CHARISSA FAY BORJATABORA MD FPPS FPIDSP CHAIR INFECTION

CHARISSA FAY BORJA-TABORA, MD, FPPS, FPIDSP CHAIR, INFECTION PREVENTION AND CONTROL COMMITTEE RITM

Objective • • Understand the importance of infection control in preventing healthcare-associated infection Know basic infection control practices such as standard precautions and Hygiene • Suggested Reading: – – – • WHO Aide-Memoire: Infection Prevention WHO Aide-Memoire: Standard Precautions WHO Aide-Memoire: Hand Hygiene Hand out/materials – – – How top Hand Rub poster How to Hand Wash poster Competency Checklist (x 1 each person) (photocopy) Hand Hygiene Quiz (x 1 each person) (photocopy) Water-Based Paint Sterile Gloves (Exam Gloves acceptable; 1 set for each person) RESEARCH INSTITUTE FOR TROPICAL MEDICINE 2

Chain of Infection Certain conditions must be met in order for a microbe or infectious disease to be spread from person to person. Infection occurs when all six links in the chain are intact. RESEARCH INSTITUTE FOR TROPICAL MEDICINE Source: OSHA 3

Ebola and the Chain of Infection in Healthcare Facilities • Pathogenic Microorganism: – Ebola virus • Reservoir: – Patient infected with Ebola • Means of Escape: – Blood and body fluids (blood, saliva, urine, sperm etc. ) • Mode of Transmission: – Direct contact with blood and body fluids of infected person – Contact with contaminated surfaces/equipment • Means of Entry: – Non-intact skin, mucous membranes, sharps injury • Host Susceptibility: – Poor nutrition, stress, exhaustion, non-intact skin RESEARCH INSTITUTE FOR TROPICAL MEDICINE 4

Infection Control • What? Breaking the chain of infection • Why? Prevent infections within health facilities • How? Consistent practice of protocols that prevent an infectious agent moving from one host to another • Who? Protects: – – Patients HCWs Visitors Other staff RESEARCH INSTITUTE FOR TROPICAL MEDICINE 5

“If carefully implemented, Infection Prevention and Control measures will reduce or stop the spread of the [Ebola] virus and protect health-care workers (HCWs) and others. ” -WHO 2014 Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola RESEARCH INSTITUTE FOR TROPICAL MEDICINE 6

Infection Control can: • Stop/reduce the spread of Ebola • Protect Health care workers • So how strong is infection control at your facility? RESEARCH INSTITUTE FOR TROPICAL MEDICINE 7

Core Components for Infection Prevention & Control (IPC) Programs Checklist �Organization of IPC program �Technical guidelines �Human resources (training, staffing, occupational health) �Surveillance of diseases and monitoring of practices �Microbiology laboratory support �Clean and safe environment �Monitoring and evaluation of IPC program �Links with public health and other services Slide adapted and used with permission from World Health Organization

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and completed FACILITY On Not going Started Review triage and placement procedure and ensure that treatment and isolation areas have been identified x Inspect identified treatment areas to check if they meet IPC recommendations (floor plan, adequate ventilation, electricity and water, comfort room etc/) x Ensure that all Airborne Infection Isolation Rooms (AIIR) are functioning correctly and are appropriately monitored for airflow and exhaust handling. (Calibration of measuring devices, check HEPA filter status) x Ensure that healthcare personnel have ready access, including via telephone, to medical consultation. Post appropriate signage alerting healthcare personnel to isolation status, PPE required, proper hygiene, and handling/management of infected patients and contaminated supplies. x Develop contingency plans for staffing, logistics, budget, procurement, security, and treatment. x

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and On Not completed going Started ADMINISTRATIVE GUIDANCE Review your hospital’s infection control procedures to ensure x adequate implementation for preventing the spread of Ebola. Review consistency with DOH, WHO, CDC guidelines. Review policies and procedures for screening, minimizing x healthcare personnel exposure, isolation, medical consultation appropriate for Ebola exposure and/or illness, and monitoring and management of potentially exposed healthcare personnel Review roles of the infection control practitioner to: x Ensure appropriate infection control procedures are being followed, including for lab, food, environmental services, and other personnel, and Maintain updated case definitions, management, surveillance and reporting recommendations.

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and completed ADMINISTRATIVE GUIDANCE Review and distribute the Guidelines for Environmental Infection Control in Health-Care Facilities. Review laboratory procedures for appropriate specimen collection, transport, and testing of specimens from patients who are suspected to be infected with Ebola virus. Review policies and procedures for screening and work restrictions for exposed or ill healthcare personnel, and develop sick leave policies for healthcare personnel that are flexible and consistent with recommendations, Review protocols for sharps injuries Ensure all HCP handling EVD patients proper medical clearance On going Not Started x x x

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and On Not completed going Started TRAINING Review ICP training status of all personnel. All training requirements in PPE and infection control should be met Educate and train HCP on the following areas: Management and exposure precautions for suspected or confirmed Ebola cases Proper use of PPE (donning and doffing) Hand Hygiene Respiratory fit test Sick leave policies Safe sharp practices Waste Management Review environmental cleaning procedures and provide education/refresher training for cleaning staff x x x Conduct education and refresher training with healthcare personnel on Ebola for special pathogen handling in the laboratory. Review plans for special handling of linens, supplies, and equipment Provide education/refresher training for healthcare personnel responsible for cleaning. x x x

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and On going completed SUPPLIES Not Started Ensure an adequate supply, for all healthcare personnel, of: • Impermeable gowns (fluid resistant or impermeable), • Gloves, • Shoe covers, boots, and booties, and • Appropriate combination of the following: o Eye protection (face shield or goggles), o Facemasks (goggles or face shield must be worn with facemasks), o N 95 respirators (for use during aerosolgenerating procedures) • Other infection control supplies (e. g. hand hygiene supplies). Conduct a detailed inventory of available supply of PPE suitable for standard, contact and droplet precautions. x x Ensure Ebola PPE supplies are maintained in triage, ED, and all patient care areas. x

INFECTION CONTROL PREPAREDNESS CHECKLIST Done and completed On going Not Started ASSESS Conduct spot checks and inspections of triage staff to determine if they are incorporating screening procedures and are able to initiate notification, isolation, and PPE procedures for your hospital. Spot-check frequently to be sure standard, contact and droplet infection control and isolation guidelines are being followed, including safe putting on and removing PPE. x x

How will you strengthen your IPC? • Administrative support • Checklists/Audit • Ebola coordinator: – Appointed staff member to oversee adherence to the infection control measures in your facility – The professional in charge of infection control in the facility – The focal person to coordinate Ebola activities and advise -WHO 2014 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 15

Breaking the Chain of Infection Activity/Discussion: In what ways can we break the chain of infection for Ebola in healthcare? RESEARCH INSTITUTE FOR TROPICAL MEDICINE 16

Breaking the Chain of Infection Reservoir: Patient infected with Ebola • • Signage and screening at entrances to healthcare settings Early identification of possible cases Separation: Isolation or cohorting of possible cases Care and monitoring of people exposed Means of Escape from the patient: Blood and body fluids • Safe handling of human remains • Symptomatic treatment of patients RESEARCH INSTITUTE FOR TROPICAL MEDICINE 17

Breaking the Chain of Infection Mode of Transmission: Direct contact with blood and body fluids of or contaminated surfaces/equipment • • • Decontamination of equipment Regular and rigorous environmental cleaning Linen and waste management Spatial separation Strategies to reduce aerosols Means of Entry: Non-intact skin, mucous membranes, sharps injury • • • Hand hygiene Standard Precautions including respiratory etiquette PPE: correct use of physical barriers for care Sharps safety Safe processing of lab samples Safe handling of body fluids Host Susceptibility: • Future - Vaccines? RESEARCH INSTITUTE FOR TROPICAL MEDICINE 18

STANDARD PRECAUTIONS

When are Standard Precautions Needed? • Basic essential component of infection control • Applied to every patient • 1 st line of protection from Ebola transmission in health facilities – Ebola symptoms are non-specific – Apply to ALL patients RESEARCH INSTITUTE FOR TROPICAL MEDICINE 20

Standard Precautions Include • Hand hygiene • Gloves before anticipated contact with body fluids, mucous membrane, non-intact skin and contaminated items • Gown and Eye protection before procedures and patient-care activities likely to involve contact with or projection of blood or body fluids. • Best practices for injection safety • Safe handling and disposal of sharp instruments • Safe cleaning and disinfection of the environment • Correct re-processing of reusable equipment • Adequate laundry and waste management WHO 2014 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 21

KEY PRINCIPLES FOR EBOLA • Prior to working with Ebola patients, all healthcare workers involved in the care of Ebola patients must have received repeated training and have demonstrated competency in performing all Ebola-related infection control practices and procedures, and specifically in donning/doffing proper PPE. • While working in PPE, healthcare workers caring for Ebola patients should have no skin exposed. • The overall safe care of Ebola patients in a facility must be overseen by an onsite manager at all times, and each step of every PPE donning/doffing procedure must be supervised by a trained observer to ensure proper completion of established PPE protocols. http: //www. cdc. gov/vhf/ebola/hcp/index. html RESEARCH INSTITUTE FOR TROPICAL MEDICINE 22

How well are standard Precautions per WHO standards currently implemented in your facility? http: //www. who. int/csr/resources/publication s/EPR_AM 2_E 7. pdf

“Ebola is an unforgiving and a frightening disease. But it can be defeated if we work together in solidarity and with effective coordination” UN Deputy Secretary General Jan Eliasson

Resources • WHO 2014 Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola http: //apps. who. int/iris/bitstream/10665/130596/1/WHO_HIS_SDS_20 14. 4_eng. pdf? ua=1&ua=1 • WHO 2011 Aide-Memoire Infection Control: Core components of infection prevention and control programmes in health care http: //www. who. int/csr/resources/publications/AM_Core. Com_IPC. pdf • WHO Standard Precautions in Health Care http: //www. who. int/csr/resources/publications/EPR_AM 2_E 7. pdf RESEARCH INSTITUTE FOR TROPICAL MEDICINE 25