Severe Acute Respiratory Syndrome (SARS)

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Severe Acute Respiratory Syndrome (SARS)

• Personal Protective Equipment (PPE)

WHO Western Pacific Regional Office April 17,
2003
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Infection Control Practice

• You can minimise YOUR risk of catching
• SARS
• by following
• infection control procedures including
• the use of Personal Protective Equipment (PPE).

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Standard Precautions(Respiratory Precautions)

• Designed to reduce the risk for occupational
  exposure to SARS infection from both recognized
  and unrecognized sources of infection

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Exposure Risks

• Patient
• Respiratory Secretions
• Blood
• Body fluids including excreta
• Skin lesions
• Staff
• Visitors

• Health Care Staff
• Respiratory secretions
• Blood
• Body fluids including excreta
• Mucous membranes
• Skin lesions
• Sharps
• Visitors

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Principles for Using PPE

• Personal Protective Equipment (PPE) is used to
• protect health care workers by preventing
  potentially
• infectious microorganisms from
• Contaminating their hands, eyes and clothing
• and
• Being transmitted to other patients and staff.

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Principles for Using PPE

• PPE reduces but does not completely eliminate the
  
• possibility of infection
• PPE is only effective if used correctly
• The use of PPE does not replace basic hygiene
  measures such as hand washing hand washing is
  still essential to prevent transmission of
  infection.

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Personal Protective Equipment for SARS
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Personal Protective Equipment (PPE)

• Cap
• Gown
• N-95 Respirator Mask
• Gloves
• Goggles
• Shoe covers

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N-95 Respirator Masks

• N-95 Respirator
• Mask

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Principles for Using the N-95 Respirator Mask

• The N-95 respirator mask is used to protect
  health care
• workers, other patients, staff or visitors by
  preventing
• potentially infectious microorganisms such as
• respiratory secretions from
• Contaminating their face including the nose and
  mouth.
• Being inhaled or ingested.

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N-95 Respirator Mask

• For respiratory
• protection wear
• an N-95
• respirator mask
• during all
• patient contact

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Proper use of N-95 Respirator Mask

• DO NOT touch the front of the mask
• Wear only one N-95 mask no need for additional
  respiratory protection
• REMOVE the N-95 mask before leaving the isolation
  unit / area

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WHY an N-95 Respirator Mask?

• N-95 respirator masks offer a higher level of
  filtration for respiratory secretions than a
  surgical mask

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HOW to use an N-95 Respirator Mask

• Use for single shift unless excess moisture
  necessitates replacement during each shift
• Label with the wearers name
• Dispose of with medical waste
• NB You must fit the mask securely over both
  your nose and mouth

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HOW to use an N-95 Respirator Mask

• Always use the correct sized mask.
• The incorrect size will not fit properly and
  will fail the fit test.
• NB You must fit the mask securely over both
  your nose and mouth so size is important.

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N-95 Respirator Masks - Fitting Instructions

Step 1
Cup the respirator in your hand with the
nosepiece at your fingertips allowing the
headbands to hang freely below your hand.
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N-95 Respirator Masks - Fitting Instructions

Step 2
Position the respirator under your chin with the
nosepiece up.
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N-95 Respirator Masks - Fitting Instructions
Step 3
Pull the top strap over your head resting it high
at the top back of your head. Pull the bottom
strap over your head and position it around the
neck below the ears.
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N-95 Respirator Masks - Fitting Instructions

Step 4
Place the fingertips of both hands at the top of
the metal nosepiece. Mould the nosepiece to the
shape of your nose by pushing inward while moving
your fingertips down both sides of
the nosepiece. Pinching the nosepiece using one
hand may result in less effective respirator
performance.
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N-95 Respirator Masks - Fitting Instructions

Step 5.1
The seal of the respirator on the face should be
fit- checked prior to wearing in the work area.
Cover the front of the respirator with both
hands, being careful not to disturb the
position of respirator.
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N-95 Respirator Masks - Fitting Instructions

Step 5.2 Positive Fit Test
Exhale sharply. A positive pressure should be
felt inside the respirator. If any leakage is
detected, adjust the position of the respirator
and/or tension of the straps. Retest the
seal. Repeat the steps until the respirator is
sealed properly.
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N-95 Respirator Masks- Fitting Instructions

Step 5.3 Negative Fit Test
Inhale deeply. If there is no leakage, the
negative pressure will make the mask cling to
your face. A poor seal will result in prompt loss
of negative pressure in the mask due to air
entering through gaps in the seal.
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When to change your N-95 Respirator Mask?

• If you touch it
• If it is grossly contaminated
• But not necessarily between
• isolated patients

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Principles for Using Goggles, Gowns, Gloves, Caps
and Overshoes

• Goggles, gowns, gloves, caps and overshoes are
  used
• to protect health care workers, by preventing
• potentially infectious microorganisms from
• Contaminating their eyes, clothing, hands, hair
  and shoes
• and
• Being transmitted to other patients and staff.

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Goggles

• Assign one pair to each worker at the beginning
  of a shift
• Wear goggles in room with SARS patients
• Leave in the container in the anteroom at the
  end of the shift to be cleaned and disinfected

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Goggles
You should use goggles to cover all of the eye
area.
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Gowns

• Long sleeved gowns must be worn when in direct
  contact with the patient
• Wear gown at all times in the patients room
• Gowns must be removed before leaving the
  patients room or dedicated anteroom
• Remove used gowns as soon as possible
  particularly when grossly contaminated

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Gowns
Gowns should be worn for every patient contact
and ideally a new gown worn for each patient
contact

• Disposable Gowns
• Use a new gown for each
• patient contact.
• Discard immediately if
• visibly contaminated.

• Reusable Gowns
• If necessary, gowns may be
• reused during one shift for the
• same patient, e.g. when short
• of supplies.
• Discard immediately if visibly
• contaminated.
• Hang gown with outside facing
• in when not in use.
• Discard at the end of the shift.

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Gloves

• Before all patient contact
• Before all cleaning
• Before handling soiled linen waste

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Gloves

• Remove after contact with patients or lab
  specimens
• Do not wear gloves outside of the patients room
  / anteroom
• Do not re-use gloves
• Wash hands after removing your gloves

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Plastic Disposable Aprons

• Plastic disposable aprons must be worn whenever
  there is a likelihood of other PPE such as gowns
  becoming wet.
• They are worn to reduce the risk of breakthrough
  and contamination of clothing worn underneath the
  PPE.
• They must be disposed of after use.

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Plastic Disposable Aprons

• Aprons must be worn when
• Performing patient care activities where soiling
  or
• increased moisture is likely
• Cleaning disinfecting the patient environment
• Cleaning disinfecting medical other patient
  care equipment
• Laundering used linen
• Cleaning and disinfecting the cleaning equipment

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Caps
Caps are worn to protect the hair from aerosols
that may otherwise lodge on the hair and be
transferred to other parts of the health care
worker such as the face or clothing by the hands
or onto inanimate objects.
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Overshoes
Overshoes are worn to protect the health care
workers shoes and feet from being splashed by
spills such as blood or other body fluids or
aerosols
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Key Points

• The use of goggles, disposable gowns, gloves,
  caps
• and overshoes for all patient contact is
  designed to
• protect both the health care worker and the
  patient.
• It also protects other patients, staff and
  visitors from potentially infectious
  microorganisms.

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Key Points

• Wear N-95 respirator mask, goggles, disposable
  gowns, gloves, cap and overshoes for all patient
  contact
• Wash hands using soap (preferably liquid) and
  water when leaving the anteroom
• Use an 70 alcohol-based hand rub solution after
  hand washing
• Wash hands when leaving the unit

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Personal Protective Equipment for SARS
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Can You Now Answer These Questions?

• Why is personal protective equipment (PPE) used?
• When should it be used?
• Who should use PPE?
• What PPE should be worn for SARS patients?
• Which mask is recommended for use with SARS
  patients? Why?
• For how long can this mask be worn before being
  changed?

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Can You Now Answer These Questions?

• What is the sequence for putting on, and taking
  off, PPE? Why?
• If the recommended mask is in short supply or not
  available, what type of mask should you (and the
  patient) wear?
• What should you do with PPE that you remove?
  Why?
• How can health care workers protect themselves
  when nursing SARS patients?

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Take Home Messages

• Personal Protective Equipment (PPE) is essential
  for all contact with SARS patients.
• Ensure N-95 respirator masks fit properly.
• Ensure goggles cover the entire eye area.
• Have sufficient PPE supplies available.
• All visitors must wear full PPE.
• Dispose of all PPE in the appropriate container
  for disposal or cleaning and disinfecting.

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Personal Protective Equipment(PPE)

• We hope YOU have learnt something about
• the use of personal protective equipment
• (PPE), its use in caring for SARS patients and
• its role in the prevention of transmission and
• infection control of SARS.
• Thank you for listening.