Beruflich Dokumente
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Infectious agent Reservoirs and/or sources human animal Environment Portal(s) of exit: Respiratory tract GI tract Genital/urinary tract Breaks in skin
of transmission
of entry
hosts
Susceptible
Modes of Transmission
Direct
Transmission
Indirect
Transmission
Vertical
infant)
transmission (mother to
Infectious Aerosols
Droplet: meningococcal meningitis, rubella, pertussis, common cold, SARS, influenza* Airborne: tuberculosis, measles, varicella, smallpox, SARS, avian influenza
Indirect contact: (fomite) RSV, SARS *Influenza traditionally droplet, increasing evidence for airborne component
Basic principles
Standard precautions
Transmission-based precautions Seasonal influenza in health care settings Vaccination of HCWs TB screening of HCWs Proper donning and doffing Choose your PPE
Basic Principles
All body fluids are potentially infectious (except sweat) blood and blood-tinged fluids including openwounds stool, urine, vomit, respiratory secretions, saliva, semen, vaginal secretions, breast milk, other body fluids such as pericardial and synovial fluids Minimize exposure to potentially infectious body fluids Infection control measures designed to break the chain of transmission
if splash, splatter, or sprays can be reasonably anticipated choose appropriate PPE as needed: gloves, gown, mask, eye protection (face shield, goggles)
3.
8.
9.
Proper environmental cleaning and disinfection Proper Handling of Linen Adherence to Bloodborne Pathogens Standards Proper patient placement Respiratory Hygiene/Cough Etiquette Safe injection practices
Dr. Ashish V. Jawarkar
When standard precautions are not enough Additional measures based on mode of transmission Contact Precautions Droplet Precautions Airborne Precautions
For known or suspected infections that represent an increased risk of spread by direct or indirect contact with the patient or the patients environment
Personal Protective Equipment Gown & Gloves for all patient interactions Don PPE on entry, discard before exiting room. (in addition to Standard Precautions)
Airborne Infection Isolation Room (AIIR) if available Patient: Mask if transport necessary (as tolerated). Health care workers (HCWs):
Higher level respirators for aerosol-gen procedure. Careful attention to proper putting on & taking off (don/doff) respirator, including seal check.
Hand hygiene before & after don/doff.
aerosol-generating procedures: N95 respirator + standard precautions (gown, gloves, goggles for spray/splash)
Vaccination of HCWs
Protect patients, protect yourself and other HCWs CDC recommends Measles, mumps, rubella (MMR): vaccinate unless documentation of immunity or previous vaccination Varicella (chicken pox): vaccinate unless documentation of immunity or previous vaccination Tdap
screening at hire and then annually for all licensed healthcare facilities (e.g., acute care hospitals, skilled nursing facilities, primary care clinics)
Gown
2.
Mask or Respirator
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Goggles/Face Shield
4.
Gloves
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Gloves
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Goggles/Face Shield
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Gown
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Mask or Respirator
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Suctioning
oral secretions?
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
chair?
a patient in a wheel
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Drawing
Gloves
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Taking
www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar
Meningococcal meningitis Pertussis Mumps Rubella (German measles) Strep pharyngitis Influenza
Engineering Controls
Administrative Controls PPE
Protects only the wearer
Dr. Ashish V. Jawarkar
Engineering Controls
Physically
separates the employee from the hazard Does not require employee compliance to be effective Examples:
physical barriers at triage airborne infection isolation room for patients with known or suspect airborne infectious diseases
Dr. Ashish V. Jawarkar
Policies, procedures, and programs that minimize intensity or duration of exposure Examples: signs on door of an airborne isolation room triage, mask symptomatic patient provide tissues/ masks/hand sanitizer to public Standard procedures/ behaviors in caring for patients e.g. hand hygiene, HCW vaccination Only as good as enforcement
Dr. Ashish V. Jawarkar
level of hierarchy - requires employee compliance for efficacy Means higher elements of hierarchy fail to adequately protect employee May involve use of gowns, gloves, eye/splash protection or respirators Last line of defense
Tight fitting respirator, designed to filter the air Protects the wearer HCW should wear when concerned about transmission by airborne route
Aerosol-Generating Procedures
Sputum
induction, bronchoscopy, elective intubation and extubation, autopsies CPR emergent intubation, open suctioning of airways
control
Questions?
Questions?