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Infection Control of Aerosol Transmissible Diseases

Dr. Ashish V. Jawarkar

The Chain Model of Communicable Diseases

Dr. Ashish V. Jawarkar

The Chain Model of Communicable Diseases

Infectious agent Reservoirs and/or sources human animal Environment Portal(s) of exit: Respiratory tract GI tract Genital/urinary tract Breaks in skin

Dr. Ashish V. Jawarkar

The Chain Model of Communicable Diseases


Modes

of transmission

Direct contact Indirect contact


Portals

of entry
hosts

Susceptible

Dr. Ashish V. Jawarkar

Modes of Transmission
Direct

Direct Contact Droplet Vector-borne

Transmission

Indirect

Transmission

Vertical

infant)

transmission (mother to

Dr. Ashish V. Jawarkar

Infectious Aerosols

Department of Medical Microbiology, Edinburgh University


Dr. Ashish V. Jawarkar

Transmission of Infections by Respiratory Aerosols


Droplets: land directly on mucosal lining of nose, mouth, eyes of nearby persons or can be inhaled. Highest exposures within 3-6 feet. Airborne: aerosols become smaller by evaporation; small aerosols ( 10 microns) remain suspended for longer periods, if inhaled travel deep into the lungs. Contact: Aerosols/ secretions contaminate nearby surface. Touch surfaces can infect self or others.

Relative contribution of three routes varies with agent.

Dr. Ashish V. Jawarkar

Modes of Transmission via Infectious Respiratory Secretions

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

Dr. Ashish V. Jawarkar

Infection Control in a Health Care Setting

Dr. Ashish V. Jawarkar

Infection Control in a Health Care Setting

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

Dr. Ashish V. Jawarkar

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

Dr. Ashish V. Jawarkar

Standard Precautions in Health Care Settings


1.
2.

Appropriate hand hygiene Barrier protective equipment:

if splash, splatter, or sprays can be reasonably anticipated choose appropriate PPE as needed: gloves, gown, mask, eye protection (face shield, goggles)

3.

Proper use and handling of patient care equipment


Dr. Ashish V. Jawarkar

Standard Precautions in Health Care Settings


4. 5. 6. 7.

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

Expanded Isolation Precautions: Transmission-based Standards

When standard precautions are not enough Additional measures based on mode of transmission Contact Precautions Droplet Precautions Airborne Precautions

Dr. Ashish V. Jawarkar

Transmission-Based Precautions: Contact 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

Dr. Ashish V. Jawarkar

Transmission-Based Precautions: Contact Precautions

Personal Protective Equipment Gown & Gloves for all patient interactions Don PPE on entry, discard before exiting room. (in addition to Standard Precautions)

Examples: MRSA, C difficile, Norovirus, other GI pathogens, RSV, antibiotic-resistant


pathogens

Dr. Ashish V. Jawarkar

Transmission-Based Precautions: Droplet Precautions


Single room preferred, no special ventilation


Patient: Mask if transport necessary. Instruct on respiratory hygiene/cough etiquette HCWs wear surgical or procedure mask within 6 feet of patient. Eye protection if splash, spray anticipated

(in addition to Standard Precautions)


Dr. Ashish V. Jawarkar

Transmission-Based Precautions: Airborne Precautions

Airborne Infection Isolation Room (AIIR) if available Patient: Mask if transport necessary (as tolerated). Health care workers (HCWs):

N95 respirator prior to entry into room, discarded after exit.

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.

Alert others if need to transfer (in addition to Standard Precautions)


Dr. Ashish V. Jawarkar

Seasonal Influenza in Healthcare Settings: Isolation Precautions


For

aerosol-generating procedures: N95 respirator + standard precautions (gown, gloves, goggles for spray/splash)

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

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

Yearly influenza vaccination


Hepatitis B: vaccinate unless documentation of previous vaccination
Dr. Ashish V. Jawarkar

Tuberculosis Screening for Health Care Workers


TB

screening at hire and then annually for all licensed healthcare facilities (e.g., acute care hospitals, skilled nursing facilities, primary care clinics)

Dr. Ashish V. Jawarkar

Sequence for Donning PPE


1.

Gown

2.

Mask or Respirator

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Sequence for Donning PPE


3.

Goggles/Face Shield

4.

Gloves

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Sequence for Removal of PPE


1.

Gloves

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Sequence for Removal of PPE


2.

Goggles/Face Shield

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Sequence for Removal of PPE


3.

Gown

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Sequence for Removal of PPE


4.

Mask or Respirator

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

What Type of PPE Would You Wear?

Giving a bed bath?


Generally none

Suctioning

oral secretions?

Gloves and mask/goggles or a face shield sometimes gown

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

What Type of PPE Would You Wear?


Transporting

chair?

a patient in a wheel

Generally none required


Responding

to an emergency where blood is spurting?


Gloves, fluid-resistant gown, mask/goggles

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

What Type of PPE Would You Wear?

Taking vital signs


Generally none

Drawing

blood from a vein?

Gloves

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

What Type of PPE Would You Wear?


Cleaning

an incontinent patient with diarrhea?


Gown, gloves

Taking

vitals on a patient with suspect TB?


N95 respirator

www.cdc.gov/ncidod/dhqp/ppe.html
Dr. Ashish V. Jawarkar

Controlling the Spread of Aerosol Transmissible Diseases in Health Care Settings


Breaking the Chain
Dr. Ashish V. Jawarkar

Aerosol Transmissible Diseases in Health Care and Public Safety Settings


Droplet Airborne

Meningococcal meningitis Pertussis Mumps Rubella (German measles) Strep pharyngitis Influenza

Tuberculosis Varicella (chickenpox) Measles SARS Avian influenza Smallpox Influenza

Dr. Ashish V. Jawarkar

Hierarchy of Infection Prevention and Control Measures


Elimination of Potential Exposures
Protects most people

Engineering Controls
Administrative Controls PPE
Protects only the wearer
Dr. Ashish V. Jawarkar

Hierarchy of Control Technologies


Goal is to reduce exposures to a hazard
Order

in which these elements are selected to control exposure is important


Elimination of Potential Exposures Engineering controls Administrative and work practice controls Personal protective equipment/apparel
Dr. Ashish V. Jawarkar

Elimination of Potential Exposures


Example: patients with mild influenza like illness stay home

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

Administrative Controls/ Workplace Practices

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

Personal Protective Equipment


Lowest

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

Dr. Ashish V. Jawarkar

Face Masks vs. N95 Respirators

Loose fitting, not designed to filter out small aerosols

Tight fitting respirator, designed to filter the air Protects the wearer HCW should wear when concerned about transmission by airborne route

Place on coughing patient (source control)


HCW should wear mask to protect patient during certain procedures (e.g., surgery, LP) protect HCW droplet precautions Mask + goggles for anticipated spray/splash

Dr. Ashish V. Jawarkar

Aerosol-Generating Procedures
Sputum

induction, bronchoscopy, elective intubation and extubation, autopsies CPR emergent intubation, open suctioning of airways

Dr. Ashish V. Jawarkar

Aerosol Transmissible Diseases Breaking the Chain


Source

control

stay home, isolate or separate mask patient


Respiratory

hygiene, cough etiquette Hand hygiene HCW protection


Vaccinate Droplet Mask Airborne- N95 respirator
Dr. Ashish V. Jawarkar

Questions?

Dr. Ashish V. Jawarkar

Questions?

Dr. Ashish V. Jawarkar