In

Respiratory
Diseases

Triwahju Astuti
Lab IP Paru & Respirasi FKUB-RSSA
Malang

 We, the Forum of International Respiratory Societies (FIRS),

convening at the 40th Union World Conference on Lung
Health in Cancn, Mexico on 6 December 2009, recognize
that hundreds of millions of people around the world suffer
each year from treatable and preventable chronic respiratory
disease; acknowledge that lung health has long been
neglected in public discourse; understand the need to unify
different health advocates behind one purpose; express the
urgency for increased awareness and action on lung
health. . . and therefore declare2010: The Year of the Lung.

Learning Objectives
Describe basic infection-control
principles.
Discuss core infection-control
measures in health-care settings.

Aim of Infection Control

Basic infection control measures
reduce risk of transmission of
pathogens from a known or unknown
source

Chain of Infection

+
Quantity of
pathogen

Virulence

Routes of
Portal of
transmission entry into
host

Susceptible
host

Routes of Transmission
Contact: Infections spread by direct or
indirect contact with patients or the
patient-care environment
(e.g., shigellosis,
viral hemorrhagic fevers)

Droplet: Infections spread by large

droplets generated by coughs, sneezes,
etc. (e.g., Neisseria meningitidis, pertussis)
Airborne (droplet nuclei): Infections
spread by particles that remain infectious
while suspended in the air (TB, measles, varicella,
and variola)

Breaking the Chain of Infection

Source control measures

-Cough etiquette, cleaning, disinfection
Modes of transmission
-Contact: hand hygiene
-Droplet: distance from source >1 m
-Airborne: ventilation
-Vector: bednets

Portal of entry into the host

-Adding barriers, e.g., PPE
Host
-Strengthen host defences, e.g.,
vaccination

ransmission of Epidemic- and Pandemic-Prone

Acute Respiratory Diseases
Seasonal Influenza in SARS and Current Avian
Humans
Influenza in Humans
Droplet

most likely route

most likely route (SARS)

possible (AI)

Airborne

possible during aerosol

generating procedures

possible during aerosol

generating procedures

Contact

possible

most likely route (SARS)

H5N1: (bird to human), and
possible (human to human)

Core Infection
Control Measures in
Health Care
Settings

Core Infection Control Measures

in Health Care Settings (1)
Early recognition and reporting
Infection control precautions
Hand hygiene: alcohol-based hand
rub, hand washing
PPE: gloves, gowns,
masks/respirators, eye protection

Core Infection Control Measures

in Health Care Settings (2)

Patient accommodation
Environmental cleaning and
waste disposal
Occupational health
management

WHO

Prevention is Primary

CDC

Early Recognition in Health Care Facilities

Health care facility staff must

quickly identify and separate
potential sources of infection
from susceptible hosts

How to identify rapidly

Rapid identification of Patients with Epidemic- or
Pandemic-Prone Acute Respiratory Diseases:

Clinical indications
Severe acute febrile respiratory illness (e.g.,
fever > 38C, cough, shortness of breath)
Exposure history consistent with ARD of potential
concern

Epidemiological indications
History of travel to area affected by ARDs
Possible occupational exposure
Unprotected contact with ARDs patient(s)

Standard
Precautions
Hand hygiene
Respiratory hygiene/cough etiquette
Use of personal protective
equipment (PPE)
Prevention of needle sticks/sharps
injuries
Cleaning and disinfection of the
environment

Droplet Precautions
Protection against respiratory
pathogens transmitted by large
droplets
In addition to Standard Precautions:
Use a medical mask when < 1 m of
patient
Maintain a distance 1 meter between
infectious patient and others
Place patient in a single room or cohort
with similar patients
Limit patient movement

Contact Precautions
Protection against contact with large
droplets
In addition to Standard Precautions:

Use non-sterile, clean, disposable gloves,

gown, apron (only if gown is not
impermeable)
Use disposable or dedicated reusable
equipment (which must be cleaned and
disinfected before use on other patients)
Limit patient contact with non-infected
persons
Place patient in a single room or cohort with
similar patients

Airborne Precautions
Protection against inhalation of tiny
infectious droplet nuclei
In addition to Standard Precautions:

Use particulate respirator

Place the patient in adequately ventilated
room ( 12 air changes per hour)
Limit patient movement

Use airborne precautions for

performance of any aerosolgenerating procedures associated
with pathogen transmission

Hand Hygiene
Hand hygiene should be performed:
before and after any direct contact with a
patient
after contact with blood, body fluids,
secretions and excretions
after contact with items contaminated
with blood, body fluids, secretions and
excretions, including respiratory secretions

Use alcohol-based hand rub or wash

hands with soap and water
Wash hands if visibly soiled

Respiratory Hygiene and Cough

Etiquette
Part of standard precautions
Education of health care workers,
patients and visitors
Source control measures (e.g., cover
cough to prevent dissemination of
infectious droplets)
Hand hygiene
Spatial separation (> 1 meter) of
persons with acute febrile respiratory
symptoms

Personal Protective Equipment

Courtesy of K. Harrima

Types of PPE Used in Healthcare

Settings
Gloves protect hands
Gowns/aprons protect skin and/or
clothing
Masks and respirators protect
mouth/nose
Respirators protect respiratory tract
from airborne infectious agents
Goggles protect eyes
Face shields protect face, mouth,

PPE for Standard Precautions:

Based on Risk Assessment
IF direct contact with blood & body fluids,
secretions, excretions, mucous
membranes, non-intact skin
Gloves
Gown
IF there is the risk of spills onto the body
and/or face
Gloves
Gown
Face protection (mask plus eye
protection goggle or visor; face shield)

PPE for Transmission-Based Precautions

Used in addition to Standard
Precautions
Contact Precautions
+
Gloves
Gown
Droplet Precautions
Medical mask
Airborne Precautions
Particulate respirator

Masks and Respirators:

Barriers and Filtration

Surgical masks
Protect against body fluids
and large particles
Particulate respirators (e.g.,
N95)
Protect against small
particles and other airborne
particles
Alternative materials (barriers)
Tissues, cloth

PPE for Persons Providing Care for Patients

with
Acute Febrile Respiratory Illness, Including
Patients with Suspected or Confirmed AI
HH Gloves Gown Medical Particulate Eye
InfectionMask Respirator Protection
Entry to isolation
room/area, but no
anticipated patient
contact
Close contact (< 1
meter) with infected
patient in or out of
isolation room/area
Performance of
aerosol-generating
procedure on patient

Risk
Asst

Risk
Asst

Risk
Asst

Risk
Asst

PPE for Interviewing Exposed

Persons and Contacts of ARDs
Patients
Asymptomatic exposed persons and contacts
(low-risk)
Routine use of PPE not recommended
Maintain 1 meter distance between interviewer
and interviewee
Use proper hand hygiene
Symptomatic exposed persons (higher-risk)
PPE recommended in community and health care
facility: Contact and Droplet Precautions
In health care facility, person should be placed in
adequately ventilated room ( 12 air changes per
hour), if possible
Maintain a distance of > 1 meter, if possible

PPE for Specimen Collection

Exposed Persons
Collecting respiratory specimens is a
high-risk, aerosol-generating
procedure
PPE recommended
Gloves
Gown
Goggles or face shield
N95 or higher level respirator
CDC

Patient Accommodation
Isolate patients with droplet or
airborne spread diseases from other
patients
Separate wards, areas, or establish
rooms for infectious patients where
isolation facilities do not exist
Only those patients with
epidemiological and clinical
information suggestive of a similar
diagnosis should share rooms
Separate patients by at least 1 meter

Patient accommodation: Natural

Ventilation Room

1
meter

Duration of IC measures for

Avian and Pandemic Influenza
Adults and adolescents > 12 years of
age from time of admission until 7
days after symptoms resolved
Infants and children 12 years of
age from time of admission until 21
days after symptoms resolved
For immunocompromised patients,
pathogen shedding may be
protracted

ironmental Cleaning and Waste Disp

Environmental cleaning:
Use appropriate procedures for the
routine cleaning and disinfection of
environmental and other frequently
touched surfaces
Waste disposal:
Treat waste contaminated with
blood, bodily fluids, secretions and
excretions as clinical waste, in
accordance with local regulations

WHO

Waste Disposal
Use Standard Precautions
Gloves and hand washing
Gown + Eye protection

Avoid aerosolization
Prevent spills and leaks
Double bag if outside of bag is
contaminated

Incineration is usually the preferred

method

Autopsy Precautions for

Influenza A (H5N1)

Follow standard PPE procedures for

autopsies
Anyone handling a corpse should
follow standard precautions for
blood and body fluids

Occupational Health Management

During an Outbreak

Monitor staff who work with

patients with an infectious
disease of potential concern for
symptoms
Screen for symptoms of
influenza-like illness among staff
reporting for duty (fever, cough)
WHO

Implementation of Core Infection Control Measures

During Rapid Containment

Early recognition and reporting

Infection control precautions
Hand hygiene
PPE: gloves, gowns,
masks/respirators, eye protection
Patient accommodation
Environmental cleaning and waste
disposal
Occupational health management

Hospital Preparedness: Key

Points
Apply standard precautions routinely in
all health-care settings
Place all patients (suspected or
confirmed with an infectious ARD) in a
room or area separate from other
patients
Practice both standard and droplet
precautions when caring for patients with
infectious ARD

Important Components for HC Facility

nfection Prevention and Control Program
Available supplies and equipment (PPE,
disinfectants)
Policies and guidelines for procedures
Ongoing educational programs for
healthcare facility staff
Process for monitoring staff health to
identify and to prevent staff-to-patient and
patient-to-staff spread of infection
Jamaica IC Guidelines

Infection Control for ARD in Heath Care

Settings
Patient
Symptoms acute ILI

Infection control
precautions

Standard and droplet precautions

+ Risk Factor
Investigation for ARD of
potential concern

Single room adequately

ventilated, if possible

Report to Public Health Authorities

Confirmed ARD of potential concern

Single room adequately ventilated (
12 air changes per hour), if possible

Different
diagnosis

Reassess
precautions

Environmental Decontamination
Cleaning MUST precede
decontamination
Disinfectant ineffective if organic
matter is present
Use mechanical force
Scrubbing
Brushing
Flush with water

Environmental Decontamination:
Disinfecting
Household bleach
(diluted)
Quaternary
ammonia
compounds
Chlorine
compounds
(Chloramin B,
Presept)
Alcohol
Isopropyl 70% or
ethyl alcohol
60%

Peroxygen
compounds
Phenolic
disinfectants
Germicides with a
tuberculocidal
claim on label
Others

Using Bleach Solutions

First clean organic material from
surfaces or items
Wipe nonporous surfaces with sponge
or wet cloth
Allow to dry
Use fresh diluted bleach daily!

Thank you