preventing transmission of respiratory infectious diseases in clinics and office settings brenda j....

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PREVENTING PREVENTING TRANSMISSION TRANSMISSION OF RESPIRATORY OF RESPIRATORY INFECTIOUS DISEASES INFECTIOUS DISEASES IN CLINICS AND OFFICE SETTINGS IN CLINICS AND OFFICE SETTINGS BRENDA J. ROUP, PhD, RN, CIC BRENDA J. ROUP, PhD, RN, CIC NURSE CONSULTANT IN INFECTION CONTROL NURSE CONSULTANT IN INFECTION CONTROL MARYLAND DEPARTMENT OF HEALTH MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND MENTAL HYGIENE

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PREVENTING TRANSMISSION OF RESPIRATORY INFECTIOUS DISEASES IN CLINICS AND OFFICE SETTINGS BRENDA J. ROUP, PhD, RN, CIC NURSE CONSULTANT IN INFECTION CONTROL MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE Slide 2 TRANSMISSION OF RESPIRATORY INFECTIOUS DISEASES AND INFLUENZA MUSHER, D. HOW CONTAGIOUS ARE COMMON RESPIRATORY TRACT INFECTIONS? NEJM, 348:13, MAR 27, 2003 MUSHER, D. HOW CONTAGIOUS ARE COMMON RESPIRATORY TRACT INFECTIONS? NEJM, 348:13, MAR 27, 2003 TELLIER, R. REVIEW OF AEROSOL TRANSMISSION OF INFLUENZA A VIRUS. EMERGING INFECTIOUS DISEASES, 12:11, NOV. 2006 TELLIER, R. REVIEW OF AEROSOL TRANSMISSION OF INFLUENZA A VIRUS. EMERGING INFECTIOUS DISEASES, 12:11, NOV. 2006 Slide 3 TRANSMISSION OF INFLUENZA DEPT OF HEALTH AND HUMAN SERVICES, PANDEMIC INFLUENZA PLAN, 2005, SUPPLEMENT 4, INFECTION CONTROL, OUTPATIENT MEDICAL OFFICES DEPT OF HEALTH AND HUMAN SERVICES, PANDEMIC INFLUENZA PLAN, 2005, SUPPLEMENT 4, INFECTION CONTROL, OUTPATIENT MEDICAL OFFICES http://www.hhs.gov/pandemicflu/plan/ http://www.hhs.gov/pandemicflu/plan/ http://www.hhs.gov/pandemicflu/plan/ http://www.pandemicflu.gov/plan/health care/maskguidancehc.html http://www.pandemicflu.gov/plan/health care/maskguidancehc.html http://www.pandemicflu.gov/plan/health care/maskguidancehc.html http://www.pandemicflu.gov/plan/health care/maskguidancehc.html Slide 4 TRANSMISSION OF INFLUENZA MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE, OFFICE OF PREPAREDNESS AND RESPONSE. MARYLAND PANDEMIC INFLUENZA PLAN, VERSION 6, DECEMBER 2006. MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE, OFFICE OF PREPAREDNESS AND RESPONSE. MARYLAND PANDEMIC INFLUENZA PLAN, VERSION 6, DECEMBER 2006. http://flu.maryland.gov/ http://flu.maryland.gov/ http://flu.maryland.gov/ Slide 5 TOPICS 1. TRANSMISSIBILITY/COMMUNICABILITY OF INFLUENZA VIRUS 2. TRIAGE/SCREENING IN OFFICE/CLINIC ENVIRONMENT 3. CONTAINMENT IN OFFICE/CLINIC ENVIRONMENT 4. DVD WHY DONT WE DO IT IN OUR SLEEVES? (www.coughsafe.com) www.coughsafe.com Slide 6 TRANSMISSIBILITY OF INFLUENZA VIRUS REFERS TO THE CAPACITY OF AN INFECTIOUS AGENT TO SPREAD FROM ONE PERSON TO ANOTHER REFERS TO THE CAPACITY OF AN INFECTIOUS AGENT TO SPREAD FROM ONE PERSON TO ANOTHER FOR INFLUENZA VIRUS, DEPENDENT UPON: FOR INFLUENZA VIRUS, DEPENDENT UPON: PARTICLE SIZE AND INFECTIVE DOSE PARTICLE SIZE AND INFECTIVE DOSE SUSCEPTIBILITY OF HOST SUSCEPTIBILITY OF HOST TEMPERATURE, HUMIDITY, AIR CURRENTS, VENTILATION TEMPERATURE, HUMIDITY, AIR CURRENTS, VENTILATION DOWNWIND OR UPWIND DOWNWIND OR UPWIND Slide 7 INFLUENZA VIRUS Slide 8 INFLUENZA VIRUS H & N Slide 9 PANDEMIC INFLUENZA VERY SERIOUS FORM OF INFLUENZA VIRUS THAT MAY CAUSE GLOBAL OUTBREAK VERY SERIOUS FORM OF INFLUENZA VIRUS THAT MAY CAUSE GLOBAL OUTBREAK AN INFLUENZA VIRUS MUST MEET THESE THREE CONDITIONS IN ORDER TO BECOME A PANDEMIC: AN INFLUENZA VIRUS MUST MEET THESE THREE CONDITIONS IN ORDER TO BECOME A PANDEMIC: 1. BE A NEW SUBTYPE OF INFLUENZA VIRUS THAT HAS NOT PREVIOUSLY OR RECENTLY CIRCULATED IN HUMANS 2. CAUSES DISEASE IN HUMANS 3. SUSTAINS HUMAN TO HUMAN TRANSMISSION Slide 10 SNEEZING Slide 11 SNEEZING Slide 12 PARTICLE SIZE OF INFLUENZA VIRUS LARGE DROPLETS (50-100 m diameter) LARGE DROPLETS (50-100 m diameter) DO NOT REMAIN SUSPENDED IN AIR DO NOT REMAIN SUSPENDED IN AIR BALLISTIC TRAJECTORY OF A FEW FEET BALLISTIC TRAJECTORY OF A FEW FEET INFECT BY DIRECT CONTACT WITH MUCOUS MEMBRANES OF MOUTH, EYES, UPPER NASAL PASSAGES INFECT BY DIRECT CONTACT WITH MUCOUS MEMBRANES OF MOUTH, EYES, UPPER NASAL PASSAGES Slide 13 PARTICLE SIZE OF INFLUENZA VIRUS INTERMEDIATE SIZE PARTICLES (10-50 m) INTERMEDIATE SIZE PARTICLES (10-50 m) TRANSMISSION OF THESE PARTICLES INFLUENCED BY: TRANSMISSION OF THESE PARTICLES INFLUENCED BY: TEMPERATURE OF AIR IN YOUR OFFICE TEMPERATURE OF AIR IN YOUR OFFICE HUMIDITY HUMIDITY AIR CURRENTS AIR CURRENTS AIR VELOCITY AIR VELOCITY REACH UPPER RESPIRATORY TRACT REACH UPPER RESPIRATORY TRACT Slide 14 PARTICLE SIZE OF INFLUENZA VIRUS INCLUDES SMALL PARTICLE AEROSOLS AND DROPLET NUCLEI ( OTHER CONTAINMENT STRATEGIES CHECK WITH BUILDING MANAGER RE: NUMBER OF AIR EXCHANGES IN OFFICE (12 OR MORE BEST) AND HUMIDITY LEVELS CHECK WITH BUILDING MANAGER RE: NUMBER OF AIR EXCHANGES IN OFFICE (12 OR MORE BEST) AND HUMIDITY LEVELS HIGH AIR FLOW WILL DILUTE INFLUENZA VIRUS AND DESSICATE HIGH AIR FLOW WILL DILUTE INFLUENZA VIRUS AND DESSICATE INCREASED HUMIDITY (>40%) WILL DECREASE VIRUS INFECTIVITY INCREASED HUMIDITY (>40%) WILL DECREASE VIRUS INFECTIVITY Slide 29 N95 RESPIRATORS THERE IS NO RECOMMENDED ROLE FOR THE USE OF N95 RESPIRATORS IN THE OFFICE/CLINIC SETTING THERE IS NO RECOMMENDED ROLE FOR THE USE OF N95 RESPIRATORS IN THE OFFICE/CLINIC SETTING USE THESE OTHER STRATEGIES, ESPECIALLY: USE THESE OTHER STRATEGIES, ESPECIALLY: TELEPHONE TRIAGE TELEPHONE TRIAGE KEEP WAITING ROOM EMPTY KEEP WAITING ROOM EMPTY GET COUGHING PATIENTS INTO EXAM ROOMS QUICKLY GET COUGHING PATIENTS INTO EXAM ROOMS QUICKLY MASK COUGHING PATIENTS MASK COUGHING PATIENTS Slide 30 TOPICS 1. TRANSMISSIBILITY/ COMMUNICABILITY OF INFLUENZA VIRUS 2. TRIAGE/SCREENING IN OFFICE/CLINIC ENVIRONMENT 3. CONTAINMENT IN OFFICE/CLINIC ENVIRONMENT 4. DVD WHY DONT WE DO IT IN OUR SLEEVES? (www.coughsafe.com) DVD WHY DONT WE DO IT IN OUR SLEEVESwww.coughsafe.com DVD WHY DONT WE DO IT IN OUR SLEEVESwww.coughsafe.com Slide 31 WEBSITES www.cdc.gov www.cdc.gov www.cdc.gov www.panflu.gov www.panflu.gov www.panflu.gov www.montgomerycountymd.gov/apc www.montgomerycountymd.gov/apc www.montgomerycountymd.gov/apc Slide 32 QUESTIONS www.montgomerycountymd.gov/apc www.montgomerycountymd.gov/apc www.montgomerycountymd.gov/apc Slide 33 STOPTHE SPREAD! This publication was supported by Cooperative Agreement Number U50/CCU302718 from the CDC to NACCHO. Its contents are solely the responsibility of the Montgomery County, Maryland Advanced Practice Center for Public Health Emergency Preparedness and Response and do not necessarily represent the official views of CDC or NACCHO. This publication is in the public domain. It may be reproduced in whole or in part by any individual or organization without permission, as long as the following citation is given: Montgomery County, Maryland Advanced Practice Center for Emergency Preparedness and Response Stop the Spread! A Toolkit for Preventing the Spread of Germs in Clinics and Office Settings. If a part or all of the publication is reproduced, the Montgomery County APC would appreciate knowing how it is used. Please use the form at our website, http://www.montgomerycountymd.gov/apc.