Professional Documents
Culture Documents
Day 1 - IPC
Day 1 - IPC
Day 1 - IPC
Objectives
Objectives
Importance of IPC
Hospital/Healthcare Facility Setting
● During an outbreak of any respiratory infection, a large proportion of infections can
be acquired in healthcare settings.
● Patients ill from other causes or with underlying health conditions are more at risk
for severe complications from COVID-19.
Importance of IPC
Community Setting
• Community spread of COVID-19 involves rapid person-to-person local
transmission.
• Slowing the outbreak at the community level is challenging and requires local,
national and international actions.
• Infection prevention and control procedures should be initiated in the community
just as they are initiated in healthcare facilities.
• There should be a clear lines of communication between healthcare facility
leadership, HCWs, and public health officials to manage community spread.
• Establish a COVID-19 Infection Prevention and Control team at each healthcare facility.
• Assign specific titles and responsibilities to each member.
• Conduct training sessions so each individual understands their roles and responsibilities
• Schedule at least weekly meetings (or more often depending on the situation) to provide
situational updates, make adjustments to facility guidelines, and coordinate public messaging.
• Establish a clear line of communication and reporting within the team.
• Establish a clear line of communication from the rest of the HCWs at the facility to appropriate
members of the team based on their roles.
Important Points
• Review emergency/outbreak plans and procedures already in place
• Evaluate the available number of healthcare personnel and resources (PPE, sanitizing
equipment, etc.) at least daily
• Implement a chain of command for reporting and task assignment
• Adopt a specific risk assessment for HCWs
• Update all healthcare workers in the facility daily and when changes are made to the IPC plans.
• Provide list of contacts with titles and roles, reporting procedures and forms to all stakeholders
• Screen using questionnaires for currently defined risk factors for COVID-19:
Hand Hygiene
WHO’s 5 MOMENTS FOR HAND HYGIENE
1. Before touching a patient
2. Before any clean or aseptic procedure is performed
3. After exposure to body fluid
4. After touching a patient
5. After touching a patient’s surroundings
Hand washing -- use at least one of the following -- for at least 20 seconds
• Soap and water
• (Sing Happy Birthday twice ~= 20 seconds)
• Alcohol-based hand rub (at least 60% alcohol) for at least 30 seconds
• If these are not readily available, 0.05% chlorine solutions from diluted
bleach can be used.
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Standard Precautions for All Patients
17
Respiratory Hygiene
● Everyone should cover their nose and mouth with a
tissue or upper sleeve when coughing or sneezing.
● Wash hands after coughing and sneezing.
● If upper respiratory symptoms, offer face masks to
patients while they are in waiting or public areas.
● Perform hand hygiene after any contact with respiratory
secretions.
● Avoid touching eyes, nose, or mouth. How a Sneeze Travels
● An airborne infection isolation room (AIIR) with special ventilation and air handling
capabilities is recommended, if available.
● If not available, place the patient in a private room with the door closed, and
provide N95 masks (or higher level respirators) for healthcare personnel to reduce
airborne transmission.
COVID-19
***CRITICAL:
Perform hand Hand hygiene
hygiene should be
performed before
and after each step!
Donning PPE
***CRITICAL:
Hand hygiene
should be
performed before
and after each step!
***CRITICAL:
Hand hygiene
should be
performed before
and after each step!
***CRITICAL:
Hand hygiene
should be
performed before
and after each step!
Masks
• Masks can be reused up to 2-3 days or longer. Avoid touching the mask when you have it on.
Apply and remove by touching only the straps.
• After removal, masks can be stored in a labeled bag for re-use.
Eye protection
• Eye protection such as goggles or face shields can be re-used. Clean after each use by using
disinfectant wipes and store in a labelled bag.
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Conservation of Masks and Respirators 34
Masks and respirators should be limited to essential healthcare workers and conserved according to
WHO “Rational Use of PPE” guidelines.
Designate a storage area or keep masks in a clean, breathable container (i.e. paper bag) between uses
Perform hand hygiene before and after touching or adjusting the mask (if necessary for comfort or to maintain fit).
or hard to breathe through
Developed with a grant from Project HOPE. Copyright © Brown
University, 2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Indications to Replace Masks and Respirators
35
They become contaminated with blood, respiratory or nasal secretions, or other bodily fluids
from patients (consider using a reusable face shield to prevent this)
PPE Recommendations
Respirator masks • Guidelines for reuse described in the previous slide.
(i.e. N95) • Some studies show that sustained heat in an oven (70 degrees C for 30 minutes) may be effective in
disinfecting the mask while maintaining integrity of N95 mask. However, this disinfecting procedure is not
an official WHO recommendation. Alcohol and chlorine-based disinfectants are NOT recommended as they
degrade the filtering capacity of the mask.
• Other methods for disinfecting and sanitizing N95s are in development.
Surgical masks • Reuse guidelines should be followed as described in the previous slide.
Face shield • Can be reused after wiping down with a disinfectant wipe or solution.
• Use proper hand hygiene and gloves when disinfecting face shields between uses.
Gloves • The reuse of single-use gloves is not recommended by WHO.
• In some situations, extended use of gloves can be used by Healthcare Workers while caring for multiple
COVID+ patients. Gloved hands can be washed with soap and water in between patients (note that
alcohol-based hand sanitizer as may degrade vinyl gloves). Gloves that become damaged or contaminated
should be discarded right away.
Gowns • Gowns (cloth or disposable) can be worn by the same health care worker while caring for multiple COVID+
patients (should be changed before seeing a non-COVID patient).
• Any gown that becomes visibly soiled or contaminated with bodily fluids should be disposed of or laundered
(in a standard washing machine on the hottest setting) before reuse.
Environmental Considerations
For Hospitalized Patients
Environmental survival of coronaviruses on surfaces: review of 22 studies
• Can persist on environmental surfaces (metal, glass, plastic) for up to 9 days
• Duration of transmissibility is believed shorter, but not known
• Can be removed with surface disinfection using:
• 62-71% ethanol
• .5% hydrogen peroxide
• .1% sodium hypochlorite
• Less effective disinfectants for coronaviruses:
• .05 - 2% benzalkonium chloride
• .02% chlorhexidine digluconate
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
38
Environmental Considerations
Environmental Considerations
For Hospitalized Patients
• Use disposable equipment for patient room wherever possible
• Daily cleaning of high touch surfaces in the room
• If done by environmental staff, they should wear same PPE as clinical staff
• After discharge, do not allow another patient into the room until cleaning is done and waiting
at least 1-2 hours (to allow air exchange)
• Personnel should at least wear gown and gloves and face mask and eye protection if
splash or sprays are used
Environmental Considerations
For Hospitalized Patients
Managing Visitors
• Limit and consider prohibiting all visits to the hospital.
• The only exception may be end-of-life care with a short visit with visitors in appropriate
PPE (mask, gloves, eye protection, gown).
• Encourage use of technology for family to keep in touch with the patient if possible
(FaceTime, Skype, What’sApp) or to contact medical staff for updates.
Post-Mortem Management
• Prevent Contact with Infectious Body Fluids:
Frequent handwashing
Transmission from respiratory droplets is not a concern
Use standard PPE
gloves, fluid-resistant gown, and eye shield
• Disinfect all equipment and potentially contaminated surfaces
Wear appropriate PPE when handling all chemicals
• Move body to cemetery for burial, or crematorium based on family wishes
Key Definitions
Healthcare Workers and Close Contacts
Healthcare Personnel:
• All paid and unpaid persons working in the healthcare facility who may have direct or indirect
exposure to patients or infectious materials and surfaces (medical supplies, devices, and
equipment, surrounding surfaces, or contaminated air.
Close contact:
• Being within 2 meters of a person with COVID-19 for 15 minutes or longer without proper PPE
(whether caring for a patient or being in a waiting area).
• Having direct contact with infectious secretions or excretions of the patient (for example,
being coughed on or touching used tissues with hand) without proper PPE.
Self-Monitoring
• Healthcare personnel monitor themselves for fever and respiratory symptoms (cough, shortness of breath, sore
throat).
• It should be made clear who they need to contact if they have fever or respiratory symptoms.
Active Monitoring
• Other healthcare personnel or public health officials communicate by phone, text message or electronic format
to assess the exposed worker for fever or respiratory symptoms.
Self-Monitoring with Supervision (for situations where there is a shortage of healthcare workers at the facility)
• On days the exposed healthcare provider is scheduled to work, other healthcare personnel may measure the
exposed worker’s temperature and assess symptoms before starting work.
• Or, the exposed healthcare worker may report their own temperature and symptoms before starting work by
direct contact, telephone calls, or any electronic or internet-based methods.
COVID-19
The WHO has provided guidance on categorizing and managing the risk to healthcare workers during
the COVID-19 outbreak
Recommendations for healthcare workers at HIGH risk Recommendations for healthcare workers at LOW risk
of COVID-19 of COVID-19
● Stop all health care contact with patients for a ● Self-monitor temperature and respiratory
period of 14 days after the last day of exposure to symptoms daily for 14 days after the last day of
a confirmed COVID-19 patient. exposure to a COVID-19 patient.
● Be tested for COVID-19 virus infection ● Healthcare workers should call health care facility
● Quarantine for 14 days. if he/she develop any symptoms suggestive
● Healthcare facilities should provide psychosocial of COVID-19.
support while in quarantine as well as continued ● Place contact/droplet precautions when caring
compensation as possible. for all patients with acute respiratory illness and
standard precautions to take care of all patients.
• Those in the high-risk category should be removed from working for 14 days after their
exposure.
• Healthcare personnel who develop signs or symptoms of COVID-19 should contact the
assigned contact person at their workplace for medical check-up before returning to work.
Collect contact information for the patient (correct phone number or other means)
Monitoring of symptoms (fever, cough, SOB) should continue in the home.
Concepts
● Place the patient in a well-ventilated single room (with open windows and an open door) if
possible.
● Limit contact of patient with others:
○ Limit the movement of the patient in the house
○ Limit the number of caregivers
○ All household members should remain at least 1 m away at all times
● Were in the same close space of a COVID-19 patient (including workplace, classroom,
household, gatherings).
● Travelled in close distance (within 1 meter) to a COVID-19 patient within a 14‐day period
after the symptoms for the COVID-19 patient started.
WHO Recommendations
● Contacts of confirmed cases should be quarantined for 14 days from the last exposure to
the patient.
● More groups may be recommended to self-quarantine based on travel history or other
exposure.
of Concepts
Quarantine = “restriction of activities or separation of persons who are not ill, but who may have been exposed
to an infectious agent or disease, with the objective of monitoring symptoms and early detection of cases”
• Various factors (cultural, geographic, economic) affect how well quarantine work.
If a decision to start quarantine is taken, the authorities should make sure:
● Appropriate physical setting and supplies for the quarantine period
● Appropriate infection prevention and control measures
● Health monitoring of quarantined persons
Quarantines
Reliable and up-to-date information must be available to
communities and individuals in quarantine
● Persons who are quarantined need to be given resources including:
○ Health care services
○ Financial, social and psychosocial support
○ Basic needs including as food, water and other essentials
● Vulnerable populations should be prioritized and carefully considered.
Summary
Infection Prevention and Control: COVID-19
• Good, understandable infection prevention and control strategies allows responsible use of
available resources to protect healthcare workers, patients, and community members.
• IPC starts with a unified team within each healthcare facility. Each team member should have a
clear understanding of their assigned roles and responsibilities.
• Staying up to date on guidelines from WHO and national health authorities is important as things
change day to day during the outbreak.
• IPC efforts within each hospital/healthcare facility should align with local community and
national response.
• Good communication and reporting are key for a successful IPC and to maintain public trust.