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Homeland Security

Personal Protective Equipment (PPE)

In all cases, following principles apply:

  • PPE reduces but does not completely eliminate the possibility of infection.

  • PPE is only effective if used correctly and at all times where contact may occur.

  • Any contact between contaminated (used) PPE and surfaces / clothing / people outside the isolation area must be avoided.

  • Used PPE must be sealed in appropriate disposal bags and sterilized or decontaminated. If staff temporarily leave the isolation area, a complete change of PPE and hand washing required.

  • The use of PPE does not replace basic hygiene measures such as hand-washing, washing is still essential to prevent transmission.

  • Exposure to the infected patient should be kept to an absolute minimum necessary for the level of care required.

    Who should use PPE?

    The staff team assigned to care for the patient should be kept to a minimum. Staff should be strictly supervised and be experienced in infection control. PPE should be used by:

  • All those who are handling infected or suspected to be infected poultry and poultry products. These include cullers and animal husbandry/veterinary staff.

  • All doctors, nurses and health care workers who provide direct patient care to avian influenza cases (keep to minimum necessary for patients' condition);

  • All support staff including medical aides, X-ray technicians, cleaners, transport staff, laundry staff (keep staff to the minimum necessary, designate avian influenza laundry staff, etc.);

  • All laboratory staff who handle patient specimens from suspect cases (keep to the minimum the staff necessary for laboratory procedures);

  • Family members who care for avian influenza patients (visits should be avoided where possible);

  • The patient(s) should wear a mask (N95 preferable) when other people are in the isolation area.

  • Contacts and international travellers during home isolation/quarantine must wear a mask (N95 preferable).

    Personal Protective Equipment

    The items included are:

  • Masks (N-95; N/P/R-100, If not available N80 or surgical masks as last resort)

  • Gloves

  • Gloves and aprons

  • Hair Covers

  • Eye protective ware (goggle)

  • Boots or shoe covers

    Storage / positioning of the supplies

  • The PPE stock should be stored where it can be readily accessed at all times (24 hours a day), and is available for dispatch to a facility/transport where suspected influenza patients are involved.

  • The stock must be accessible after hours and on weekends.

    Hand washing

    It is the single most important and effective component for preventing the transmission of infection. Running water and soap with friction should be ideally used for 15 to 20 seconds. It is important to dry hands after washing. A 70% alcohol-based hand rub solution after hand washing can be used.

    Hand washing  should be done:

  • After removing gloves

  • Before and after patient contact or contact with potentially infected material

  • After contact with blood and body fluids

  • After taking samples

  • After taking blood pressure or vital signs from patient

  • After using bath room

  • After blowing/wiping nose

  • Before eating and preparing food.

  • When leaving the isolation unit.

    Linen handling

  • Designated laundry staff should put patient's linen in bags and seal in the isolation room itself.

  • Laundry staff should wear full PPE.

  • Washing should be done in laundry with hot water and detergent, bleach may be added if compatible with the detergent being used.

    Waste disposal

    The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:

  • Puncture proof and leak proof containers should be used for sharps.

  • Waste should be collected in designated color coded plastic bags for sterilization and disposal.

  • Double bag system for transport should be used.

    Cleaning and disinfection of hospital environment and equipment

    The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:

  • Cleaning staff should wear full PPE

  • Cleaning should be done thoroughly to be followed by disinfection

  • Isolation, X-ray and changing rooms should be cleaned and disinfected

  • Items and areas requiring cleaning and disinfection are:

  • Bedside table, bed stand, accessible areas of bed and floors (Use 0.1% sodium hypochlorite as disinfectant)

  • If any surface is grossly contaminated, pour 1% sodium hypochlorite first and leave it for 10-15 minutes to be followed by cleaning and usual disinfection (0.1% sod. hypochlorite).

  • Basins and bedpans should be cleaned and disinfected before being used for another patient.

  • Spray disinfectant is prohibited.

    Respirators

    Surgical masks are not respirators and are not certified as such; they do not protect the user adequately from exposure. The primary purpose of a surgical facemask is to help prevent biological particles from being expelled by the wearer into the environment. Persons suspected of having avian influenza should be separated from others and asked to wear a surgical mask. If a surgical mask is not available, tissues should be provided and patients should be asked to cover their mouth and nose when coughing.

    The benefit of wearing masks by well persons in public settings has not been established and is not recommended as a public health control measure at this time. Surgical masks are not adequate PPE for airborne infections. Even though influenza is primarily spread via droplet, there may also be airborne spread. An N95 respirator or PAPR should be recommended, at least in the initial stages of a pandemic and while supplies last.

    In contrast to healthcare workers who necessarily have close contact with ill patients, the general public should try to avoid close contact with ill individuals. Nevertheless, persons may choose to wear a mask as part of individual protection strategies that include cough etiquette, hand hygiene, and avoiding public gatherings. Mask use may be most important for persons who are at high risk for complications of influenza and those who are unable to avoid close contact with others or must travel for essential reasons such as seeking medical care.

    Respirators are designed to help reduce the wearer's exposure to airborne particles. Respirators protect the user in two basic ways. The first is by the removal of contaminants from the air. Respirators of this type include particulate respirators, which filter out airborne particles; and "gas masks" which filter out chemicals and gases. Other respirators protect by supplying clean respirable air from another source. Respirators that fall into this category include airline respirators, which use compressed air from a remote source; and self-contained breathing apparatus (SCBA), which include their own air supply.

    Respirators are designed to reduce exposures of the wearer to airborne hazards. Biological agents, such as viruses, are particles and can be filtered by particulate filters with the same efficiency as non-biological particles having the same physical characteristics (size, shape, etc.). However, unlike most industrial particles there are no exposure limits established for biological agents. Therefore, while respirators will help reduce exposure to avian influenza viruses, there is no guarantee that the user will not contract avian flu. Respirators may help reduce exposures to airborne biological contaminants, but they don't eliminate the risk of exposure, infection, illness, or death.

    Beards, long mustaches, and stubble may interfere with a good seal and cause leaks into the respirator. Many medical facemasks, not approved as respirators, do not seal tightly to the face allowing airborne hazards to enter the breathing zone. Even those medical facemasks that appear to seal tightly to the face have not been designed to protect the wearer from airborne hazards. Therefore, they should not be considered an equivalent substitute for government-approved respirators.

    According to CDC and WHO, because of the uncertainty in transmission and risk of serious disease, isolation precautions identical to caring for patients with severe acute respiratory syndrome (SARS) should be used for health care workers who are exposed to patients with known or suspected avian influenza. These include gloves, gown, eye protection and US NIOSH certified N-95, European CE certified EN143P2 / EN149 FFP2, or comparable national/regional particulate respirators. An N-95 filters at least 95% of airborne particles. Higher level particulate respirators may also be used. Disposable PPE should be properly discarded, and non-disposable PPE should be cleaned and disinfected. Hand hygiene measures should be performed after removal of PPE.

    Recent CDC infection control guidance documents provide recommendations that health care workers protect themselves from diseases potentially spread through the air (such as SARS or Tuberculosis) by wearing a fit-tested respirator at least as protective as a NIOSH-approved N-95 respirator. The N95 only offers protection down to .3 microns, and viruses are smaller than this -- human SARS coronaviruses measure between .1 and .2 microns. But viruses often travel on larger particles, such as globs of mucus, which can be filtered. Available data suggest that infectious droplet nuclei may range in size from 1 mm to 5 mm; therefore, respirators used in health care settings should be able to efficiently filter the smallest particles in this range.

    An N-95 respirator is one of nine types of disposable particulate respirators. Particulate respirators are also known as "air-purifying respirators" because they protect by filtering particles out of the air you breathe. Workers can wear any one of the particulate respirators for protection against diseases spread through the air -- if they are NIOSH approved and if they have been properly fit-tested and maintained. NIOSH-approved disposable respirators are marked with the manufacturer's name, the part number (P/N), the protection provided by the filter (e.g. N-95), and "NIOSH."

    An N100 mask is well suited for those who want NIOSH's highest rated filtration efficiency in a maintenance free respirator. It provides a minimum filter efficiency of 99.97% against non-oil based particles. It is nearly 200 times more effective than the N95 filter, and is also about ten times more expensive.



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