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Infection Control Aspects of Influenza

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... self monitoring form ... Sputum induction ET intubation and extubation CPR Open suctioning of airways Autopsies Non ... Prevention and Controls US CDC ... – PowerPoint PPT presentation

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Title: Infection Control Aspects of Influenza


1
Infection Control Aspects of Influenza
  • Chariya Sangsajja, M.D.
  • BIDI, DDC, MOPH
  • October 2011

2
Human-to-Human Transmission of Influenza(1)
  • Large respiratory droplet distancelt,6 ft.
  • Contact with large respiratory droplet
  • Airborne transmission over longer distances has
    not been documented

3
Human-to-Human Transmission of Influenza (2)
  • Smaller droplet nuclei at close-range exposure
    ?, may be important under special condition e.g.
    aerosol- producing procedures
  • All respiratory secretions and bodily fluids,
    including diarrheal stools are considered to be
    potentially infectious

4
WHO Categories of Infection Prevention and
Controls
  • Administrative controls
  • Environmental/ engineering controls
  • Personal protective equipments

5
US CDC Fundamental Elements to Prevent Influenza
Transmission (1)
  • Seasonal Influenza vaccine
  • Respiratory hygiene and cough etiquette
  • Appropriate management of ill HCWs

6
US CDC Fundamental Elements to Prevent Influenza
Transmission (2)
  • Adherence to IC precautions for all patient-care
    activities and aerosol-generating procedures
  • Implementing environmental and engineering IC
    measures

7
Administrative Control Strategies (1)
  • Hospital Policy Plan
  • Monitor influenza activities
  • Clinical and IC practices guidelines
  • Education, training and monitoring
  • Minimize potential exposures

8
Hospital Preparedness
Training
Clinical Practice Guidelines
Isolation Room
Exercise
9
Hand Hygiene Training Program
10
Minimize Potential Exposures
  • During periods of increased influenza activity,
    minimizing OPD and ER visits for patients with
    mild ILI who are not at increased risk for
    complications from influenza
  • Set up Hotline Center
  • Visitors screening for ILI symptoms

11
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12
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13
Administrative Control Strategies (2)
  • Implementing respiratory hygiene cough
    etiquette programs
  • Triage system, alerting sign managing patient
    flow
  • Provide facemask, alcohol hand-rub at facility
    access point
  • Provide space and separate area for ILI
    patients

14
Infection Control Recommendations
  • Standard precautions hand hygiene, gloves
  • Droplet precautions
  • Respiratory hygiene/cough etiquette
  • Use cautions when performing aerosol-generating
    procedures

15
Respiratory Hygiene / Cough Etiquette
  • Apply to all patients with respiratory illness
  • Posting visual alerts
  • Source control measures
  • Early recognition, separation and isolation
  • Droplet precautions
  • Hand Hygiene
  • Waste management

16
Alerting Poster
17
Droplet precaution by using mask
18
2
1
3
Steps to take off the surgical mask
19
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20
Sink at patient waiting area
21
Posting visual alerts Early recognition and early
implementation of IC practices
22
Screening site
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23
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24
????????????? ILI ??? OPD
25
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26
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27
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Portable X-Ray
28
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29
Administrative Controls Strategies(3)
  • Isolation ward/room
  • Limiting the number of persons in present in
    patient room
  • Screening personnel and visitors
  • Patients and visitors recommendations

30
Patient Placement
  • Single room confirmed case, suspected case ,
  • Cohort ward confirmed cases
  • AIIR patients who need mechanical ventilation

30
31
Patient Placement
Single Room
32
Cohort Ward
33
AIIR
34
Bamras
34
10/11/2013
35
Airborne Infection Isolation Room
36
Cohort Ward
37
Patient recommendations
  • Hand hygiene
  • Personal hygiene
  • surgical mask
  • Post discharge recommendations

38
Family Members/Visitors Recommendations
  • Visitor Limiting
  • Visitor Screening ILI, high risk group
  • PPE
  • Hand Hygiene

39
Monitor and Manage Ill HCWs(1)
  • Screening for ILI before they come on duty,
    register form
  • HCWs ILI surveillance system, self monitoring
    form, self-reporting and isolating
  • Develop sick leave policies for HCWs

40
Monitor and Manage Ill HCWs(2)
  • Stop patient-care activities, don a facemask,
    promptly notify ICN
  • Keeping personnel with mild ILI at home to
    reduce the risk of spreading influenza

41
HCW ILI Monitoring Form
Day1 Day2 Day3 Day4 Day5
Date. Date. Date. Date. Date.
AM temp AM temp AM temp AM temp AM temp
PM temp PM temp PM temp PM temp PM temp
ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes
Day6 Day7 Day8 Day9 Day10
Date. Date. Date. Date. Date.
AM temp AM temp AM temp AM temp AM temp
PM temp PM temp PM temp PM temp PM temp
ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes
42
Monitor and Manage Ill HCWs(3)
  • Exclude from work until 24 hours after they no
    longer fever
  • Considered for temporary reassignment or
    exclusion from work for 7 days from symptoms
    onset or until the resolution of symptoms
    whichever is longer

43
Engineering Controls(1)
  • Separate triage areas, installing partitions
  • Using local exhaust ventilation for aerosol
    generating procedures or perform in AIIR
  • Using hood/Bio-safety cabinet in laboratory

44
Aerosol-generating procedures produce large
small particle aerosols
  • Bronchoscopy
  • Sputum induction
  • ET intubation and extubation
  • CPR
  • Open suctioning
  • of airways
  • Autopsies
  • Non-invasive positive pressure ventilation
  • NP swab/aspiration
  • Aerosolized medication
  • High-frequency ventilation

45
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46
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47
Bio-safety Cabinet
47
48
Engineering Controls
  • Using closed suctioning systems
  • Using high efficiency particulate filters on
    mechanical and bag ventilators
  • Ensuring effective ventilation and thorough
    environmental surface hygiene

49
Closed circuit suctioning system
50
Bacterial / virus HEPA filter
51
Personal Protective Equipments (PPE)
  • Supplies
  • Training
  • Proper PPE
  • Monitoring

52
PPE Seasonal and Pandemic Flu 2009
  • Surgical mask
  • N-95 mask, Goggles Aerosol-generating
    procedures
  • GOWN
  • GLOVES

53
Aerosol-generating procedures produce large
small particle aerosols
  • Bronchoscopy
  • Sputum induction
  • ET intubation and extubation
  • CPR
  • Open suctioning
  • of airways
  • Autopsies
  • Non-invasive positive pressure ventilation
  • NP swab/aspiration
  • Aerosolized medication
  • High-frequency ventilation

54
Research on Influenza IC
  • PPE N-95 mask vs surgical mask
  • Unpublished multiple hospital study in China
  • N-95 provided 75 protection against
    lab-confirmed flu
  • N-95 were 42 more effective than surgical mask
    over all

55
Research on Influenza IC
  • Household influenza transmission Cowling B.,et
    al
  • HHalcohol hand rub vs.
  • HHfacemask vs. control gr.
  • Substantial and significant benefits of
    facemask and HH if implement within 36 hours of
    index case ILI onset

56
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