bird flu, avain influenza
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AVIAN INFLUENZA:
IN-PATIENT ISOLATION AND
PROTECTION OF HEALTH CARE WORKERS
Dr. Ram Sharan MehtaMedical-Surgical Nursing Department
College of Nursing
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RS MEHTA 2
“Hospital should do the sick no harm”
– Florence nightingale.
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Avian influenza outbreak sites in Nepal
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Introduction Avian influenza, more commonly
known as bird flu, is a growing concern.
Human can contract it from contact with infected birds (often Poultry) or there secretions or excrement.
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Introduction… Transmission from human to
human is rare; but is also a potential concern.
Symptoms of it are similar to influenza but complications can be more severe and deadly.
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Effects on Healthcare System Healthcare facilities would be
overwhelmed including shortage ofhospital staffbedsventilatorssupplies
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In-patient Isolation
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• 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
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Early Recognition in Health Care Facilities
Health care facility staff must quickly identify and separate potential sources of infection from susceptible hosts
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How to identify rapidly
Rapid identification of Patients with Epidemic- or Pandemic:
Clinical indications Severe acute febrile respiratory illness
(e.g., fever > 38°C, cough, shortness of breath) Exposure history
Epidemiological indications History of travel to area affected Possible occupational exposure Unprotected contact with patient(s)
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Steps for Triage of All AI CasesSteps Example
Determine type and severity of illness
Does Patient has pneumonia or other complications.
Assess level of care neededDoes the patient need: Anti-virals? Oxygen? A ventilator?
Assess available health care resources
Does the health care facility have a ventilator?
Advise on patient referral and transport
Does a nearby facility have a ventilator? Can the patient make the trip?
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Duration of infection control measures
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
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•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 policy
Environmental Cleaning & Waste Disposal
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Waste Disposal Use Standard Precautions
Gloves and hand washingGown + Eye protection
Avoid aerosolization Prevent spills and leaks
Double bag if outside of bag is contaminated
Incineration is usually the preferred method
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Cleaning practices
1. Floor
2. Spills of blood/
body fluids on floor
3. Walls & curtains
4. Furniture
5. Surgical instruments
6. Fans & light
7. Cheatle forceps
8. Mattress/pillows
9. Toilet care
10. Fumigation11. Ventilator12. Infusion pump
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Autopsy Precautions Follow standard PPE procedures
for autopsies Anyone handling a corpse should
follow standard precautions for blood and body fluids
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Hospital Preparedness: Key Points
Apply standard precautions routinely in all health-care settings
Place all patients (suspected or confirmed) in a room or area separate from other patients
Practice both standard and droplet precautions when caring for patients with infectious
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Monitor and Manage ill Healthcare Personnel
(HCP)HCP who develop fever and respiratory symptoms should be:
Instructed not to report to work, or if at work, to stop patient-care activities, put facemask, and promptly notify their supervisor.
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Excluded from work until at least 24 hours after they no longer have a fever (without the use of fever-reducing medicines).
If symptoms such as cough and sneezing are still present, HCP should wear a facemask during patient-care activities.
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Protection of Health Care
Workers
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Hospital air as a source
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STANDARD AND EXPANDED ISOLATION
PRECAUTIONS
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Standard Precautions• Previously called Universal Precautions• Assumes blood and body fluid of ANY
patient could be infectious• Recommends PPE and other infection
control practices to prevent transmission in any healthcare setting
• Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings8/29/2013
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PPE for Standard Precautions (1)• Gloves – Use when touching blood, body
fluids, secretions, excretions, contaminated items; for touching mucus membranes and non-intact skin
• Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated
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PPE for Standard Precautions (2)
• Mask, goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions
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PPE for Transmission-Based Precautions
Used in addition to Standard Precautions Contact Precautions
Gloves Gown
Droplet Precautions Medical mask
Airborne Precautions Particulate respirator
+
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Protective barriers
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What Type of PPE Would You Wear?
• Giving a bed bath?• Suctioning oral
secretions?• Transporting a
patient in a wheel chair?
• Responding to an emergency where blood is spurting?
• Drawing blood from a vein?
• Cleaning an incontinent patient with diarrhea?
• Irrigating a wound?
• Taking vital signs?
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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
• Transporting a patient in a wheel chair?
• Generally none required• Responding to an
emergency where blood is spurting?
• Gloves, fluid-resistant gown, mask/goggles or a face shield
• Drawing blood from a vein?• Gloves
• Cleaning an incontinent patient with diarrhea?
• Gloves w/wo gown• Irrigating a wound?
• Gloves, gown, mask/goggles or a face shield
• Taking vital signs?– Generally none
PPE Use in Healthcare Settings8/29/2013
Personal protective equipment (gloves, gowns, shoe covers, face shields, goggles, surgical masks)
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PPE for Expanded Precautions
• Expanded Precautions include–Contact Precautions–Droplet Precautions–Airborne Infection Isolation
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Contact Precautions• Gown and gloves for contact with
patient or environment of care
• In some instances these are required for entering patient’s environment
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Droplet Precautions• Surgical masks within 3 feet
of patient
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Masks and N95 Respirators, FDA
Masks, help block large-particle droplets, splashes, sprays or splatter that may contain germs from reaching your mouth and nose.
Facemasks may also help reduce exposure of the wearer's saliva and respiratory secretions to others.
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Masks and N95 Respirators, FDA
A respirator is used to reduce the wearer's risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors.
A commonly used respirator is a filtering face-piece respirator (often referred to as an N95).
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Airborne Infection Isolation
• Airborne Infection Isolation – Particulate respirator
Negative pressure isolation room also required
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Key Points About PPE• Don before contact with the patient,
generally before entering the room• Use carefully – don’t spread contamination• Remove and discard carefully, either at the
doorway or immediately outside patient room; remove respirator outside room
• Immediately perform hand hygiene
PPE Use in Healthcare Settings
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Hand Hygiene• Required for Standard and Expanded
Precautions• Perform…
– Immediately after removing PPE– Between patient contacts
• Wash hands thoroughly with soap and water or use alcohol-based hand rub
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Efficacy of Hand Hygiene Preparations in Killing Bacteria
Good Better Best
Plain Soap Antimicrobial soap
Alcohol-based hand rub
Health care personnel as a source
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USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT
THE SPREAD OF CONTAMINATION
■ Keep hands away from face ■ Limit surfaces touched ■ Change gloves when torn or heavily contaminated ■ Perform hand hygiene
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Antiseptics & Disinfectants
1. Methyl spirit – 70%
2. Betadine – 5%, 7.5%
3. Gluteraldehyde (cidex)
4. Hydrogen peroxide 3%
5. Bleaching powder
Antiseptics & Disinfectants
6. Sodium hypochlorite 1%7. Phenolics (carbolic acid)8. Lysol – 2.5%9. Dettol 4%10. Savlon: 3% for 2min (non infectious) & 5% for
20min (infectious)
WARD CLEANING PRACTICES FlOOR-Wet mopping-2% carbolic acid is
recommended FURNITURE-Bed ,tables ,chairs etc should be
cleaned with detergent and (2% carbolic acid )routinely.
TOILET-Cleaned with detergent &
phenol.
CONTINUED… FANS AND LIGHTS-Wet moping with
detergent weekly.MATTRESS/PILLOW-cover with plastic and
clean with disinfectantFUMIGATION-For 1000sq ft, 500ml
formalin & 1000ml water for 24 hours.
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Thank you