtypes
  • Only Type A is divided into subtypes
  • Based on presence of two viral surface proteins
    (antigens)
  • Hemagglutin (H)
  • Neuraminidase (N)
  • Number of surface proteins identified in
    influenza A viruses
  • 16 hemagglutinin
  • 9 neuraminidase

29
Pandemic Subtypes
  • In the 20th Century, 3 different subtypes have
    caused pandemics
  • H1N1
  • H2N2
  • H3N2
  • Subtypes are designated as H protein type (1-16)
    solely, OR followed by the N protein type (1-9)

30
Terminology
  • Avian (bird) flu is caused by influenza A viruses
    that occur naturally among birds
  • Different subtypes of these viruses exist because
    of changes in certain proteins on the surface of
    the influenza A virus and the way the proteins
    combine
  • hemagglutinin HA
  • neuraminidase NA
  • Each combination represents a different subtype
  • All known subtypes of influenza A viruses can be
    found in birds
  • The avian flu currently of concern is the H5N1
    subtype

31
H5N1 Virus
  • H5N1
  • spreading rapidly
  • first appeared in Asia
  • epizootic (an epidemic in nonhumans)
  • panzootic (affecting animals of many species,
    especially over a wide area)
  • killing tens of millions of birds
  • spurring the culling of hundreds of millions of
    birds to stem its spread
  • Most references to "bird flu" and H5N1 in the
    popular media refer to this strain

http//en.wikipedia.org/wiki/H5n1
32
Seasonal Influenza
  • Refers to periodic outbreaks of acute onset viral
    respiratory infection caused by circulating
    strains of human influenza A and B viruses
  • Between 520 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

33
Avian 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

34
Low Pathogenic Avian Influenza
  • 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

35
High Pathogenic Avian Influenza
  • 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

36
Humans 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)

37
Influenza 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

38
Critical Response Elements
  • Rapid detection of unusual influenza outbreaks
  • Isolation of possible pandemic viruses
  • Immediate notification of national and
    international health authorities

39
  • URL http//www.who.int/en/
  • WHO is the directing and coordinating authority
    for health within the United Nations system.
    It is responsible for providing leadership on
    global health matters, shaping the health
    research agenda, setting norms and standards,
    articulating evidence-based policy options,
    providing technical support to countries and
    monitoring and assessing health trends.
  • WHO URL for Avian Influenza http//www.who.int/top
    ics/avian_influenza/en/

40
Public Health Map/GIS Map Library
World Areas reporting confirmed occurrence of
H5N1 avian influenza in poultry and wild birds
between January and June 2007
41
Public Health Map/GIS Map Library
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)
42
WHO Pandemic Alert Response System
  • URL http//www.who.int/csr/en/
  • Purpose The world requires a global system that
    can rapidly identify and contain public health
    emergencies and reduce unneeded panic and
    disruption of trade, travel and society in general

43
WHO Pandemic Alert System
  • Phase 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

44
WHO Pandemic Alert System
  • Phase 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

45
WHO Pandemic Alert System
  • Phase 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

46
Sentinel Provider Network
  • Operated by the CDC (Centers
    for Disease Control and Prevention
  • URL http//www.cdc.gov/

47
CLINICALDIAGNOSIS
48
Clinical Presentation of Influenza
  • 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 --------------------- gt Fulminant
49
Clinical 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

50
Accuracy 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)

51
Clinical Signs Symptoms
  • Sensitivity - The likelihood of a clinical sign
    or symptom to accurately detect influenza
    infection in a group of patients
  • Specificity - The likelihood of a clinical sign
    or symptom to exclude influenza infection in a
    group of patients who do not have influenza

52
Laboratory DiagnosisSeasonal 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 viruses
  • HHS/CDC Influenza Laboratory Diagnostic
    Procedures
  • http//www.cdc.gov/flu/professionals/labdiagnosis.
    htm

53
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

54
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

55
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

56
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

57
Treatment and PreventionSeasonal Influenza
  • Antiviral medications
  • Vaccinations
  • Intranasal live attenuated vaccine
  • Injectable, inactivated trivalent vaccine

58
Treatment and PreventionPandemic Influenza
  • Antiviral medications
  • HHS recommends use of neuraminidase inhibitors
    zanamivir and oseltamivir because of influenza
    resistance to amantadine and rimantadine

59
Poster
  • A printable poster on the sequences for putting
    on and taking off PPE, which can be used for
    employee training and can be posted outside
    respiratory isolation rooms, is available at
    http//www.cdc.gov/ncidod/sars/ic.htm

60
Patient Screening Plan
  • Screen all patients for influenza-like illness
  • Routinely implement strategies

61
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

62
EpidemicRespiratoryInfection
  • 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

63
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

64
Level READY
  • Baseline activities to ensure preparedness in the
    absence of known active epidemic of ERI in the
    world
  • ERI
  • Epidemic
  • Respiratory
  • Infection

65
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)

66
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)

67
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

68
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

69
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

70
Epidemic Respiratory Infections
  • Patient Flow
  • This chart shows possible patient responses to
    risk factor screening questions

71
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

72
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

73
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

74
Self-Triage
  • Question You may have influenza
  • When should you seek additional help from a
    healthcare provider?

75
Home Care Guide for Influenza
  • Common symptoms
  • Supplies to have on hand
  • Caring for a person with influenza
  • When to seek additional medical advice

76
Symptom and Care Log for Home Care
  • Copy, fill out, and bring log sheets to
    healthcare provider visits

77
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

78
Planning Checklists and Example Plans
  • Many government and private organizations have
    developed viable resources including
  • planning checklists
  • example plans
  • communication plans

79
Assistance Available from
  • Safety and Health Program Management Guidelines
  • Management leadership and employee involvement
  • Worksite analysis
  • Hazard prevention and control
  • Safety and health training

80
INFECTIONCONTROL
81
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

82
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

83
First, Conduct Risk Assessment
  • 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

84
Next, Implement Procedures
  • Include
  • 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

85
Then, 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

86
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

87
Personal Protective EquipmentGloves
  • HHS recommends the use of gloves when there is
    contact with blood and bodily fluids, including
    respiratory secretions
  • latex
  • vinyl
  • nitrile
  • other synthetic materials

88
Personal Protective EquipmentGowns
  • 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

89
Personal Protective EquipmentGoggles/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
    protection for infection control, visit NIOSHs
    website at http//www.cdc.gov/niosh/topics/eye/
    eyeinfectious.html

90
Personal Protective EquipmentRespiratory
Protection
  • Comply with OSHAs 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

91
Personal Protective EquipmentNIOSH-Certified
Respirators
  • NIOSH-certified respirators are marked with the
  • manufacturers name
  • part number
  • protection provided by the filter (e.g., N95)
  • NIOSH
  • This information is printed on the
  • facepiece
  • exhalation valve cover, or
  • head straps
  • If a respirator does not have these markings and
    does not appear on the Certified Equipment List,
    it has not been certified by NIOSH

92
Required Elements of an OSHA Respirator Program
  • 1. Selection
  • 2. Medical evaluation
  • 3. Fit testing
  • 4. Use
  • 5. Maintenance and care
  • 6. Breathing air quality and use
  • 7. Training
  • 8. Program evaluation

93
Filtering 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
94
Medical Evaluation
  • If these masks are required, then
  • Provide a medical evaluation according to the
    OSHA standard
  • Required to determine employees ability to use a
    respirator before fit testing and use
  • Identify a PLHCP
  • Required to perform medical evaluations using a
    medical questionnaire OR an initial medical
    examination that obtains the same information

95
PLHCP
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
96
Medical Evaluation
  • Medical Evaluation
  • Must obtain information requested by
    questionnaire in Sections 1 and 2,
    Part A of Appendix C
  • Follow-up medical examination
  • Required for employee who gives a positive
    response to any question among questions 1
    through 8 in Section 2, Part A of App. C OR
    whose initial medical examination demonstrates
    the need for a follow-up medical examination

97
OSHA Respirator Medical Evaluation
Questionnaire Page 1 of 10
98
Medical Evaluation
  • Annual review of medical status is not required
  • At a minimum, employer must provide additional
    medical evaluations if
  • Employee reports medical signs or symptoms
  • PLHCP, supervisor, or program administrator
    indicates an employee needs to be reevaluated
  • Change occurs in workplace conditions that may
    increase the burden on an employee

99
Fit Testing
  • Employees using tight-fitting facepiece
    respirators must pass an appropriate qualitative
    fit test (QLFT) or quantitative fit test (QNFT)
  • prior to initial use
  • whenever a different respirator facepiece (size,
    style, model or make) is used, and
  • at least annually thereafter

100
Fit Testing
The respirator used for fit testing MUST be the
same make, model, style, and size of respirator
that will be used by the employee.
101
Quantitative Fit Test - QNFT
  • 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)

102
Qualiitative Fit Test - QLFT
  • A pass/fail fit test to assess the adequacy of
    respirator fit that relies on the individuals
    response to the test agent.
  • Isoamyl acetate
  • Saccharin
  • Bitrex
  • Irritant smoke

Saccharin Fit Test Kit
103
Training and Information
  • Employees who are required to use respirators
    must be trained such that they can demonstrate
    knowledge of at least
  • why the respirator is necessary
  • limitations and capabilities of the respirator
  • effective use in emergency situations
  • how to don the respirator
  • How to perform user seal check (each time)
  • recognition of medical signs and symptoms
  • Proper disposal of the respirator

104
Personal Protective EquipmentPutting on and
Removing PPE
  • 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

105
User Seal Check
  • Check the seal each timeyou don the respirator
  • Place one or both hands completely
  • over the middle panel
  • Inhale and exhale sharply
  • If air leaks around your nose, readjust the
    nosepiece
  • If air leaks between the face and face seal of
    the respirator, reposition it and adjust straps
  • If you cannot achieve a proper seal, do not enter
    the contaminated area
  • See your supervisor

106
Time / Use Limitation
  • If the respirator becomes damaged, soiled, or
    breathing becomes difficult, leave the
    contaminated area and replace the respirator
  • Wear a respirator only once
  • Remove and dispose of a respirator in an
    appropriate trash receptacle
  • Upon re-entry, don a new respirator

3M 1860 N95 HEALTH CARE RESPIRATOR
107
Healthcare Respirator
  • NIOSH approved as an N95 particulate filter
    respirator
  • Designed to be fluid resistant to splash and
    spatter of blood and other infectious materials
  • Intended for use against both mechanically
    generated particulates and thermally generated
    fumes, plumes and smokes
  • Applications include
  • OR Laser Surgery
  • Electrocautery
  • Other powered medical instruments
  • Exposure to Mycobacterium tuberculosis
  • Aerosol droplet transfer, e.g. working with
  • SARS patients
  • Dental care where aerosol and particle
  • exposures are possible
  • Aerosols created during use and manipulation of
    chemotherapy solutions
  • Removal of casts or other dust producing activity

3M Health Care Particulate Respirator and
Surgical Mask 1870
108
Healthcare Respirator
  • Filter efficiency level 95 or greater against
    particulate aerosols free of oil
  • Fluid resistant
  • Disposable
  • May be worn in surgery
  • Fits a wide range of face sizes
  • Meets CDC guidelines for Mycobacterium
    tuberculosis exposure control

3M Health Care Particulate Respirator and
Surgical Mask 1860
109
Healthcare Respirator
  • NIOSH approved as an N95 particulate filter
    respirator
  • Intended for use by operating room personnel and
    health care workers
  • Meets CDC guidelines for TB control
  • Helps protect patients and health care workers
    from the transfer of microorganisms, blood and
    bodily fluids

Kimberly-Clark Fluidshield PFR95 N95 Particulate
Filter Respirator and Surgical Mask
110
Healthcare Respirator
  • Moldex 3200 Series N95 Particulate Respirators
  • Both an N95 respirator and surgical mask
  • Latex free
  • First and only NIOSH-approved single strap N95
    respirator
  • Meets CDC guidelines for TB exposure control
    standards

Moldex 3200 Series N95 Particulate Respirator
111
SUMMARY
  • This course has covered
  • Definition of Pandemic Influenza
  • Transmission Routes
  • Clinical Diagnosis
  • Control
  • Prevention

112
Questions?
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