Severe Acute Respiratory Syndrome -SARS

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					Infection Control Measures Click to edit Master title style to Prevent Hospital • Click to edit Master text styles Transmission • Second level
• Third level Severe Acute Respiratory • Fourth level Syndrome (SARS) • Fifth level
WHO Western Pacific Regional Office 14 October
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Overview title style Click to edit Master
• • • • • • • • • Epidemiology and Clinical Management Click to edit Master text styles Infection Control Precautions Second level Laboratory Third level Safety Fourth level Safety Mortuary Fifth level Linen, Laundry, Waste Management Environmental Cleaning
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Background Click to edit Master title style
• ApproximatelyMaster text styles countries • Click to edit 8098 cases in 29 as of 31 July 2003 • Second level • Third level • At Fourth level least 774 deaths • • Fifth level • 1707 Cases (21%) have been health care workers

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Chronology Click to edit Master title style
• •SARS, to edit Master text styles of unknown Click an atypical pneumonia •etiology, levelrecognized at the end of Second was February 2003 • Third level • Fourth level • •The World Health Organization (WHO) coFifth level ordinated the international responses to provide epidemiological, clinical and logistical support as required
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Chronology Click to edit Master title style
11 February • Chinese health officials reported “atypical Click to edit Master text styles • pneumonia” in Guangdong Province, Second level China; 305 cases/5 deaths (Nov 02–Feb 03) • Third level • Fourth level 19 Fifth level • February Hong Kong confirms human infection of Influenza H5N1
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Chronology Click to edit Master title style
5 March • Outbreak edit Master text styles Click to in Hanoi recognized 11 March level • Second Hong Kong reports SARS outbreak

• Third level • Fourth 13 March level • Singapore reports 3 SARS cases Fifth level

15 March The disease spread to outside Asia (Canada, Germany)

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Chronology Click to edit Master title style WHO initiates :
• Global Alert (12 March)

• Click to edit Master text styles • • Travel Advisory (15 March; 2, 23 & 29 April) Second level Third level • • Enhanced global surveillance • Fourth level • Global Outbreak Alert and Response Network • Fifth level
• Specific Global Networks (Lab, Case Management, Epidemiology)
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Chronology Click to edit Master title style
Forward planning of Activities since then : • Infection Control Guidelines – bi-regional • Click to edit Master text styles guidelineslevel now cover all issues for will • Second Infection Control practice in a Health Care • Third – due Facility level out soon • Fourth Control Programme – will support • Infectionlevel member states in how to set up an IC • Fifth level programme • IC Audit tool – for self evaluation of HCF
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Click toEpidemiology style edit Master title
• Cause : SARS CoV • Click to edit Master text styles • Highly infectious • Second level • Mainly affects adults • Third level • Superspreading events important in •transmission process Fourth level •No reports of transmission occurring before Fifth level • onset of symptoms
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Click toEpidemiology style edit Master title
• •Means to edit Master text styles Click of transmission • Second level Evidence of person to person transmission • Third level • Close contact with body fluids (especially Fourth level respiratory • Fifth level droplets )
Contaminated hands, clothes, equipment; environment may also be important
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Click toEpidemiology style edit Master title
• •Risk factors for transmission Click to edit Master text styles • Second level • •High risk medical procedures: Third level • Intubation • Fourth level • Bronchoscopy • Fifth level

• Cough-inducing procedures (sputum induction, administration of nebulised medications, suctioning)
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Click toEpidemiology style edit Master title
• •Incubation period text styles Click to edit Master
– 2 –10 days and up to 13 days in exceptional • Second level cases Onset and • –Third level duration of infectivity unknown

• Fourth level • Fifth level • Organism survival in environment
– Duration unknown – Data has shown SARS CoV may survive for 2-3 days
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Case Definitions Developed forto edit Master title style Click public health purposes in the interoutbreak period A • Click to edit Master text styles person with a history of:

• Second •Fever (> 38oC)level
•AND one orlevel of the symptoms of lower respiratory tract • Third more illness (cough, difficulty breathing, shortness of breath)

• Fourth level •AND Radiographic evidence of lung infiltrates consistent with • Fifth level pneumonia or RDS or autopsy finding consistent with the
pathology of pneumonia or RDS without an identifiable cause •AND No alternative diagnosis can fully explain the illness
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Case Definitions Click to edit Master title style Laboratory case definition of SARS
•A person with symptoms and signs that are clinically • Click to edit Master positive laboratory findings for suggestive of SARS AND with text styles SARS-CoV based on one or more of the following diagnostic • Second level criteria:

• Third level a) PCR for SARS-CoV – using a validated method from: • Fourth level •At least 2 different clinical specimens (eg nasopharyngeal or stool) OR level • Fifth
•The same clinical specimen collected on 2 or more occasions during the course of the illness

•Two different assays or repeat PCR using a new RNA extract 14 from the original clinical sample on each occasion of testing

Case Definitions b) Seroconversionedit Master title style Click to by ELISA or IFA
• Negative antibody test on acute serum followed by positive antibody testto edit Masterphase serum tested in parallel OR • Click on convalescent text styles • Fourfold or greater rise in antibody titre between acute and • Second level convalescent phase sera tested in parallel

• Third level c) Virus Isolation • Fourth level •Isolation in cell culture of SARS-CoV from any specimen AND • confirmation PCR Fifth level using a validated method
•Testing should only be undertaken in a national or regional reference laboratory as per WHO guidelines.
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Contacts Click to edit Master title style
Definition to edit Master text styles • Click CloseSecond level • contact : having cared for, lived with, or had direct contact with the respiratory secretions or body • Third suspect fluids of alevel or probable case of SARS.

• Fourth level Contacts oflevel • Fifth persons under investigation for SARS

should be traced and quarantined until SARS has been ruled out as the cause of the illness

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Clinical picture in SARS patients
Exposure to SARS Fever, myalgia, dry non-productive cough cough, headache shortness of breath Incubation period
~2 to 10 days up to 13 days reported Prodrome ~ 1- to 2 days Recovery approx 90%

Lower respiratory phase
From day 4 onwards Acute respiratory distress syndrome approx 10%

Infectivity
None /very low Low Very high

Clinical Picture Onset / Presentation Click to edit Master title style
• •Sudden onset of high fever with Click to edit Master text styles •myalgia, chills, rigors and a nonSecond level •productive cough Third level
• Fourth level • •Most cases have bilateral pneumonia Fifth level

• ~ 90% begin to recover from day 6 or 7
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Clinical Picture Click to editPresentation style Onset / Master title
• Rapid deterioration in 10% (+/-) of cases • Click to edit Master text styles • Second level  Acute RDS • Third level  Require ICU admission & • Fourth level mechanical ventilation • Fifth level • Case fatality rate: ~ 6%
• No specific treatment available
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Clinical Picture – Management

Click to edit Master title style SUPPORTIVE TREATMENT
• Click to edit Master text styles • Antibiotic Therapy: •to cover causative organisms Second level • Third level • •Prophylactic Antibiotic Therapy: Fourth level • to prevent secondary bacterial infection Fifth level

• Maintain oxygenation:  intubate and ventilate as necessary
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Clinical Picture – Management

Click to edit Master title style
SUPPORTIVE TREATMENT
• Click to edit Master text styles Avoid interventions which may cause • Second level aerosolisation of respiratory secretions: • Third level  Bronchoscopy • Nebulised bronchodilators Fourth level • Chest physiotherapy Fifth level

 Gastroscopy  Any procedure / intervention that may release respiratory secretions
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Clinical Picture – Management Click to edit Master title style
• Click to edit Master text styles SUPPORTIVE TREATMENT • Second level • Third level In severe cases corticosteroids and ribavirin • Fourth level used, however there have been • is no evidence to support their general Fifth level or routine use at this stage.
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Summary – SARS
• Multi - Country Outbreak Click to edit Master

title style

• New Pathogen: •  CoronaVirus family – SARS CoV Click to edit Master text styles

• Second level • • Clinical Picture: Third level  Fever and respiratory symptoms • Fourth level  ~ case fatality rate currently 4% • Fifth level

• Transmission:  Close contact with symptomatic case(s)  Contaminated hands and objects
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Summary – SARS

Click to edit Master title style • Prevention & Control:  Identification • Isolation of suspect and probable cases Click to edit Master text styles • Tracing & quarantine of close contacts Second level  Infection control precautions for all • Third level suspect and probable cases • Public Education Fourth level • Fifth level • Health care workers are currently at greatest risk therefore:  Infection control precautions are 24 essential

Infection Control Precautions Click to edit Master title style
Infection Control precautions (previously • knownto edit Master text styles Click as Barrier nursing techniques) are • designedlevel Second to prevent infection from the patient to the staff/visitor or the staff/visitors to other • Third level patients. • Fourth level • Fifth level Strict precautions must be used for all SARS patients.
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Patient Management Click to edit Master title style
 SARS : Infection Control Goals

• Click to edit Master text styles • Second level  SARS Admissions - Triage • Third level • Fourth level  Components of SARS Isolation • Fifth level
 SARS : Infection Control Practices
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SARS : Infection Control Goals Click to edit Master title style
In addition to providing the best possible • clinical care: Master text styles Click to edit • Second level • Third level any suspect cases. Detect early • Fourth level Implement appropriate isolation measures. • Fifth level Protect health care personnel. Protect other patients. Protect family and community members.
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Triage for SARS Admissions Click to should be separate wards/areas If possible, there edit Master title style
for each of the following categories :

• Click to edit Master text styles  Patients with colds, sniffles and runny noses • Second level should be isolated in a single room / area • Third cases  Suspectlevel • -Fourth level room Place in a single  Probable cases • Fifth level
- If cohort nursing, keep probable and suspect cases apart - May share room with other probable cases; where possible use a single room for all patients
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Components of SARS Isolation Click to edit Master title style
•• Facilityedit Master text styles Click to •• Administrative Controls Second level Third level •• Clinical Surveillance of Staff Fourth level •• Organization of Isolation Area Fifth level •• Protective Equipment • Standard Precautions
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• • Good ventilation

Facility Click to edit Master title style Isolated from other patient / staff movement

• –Click to edit Master text styles Air movement: corridor to room to outdoors Turn off central • –Second level air-conditioning systems unless the room can be isolated from the system. • Third level • Sinks and running water Fourth bathroom facilities • •Adequatelevel Fifth level • •Capacity to handle waste and laundry
• Sufficient rooms for expected number of patients • Contingency plans for converting other areas to isolation facilities
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ISOLATION WASH/TOILET

General Principles of isolation unit

Click to edit Master title style A
F

• ISOLATION ROOMMaster text styles Click to edit CHANGE Negative pressure/ ROOM (e.g. blow air out of • Second level E window with fan) D • Third level A D B C • Fourth level E A • Fifth level A. Disinfection station
B. Container for disinfection of reusable items e.g. goggles C. Biohazard bag for used (personal protective equipment) disposal D. Wall -mounted alcohol hand wash dispensers E. External windows only. Keep clear of public. F. Storage for general ward clothes, new PPE

GENERAL ACCESS AREA

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ISOLATION WASH/TOILET

General Principles of Isolation Unit

Click to edit Master title style
A
F

ISOLATION ROOM Negative pressure/ • Click to edit Master CHANGE ROOM text styles (e.g. blow air out of window E with fan) D

• Second level A D • Third level B E A B • Fourth level A. Disinfection station • Fifth level B. Container for disinfection of reusable items
C. D. E.

GENERAL ACCESS AREA

C

F.

e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall-mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE
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Facility Click to edit Master title style Isolation Area – Full IC Precautions required
Colour codes

• Greento edit Master text styles Click • • Second level (GO) : General [reduced] staff movement • Third level •• Yellowlevel Fourth (CAUTION) : Limited staff movement • Fifth level

• Red
(RESTRICTED) : Assigned staff only
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• Limit and control points of entry to SARS ward(s) edit Master text styles • Click to • • • • Second level – One entrance Third level control entrance – “Guard” to Fourth permitted visitors (staff & visitors) – Log oflevel Fifth level – Visitors must be restricted or preferably
– –

Administrative Controls Click to edit Master title style

forbidden with NO EXCEPTIONS Limit patient travel/transport outside unit Minimize the number of staff exposure to cases
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Administrative Controls Click to edit Master title style
• Assignment of responsibility • Click to edit Master text styles • Second level – Determining patient placement • – Overseeing implementation and enforcement Third level of infection • Fourth level control measures • – Enforcing access restrictions Fifth level
– –

Supply acquisition and distribution Surveillance of Health Care Workers (HCWs)
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• Maintain list of all staff who worked with SARS patients or on the SARS ward;

Clinical Surveillance of Staff Click to edit Master title style

• –Click to edit Master text fever; and styles Systematically monitor for • –Second level Twice daily temperature for staff working in the area • Third(baseline Chest X-Ray may be needed ) level • Screen for symptoms of SARS-like illness among •staff reporting for duty. Fourth level • •List contact information for: Fifth level
Persons visiting or caring for SARS patients; and – Contacts of HCWs in close contact with SARS patients.
–
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Organization of SARS Isolation Area
• Put Up Signs: eg. SARS Isolation Area • Designated area Master text styles equipment • Click to edit for clean protective

Click to edit Master title style

• – •– • Separation of clean and dirty supplies including an • Fourth level area for level • Fifth containment of waste and soiled linen
–

–

Instructions for using protective equipment Second level Accessible to personnel Third level Sufficient inventory to meet daily needs

–

Color-coded bags and containers for contaminated waste and laundry Containers for laundry and all waste should have footoperated lids
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ISOLATION WASH/TOILET

General Principles of Isolation Unit

Click to edit Master title style
A
F

ISOLATION ROOM Negative pressure/ • Click to edit Master CHANGE ROOM text styles (e.g. blow air out of window E with fan) D

• Second level A D • Third level B E A B • Fourth level A. Disinfection station • Fifth level B. Container for disinfection of reusable items
C. D. E.

GENERAL ACCESS AREA

C

F.

e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall-mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE
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Infection Control Click to edit Master title style
• • • • •

“You edit Master text styles Click tocan minimize YOUR risk of catching Second level Third level SARS Fourth level Fifth level by following Infection Control Precautions.”
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Infection Control Precautions Click to edit Master title style for SARS
• • • • • Click to edit Master text styles Standard Precautions Second level + Third level Fourth level Respiratory Precautions Fifth level +

Contact Precaution
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Exposure Risks Click to edit Master title style
• Patient: • Health Care Staff: Respiratory – styles • –Click to edit Master text Respiratory secretions secretions – Blood • Second level – Blood – Body fluids including • Third level – Body fluids excreta • Fourth level including excreta – Mucous membranes • –Fifth level Skin lesions – Skin lesions
– –

Staff Visitors

– –

Sharps Visitors
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Click to edit Master title style

Hand Washing

• Click to edit Master text styles • Second level • Third level An essential Infection Control • Fourth level precaution to prevent the • Fifth level

transmission of SARS

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Principles of Hand Washing Click to edit Master title style

Hand Washing : • •Is the single most important and effective Click to edit Master text styles component for preventing the transmission of •infection. Second level Third level • •Is designed to remove transient •microorganisms that may have been picked Fourth level •up from the environment. Fifth level • Prevents the transfer of these microorganisms to other patients, staff and equipment. • Is best performed using soap (preferably liquid) and warm running water. 43

Handwashing – When? – After removing gloves Click afteredit Master title style to patient – Before and
contact – After contact with blood or • Click to edit Master text body fluids from any • patient level Second – After taking blood • pressurelevel signs Third or vital • from any level Fourth patient

styles

Other times:

• After using bathroom Fifth level –
– After blowing or wiping nose – Before eating – Before preparing food

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Handwashing – How? Click to edit Master title style
Handwashing procedure : • Click to edit Master text styles • Second level Running water • Third level Soap (preferably liquid) • Fourth level • Fifth level  Friction Or use Alcohol-based hand rub

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Handwashing Steps
Click to edit Master title style Step 1 edit Master text styles • Click to
• Second and Wet hands level wrists. • Third level Apply soap • Fourth level • Fifth level

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Handwashing Steps
• Click to edit Master text styles • Second over Right palmlevel left. • Third level • Fourth level Left over right. • Fifth level

Click to edit Master title style Step 2

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Handwashing Steps
Click to edit Master title style
• Click Step 3 to edit Master text styles

• Second level Palm to palm • Third level • Fourth level with fingers • Fifth level interlaced.
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Click to edit Master title style Step 4to edit Master text styles • Click
Back of the • Second level fingers to the • Third level opposing fingers • Fourth level and interlocked. • Fifth level

Handwashing Steps

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Handwashing Steps
Rotational rubbing of • Second level • right thumb the Third level by • Fourth level clasping it in the left • Fifth level palm. And vice versa.
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Click to edit Master title style Step 5to edit Master text styles • Click

Click to edit Master title style Step 6
• Click to edit Master text styles Rotational rubbing • Second and backwardslevel forwardslevel tops of • Third with fingers and thumb of • Fourth level right hand in left. • Fifth level

Handwashing Steps

And vice versa.
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Drying Your Hands Click to dry your hands title style It is important to edit Masterthoroughly after
washing them because :

• Click to edit Master text styles • Damp hands collect microorganisms • Second level • Damp hands spread potentially infectious •microorgansims Third level • •Damp hands may become colonised with Fourth level potentially infectious microorganisms • Fifth level
Therefore it is important to “pat dry” your hands thoroughly. “Pat drying” also helps to prevent damage to skin.
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Handwashing Tips style Click to edit Master title
Remember: • Click to edit Master text styles • Second level Wash hands for a minimum of 15 to 20 • Third seconds. level • Fourth level • Fifth level have washed all areas properly. Ensure you

Dry hands thoroughly.
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Handwashing Tips style Click to edit Master title
Alcohol based hand gels/ lotions • Click to edit Master text styles  Use on clean (unsoiled) hands • Second level Use enough of the product to cover hands • Third level hands using the same steps as Vigorously rub • Fourth (do not Step 1 – 6 level wet hands prior to applying the Fifth level • solution/gel)

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Click to edit Master title style

Handwashing in Difficult Situations

If running water is not immediately available, • Click to you do? what shouldedit Master text styles • Second level Use a basin of clean water and wash hands. • Third level Use a clean basin each time. • Fourth level Use fresh water each time. • Fifth level DO NOT contaminate sources of fresh / clean water by handling ladles or dippers.
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Handwashing in Difficult Situations

Click toimmediately available,style edit Master title what If water is not
should you do? • Click to edit Master based hand Use an 70% alcohol –text styles rub solution. • Second level Use sufficient amount to completely cover your hands. • Third level Wash your hands using running water • Fourth level andFifth level • soap as soon as they become soiled
NB: Alcohol is very effective when hands are clean (i.e.. not soiled with blood, body fluids etc)
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Click to edit Master title style
• Standard Precautions • Second level • Respiratory • Precautions Third level Fourth level • • Contact Precautions • • Hand Washing Fifth level • PPE • Exposure Risks • Patient transport

Infection Control Precautions

Other Infection Control • Click to edit Master text styles Factors
• Patient and family education • Laboratories / Specimens • Mortuary Care • Waste and Linen Handling • Cleaning & Disinfection
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Precautions

Personal Protective Equipment (PPE)

Click to edit Master title style
• N-95 Respirator Mask must be worn

• •• • •• •

• Disposable Gloves

Click to edit Master text styles Goggles level Second (protective glasses) Third level Disposable or Reusable Gowns Fourth level Fifth level

• Cap and shoe covers are optional
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Personal Protective Equipment for SARS

Click to edit Master title style
• • • • • Click to edit Master text styles Second level Third level Fourth level Fifth level

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Personal Protective Equipment Click to edit(PPE) title style Master
• • • • •

N-95 Respirator Mask Click to edit Master text styles Gloves Second level Gown Third level Goggles Fourth level Fifth level Optional Cap Shoe covers
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Principles for Using PPE Click to edit Equipment (PPE) is used Master title style Personal Protective
to protect health care workers by preventing • Click to edit Master text styles potentiallylevel infectious microorganisms from: • Second • Third level •• Contaminating their hands, eyes and Fourth level clothing; • Fifth level and • Being transmitted to other patients and staff.
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Principles for Using PPE Click to edit Master title style
• PPE reduces but does not completely •eliminate edit Master text of infection. Click to the possibility styles • Second level •PPE is level effective if used correctly. Third only • • Fourth level •The use of PPE does not replace basic Fifth level • hygiene measures such as hand washing – hand washing is still essential to prevent transmission of infection. 62

N-95 edit Master title style Click to Respirator Masks
• • • • • Click to edit Master text styles types of Different Second level N-95 Respirator Masks Third level Fourth level Fifth level

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Principles for Using the N-95 Respirator title style Click to edit Master Mask
• Click respirator mask is used to The N-95 to edit Master text styles protect health care workers, other patients, staff or visitors by • Second level preventing potentially infectious microorganisms • Third level such as respiratory secretions from:
mouth. • Being inhaled or ingested.
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• Fourth level Fifth level • • Contaminating their face including the nose and

N-95 Respirator Mask Click to edit Master title style
• Click to edit Master text styles For respiratory • Second level protection wear • Third level an N-95 • Fourth level respirator mask • Fifth level during all patient contact
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Proper use of N-95 Respirator Click to edit Master title style Mask
•• DO NOTedit Masterfrontstyles mask once Click to touch the text of the • the mask has been fitted Second level • Third level •• Wear only one N-95 mask – no need for Fourth level additional respiratory protection • Fifth level

• REMOVE the N-95 respirator mask before leaving the isolation unit / area
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WHY an N-95 Master title style Click to edit Respirator Mask?
• • • • • Click to edit Master text styles N-95 respirator masks offer a Second level higher Third level level of filtration for Fourth level respiratory secretions than a Fifth level surgical mask

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HOW to use an N-95 Respirator Click to editMask title style Master
• Use for single shift unless excess moisture •necessitates replacement during each shift or it has Click to edit Master text styles •become contaminated by touching or soiling Second level
Label level • –Third with the wearer‟s name • Fourth level • Dispose of with medical waste • Fifth level

NB: You must fit the mask securely over both your nose and mouth 68

HOW to use an N-95 Respirator Click to editMask title style Master
•• Always use the correct sized mask. Click to edit Master text styles • Second level •• The incorrect size will not fit properly and Third level will fail the „fit test‟. • Fourth level • Fifth level NB: You must fit the mask securely over both your nose and mouth so size is important.
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N-95 Respirator Mask Click to edit Master title style
• This is to edit Master text styles Click only one example (brand) of an • Second level N95 respirator mask.

• • • •

Third level Fourth level N95 Other types of maskslevel be fitted Fifth must
according to the manufacturers instructions
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N-95 Respirator Masks Click FittingMaster title style - to edit Instructions
Step 1 • Click to edit Master text styles Cup the respirator • Second level in your hand with theThird level at • nosepiece your fingertips • Fourth level allowing the • Fifth level headbands to hang freely below your hand.
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N-95 Respirator Masks Click to edit Master title style - Fitting Instructions
• Click Step 2 to edit Master text styles • Second level Position the • Third level respirator under your chinlevel the • Fourth with nosepiece up. • Fifth level

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Step 3 Pull the top strap • Click to edit Master text styles over your head • Second level resting it high at the • back of your topThird level head. Pulllevel • Fourth the bottom strap over • Fifth level your head and position it around the neck below the ears.

N-95 Respirator Masks Click FittingMaster title style - to edit Instructions

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N-95 Respirator Masks - to edit Instructions Click Fitting Master title style Step 4
Place the fingertips of both hands at the top ofMaster text • Click to edit the metal nosepiece. Mould the • Second level nosepiece to the shape of your nose by pushing • Third level inward while moving your fingertips down both sides • Fourth level of the • Fifth level nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.

styles

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Step 5.1

N-95 Respirator Masks - to edit Instructions ClickFitting Master title style

The seal of the respirator • Click to edit Master on the face should be fit- text styles • Second level checked prior to wearing in the work area. • Third level

• Fourth level Cover the front of the • Fifth level both respirator with
hands, being careful not to disturb the position of respirator.
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N-95 Respirator Masks - to edit Instructions ClickFitting Master title style
Step 5.2 Positive Fit Test
Exhale sharply. A Master text • Click to edit positive pressure should be felt • Second level inside the respirator. If • Third level any leakage is detected, adjust the position of the • Fourth level respirator and/or tension • straps. level the seal. Fifth Retest of Repeat the steps until the respirator is sealed properly.

styles

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N-95 Respirator Masks Click to edit Master title style - Fitting Instructions
Step 5.3 Negative Fit Test • Click to edit there is Inhale deeply. If Master text styles no leakage, the negative • Second level pressure will make the • Third level mask cling to your face. • Fourth level A poor seal will result in • Fifth level 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 ClickRespirator Mask? style to edit Master title
 Click to touch the front of the mask • If you edit Master text styles
• Second level • If it level  Thirdis grossly contaminated • Fourth level • Fifth level

If it becomes wet

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Principles for Using Goggles, Gowns, Click to edit Master title style Gloves, Caps and Overshoes
• Click to edit Master text styles Goggles, gowns, gloves, caps and overshoes are • Second level used to protect health care workers, by preventing • Third level potentially infectious microorganisms from : • Fourth level Fifth level • • Contaminating their eyes, clothing, hands, hair and
shoes and • Being transmitted to other patients and staff.
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Goggles Click to edit Master title style
• Assign one pair to each worker at the • beginning of a shift text styles Click to edit Master • Second level Third level •• Wear goggles in room with SARS patients • Fourth level •• Fifth levelthe container in the anteroom at Leave in the end of the shift to be cleaned and disinfected
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Goggles Click to edit Master title style
• Click to edit Master text styles • Second level You should use • Third level goggles to cover • Fourth level allFifth level area. of the eye •

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• Long sleeved gowns must be worn when in direct •contact with the Master text styles Click to edit patient Second level • •Wear gown at all times in •the patient’s room Third level • Gowns must be removed • Fourth level before leaving the patient’s •room orlevel Fifth dedicated anteroom • Remove used gowns as soon as possible particularly when grossly contaminated

Click to edit Master title style

Gowns

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Gowns A new Gown should Master title style Click to edit be worn for every patient
contact

• Click to edit MasterReusable Gowns text styles Disposable Gowns If necessary, gowns may be • Second level reused during one shift for • a new level UseThird gown for the same patient, e.g. when each patientlevel short of supplies. • Fourth contact. Discard immediately if • Fifth level Visibly contaminated.
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 Click to edit Master title style
• Before all patient • contactto edit Master text styles Click

• •• • ••

Second level Before level Third all cleaning Fourth level Beforelevel Fifth handling
soiled linen & waste

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•

Gloves Click to edit Master title style Remove after contact with
patients or lab specimens

• Click to edit Master text styles • • Do not wear gloves outside Second level of the patient‟s room / • anteroom Third level • Fourth level • • Do not re-use gloves Fifth level
• Wash hands after removing your gloves
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• Plastic disposable aprons must be worn • whenever there is atext styles of other Click to edit Master likelihood PPE such as gowns becoming wet. • Second level • Third level • They are worn to reduce the risk of • Fourth level breakthrough and contamination of • clothing worn underneath the PPE. Fifth level
• They must be disposed of after use.

Plastic Disposable Aprons Click to edit Master title style

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Plastic Disposable Aprons Click tobe worn when : title style edit Master Aprons must
• Performing patient care activities where • soilingto edit Master moisture is likely; Click or increased text styles Second level •• Cleaning and disinfecting the patient • environment. Third level •• Cleaning and disinfecting medical; other Fourth level patient care equipment. • Fifth level • Laundering used linen. • Cleaning and disinfecting the cleaning equipment.
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Caps Click to edit Master title style
Caps are optional and worn to protect the hair text styles • Click to edit Master from aerosols that may • Second level occur from high risk • Third level procedures such as intubation or • Fourth level bronchoscopy

• Fifth level

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Overshoes Click to edit Master title style
Overshoes are • Click to editworn to text styles optional and Master • Second level protect the health care worker‟s shoes • Third level and feet from being • Fourth level splashed by spills • Fifth level such as blood or other body fluids or aerosols
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•

• Second level • •Wash hands using soap (preferably liquid) and Third level water when leaving the anteroom • Fourth level Fifth level • •Use an 70% alcohol-based hand rub solution after
hand washing • Wash hands when leaving the unit
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gowns, gloves (and hats, overshoes – optional in high risk situations) for all patient contact & •aprons when necessary text styles Click to edit Master

Key Points Click respirator mask, goggles, disposable Wear N-95 to edit Master title style

Personal Protective Equipment for SARS

Click to edit Master title style
• • • • • Click to edit Master text styles Second level Third level Fourth level Fifth level

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Patient Transport Click to edit Master title style
It is essential to avoid all unnecessary • Click to edit Master text styles transport of isolated SARS patients to • Second level control and prevent the potential spread of • Thirdinfection. SARS level • Fourth level • Fifth level

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Patient Transport If the patient needs to be out of their room for an Click to edit Master title style essential procedure, e.g. X-Ray
• • • • •
Transport route must avoid styles Click to edit Master textpopulated areas. Second level – Patient must wear an N-95 respirator mask (standard surgical masks can be used by patients if N-95 Third level respirator masks are not tolerated or are in insufficient supply) and an Fourth level isolation gown. – Accompanying staff must wear : Fifth level
–
•

N-95 respirator mask • Gloves • Gown • Goggles
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•

Patient Transport Click –Ambulance Transport to edit Master title style
–

• •  N-95 respirator mask, disposable gown, goggles, gloves Third level • • Clean and disinfect ambulance after transport • – Standard cleaning and disinfecting Fourth level or • Fifth level

No dedicated ambulance needed Click patient Master text styles – Maskto edit (N-95 respirator mask) – Transporters wear personal protective equipment Second level

1:100 dilution of bleach; after 10 minute contact time, clean and disinfect using standard procedures. DO NOT use spray cleaners
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Patient, Family & Community Click to edit Master title style Education
• •Education forMaster text styles family and Click to edit the patient, their •the community is essential in the control and Second level prevention of the SARS Virus. • Third level • Fourth level • It is particularly essential for those persons • Fifth level requiring hospital or home isolation to understand the necessary restrictions.
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Patient, Family & Community Click to edit Master title style Education
Explain: • Click to edit Master text styles • What SARS is (to date)
• • • • • • Second level Third level Why isolation is required. Fourth level Fifth level Precautions required including PPE

• Hand washing procedures
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Patient and Family Education Click to edit Master title style
• Teach the patient and family members:

• Click to edit Master text styles – about the SARS illness • Second level and • – the reason for the precautions being used Third level • Fourth level • Teach the patient and visiting family members: • Fifth level
– –

how to perform hand hygiene how to wear an N-95 respirator mask, gown, gloves and goggles (if available)
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Patient and Family Education Click to edit Master title style
Explain to the patient and family why • Click to edit Master text styles disposable equipment is being used • Second level such as: • Third level • Fourth level • Eating utensils • Fifth level • Medical equipment • Patient gowns
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Laboratories Click to edit Master title style
• Laboratory staff must ensure that their • practicesedit Master text styles Click to are meticulous. • Second level • Third level • Fourth level • Fifth level

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Click to edit Master title style Laboratories
• Click to edit Master text styles • Second level • •Advance planning in each Third level • designated laboratory is essential to Fourth level ensure that specimen handling, • Fifth level transportation and storage is managed according to the guidelines.
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Bio Safety for SARS in Click toLaboratories style edit Master title
The following activities may be performed in biosafety • Click to edit facilities text styles level 2 (BSL-2) Master with appropriate work practices • Second level • • Third diagnostic tests Routine level • • Fourth level involving known inactivated viru Manipulations and/or incomplete, non-infectious portions of the • Fifth level viral genome
• Routine examination of mycotic and bacterial cultures

• Final packing of specimens for transport

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Bio Safety for SARS in Click toLaboratories style edit Master title
Precautions for BSL-2 labs

• Click to edit for any procedure that biological safety cabinet Master text styles may generate aerosolsSecond level •
• PPE toThird level • be worn: •disposable gloves

• Fourth level • solid-front or wrap-around gowns with cuffed sleeves • protection • eyeFifth level
• surgical mask, or full-face shield, according to the risk of aerosols and exposure • When working at a biological safety cabinet, a full face shield is not necessary.
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Bio Safety for SARS in Click toLaboratories style edit Master title
Precautions for BSL-2 labs

• Click to edit Master text styles •Use sealed centrifuge cups – unload in a safety cabinet • Second level •Decontaminate work surfaces and equipment • Third level •Biological waste should be treated as outlined in the WHO Laboratory Biosafety Manual – 2nd Edition (Revised), 2003 • Fourth level • Fifth level

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Bio Safety for SARS in Click toLaboratories style edit Master title
BSL-3 facilities & BSL-3 work practices are required • Click to edit Master text styles for:

••Viral cell culture of the etiologic agent Second level ••Manipulations involving growth or concentration of the Third level •etiologic agent. Fourth level WhenFifth level or process cannot be conducted within a • a procedure

biological safety cabinet, then appropriate combinations of personal protective equipment (e.g., respirators, face shields) and physical containment devices (e.g., centrifuge safety cups or sealed rotors) must be used.
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Specimen Collection Click to edit Master title style
• • • • •• •• •• • Wear full PPE Click to edit Master text styles Write clinical details on the request form Second level Samples should be collected by clinical staff Third level Label the clinical samples clearly Fourth level Change PPE between patients Fifth level Discard all disposable materials in a biohazard bag
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Storage of Specimens Click to edit Master title style
• • • • • • • Respiratory samples and frozen tissues: Click to edit Master text styles o – store at –70 C Second level Third level Serum: Fourth at 4 - 8oC for 24-48 hours level – store Fifth level or
–

at -20oC for longer periods
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Patient Specimens Click to edit Master title style
• Treat all • •patient to edit Master text styles Click specimens as • Second level highly •infectious Third level •
Do not contaminate outside of container

• Fourth level Fifth level • •Use leak
proof containers for collection

Transport specimens in leak-proof outer containers e.g. a sealed plastic bag
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Mortuary Precautions Click to edit Master title style
Health care workers must wear full PPE: (N-95Click to edit Master text styles Gloves) • respirator mask, Goggles, Gown,

• Second level Health Care Workers must: • Prepare the  Third level body • Place level  Fourthin a body-bag or leak-resistant bag • Fifth level or  Place in plastic sheeting, wrap the body and tape/seal with waterproof adhesive tape
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Mortuary Precautions The Click tobe placed in cold storage (3°C : body must edit Master title style
+/- 2°C ) as soon as possible after the body is • Click and wrapped in a bag or plastic sheeting. prepared to edit Master text styles

• Second level The need for a post mortem must be discussed • Third level with the designated national laboratory as there • Fourth level are potential infection risks for personnel during a • Fifth level
post mortem.
Post mortems must be performed wearing full PPE
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Mortuary Care Click to edit Master title local Although all due deference must be given tostyle
cultural and religious customs associated with the death of ato edit Mastercommunity, the following • Click member of the text styles must be considered to minimize the potential risk of • Second level spread of the SARS Virus. • Third level • The body must not be embalmed, to reduce • Fourth level exposure risk. •• Fifth need for cremation with minimal delay. The level • The delaying of a „wake‟ to celebrate the life of the individual until all close contacts and possible secondary contacts are cleared.
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Linen & Laundry Waste Management Click to edit Master title style
• Health care and laundry workers must • understand the Master text styles linen Click to edit importance of handling correctly to prevent the spread of potentially • infectious level Second microorganisms

• •• •

Third level Linen can be washed using routine laundry Fourth level practices. Fifth level

• The health care facility should follow routine waste management practices but all waste must be incinerated.
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Click to edit Master title style
All contaminated or soiled linen is potentially • Click to edit Master infectious therefore:

Linen

text styles

• Second level • • Wear full PPE when handling Third level linen. • Fourth level Fifth level • • Separate grossly contaminated
linen from non- contaminated linen in the patient‟s room for ease of handling in the laundry.
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• •

Laundry Click to editbags and double bag for Master title style Place in color-coded
transport. • Clicksortedit Master laundry to avoid the Do not to linen in the text styles creation of aerosols. • Second level Staff handling • Third level linen should wear full PPE as per standard procedures for SARS. • Fourth level Use routine detergents.

• •

• Fifth level

Bleach may be added if desired, and compatible with the detergent being used.
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Waste Click to edit Master title style
• • • • • • • Wear full PPE when handling waste. Click to edit Master text styles Second level Clinical waste: all items from treatment Third level areas Fourth level – Soiled surgical dressings Fifth level – Swabs
– – –

Masks Gowns Other contaminated waste

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•

Waste Sharps Containers. Click to edit Master title style

Click to edit in designated color-coded •• Collect wasteMaster text styles • plastic bags for incineration. Second level • Third level Fourth bag •• Double levelfor transport. • Fifth level • Contact the local authorities for assistance if the health care facility does not have incineration facilities.
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Disposal containers should be puncture-resistant and leak- proof.

Sharps Disposal Click to edit Master title style

• • • • • • ••

Click to edit Master text styles Second level Do not overfill container Third level into Do not reach Fourth level container Dispose of used sharps Fifth level
into the sharps container

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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
• Cleaning is usually sufficient for prevention and • control to edit Master text SARS infection the use Click of infection, but for styles • of a disinfectant following cleaning is Second level recommended Third level • • It is essential to clean thoroughly before • disinfecting the environment or equipment. Fourth level • Cleaning and disinfection must be carried out at • least daily and particularly when gross Fifth level contamination occurs. • In some instances it may be necessary to disinfect to render the item safe to handle.
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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
• • • • • Click to edit Master text styles Cleaning and disinfecting patient Second level rooms and equipment is one of the best ways Third level to reduce transmission of infection Fourth level Fifth level
Wear full PPE when cleaning and disinfecting
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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
• To communicate infection risk, use signs.

• Click to edit Master text styles eg. SARS Isolation • Second level Third level • •Protect patients & staff by: • Fourth level •- Cleaning and disinfecting Fifth level
equipment.

- Cleaning and disinfecting the room and anteroom.
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Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style
Click to edit area around patients •• The immediateMaster text styles
must be

• considered heavily contaminated. Second level • Third level • Bedside table, bed stand, and accessible areas of • bed and floors must be cleaned with detergent Fourth level • and warm water at least daily (preferably twice a Fifth level
day).
•

In addition, disinfect all surfaces after cleaning.
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Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style
• Contain and dispose of infectious materials in • waste containers : Click to edit Master text styles – Put waste containers near entrance / exit to • Second level patient room.

• Third level • • Provide dedicated patient equipment when Fourth level possible. • Fifth level
• Clean and disinfect patient care equipment immediately after use depending on the type of equipment.
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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
UseClick to edit Master text agents for cleaning • standard procedures and styles And disinfecting environmental surfaces and • Second level patient care equipment.

• Third level Fourth level • • Use detergent and warm water, rinse in hot • water and dry. Fifth level
• Use disinfectant afterwards.

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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
• When areas and inanimate objects are • grossly contaminated use: Click to edit Master text styles • – 1:100 sodium hypochlorite (bleach) solution Second level to disinfect • Third level (before cleaning) – it will reduce the viral load and the potential • Fourth level to spread. for infection • Fifth level • Then use the standard cleaning and disinfecting procedures mentioned previously.
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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
•

All reusable patient items such as basins and • bedpans should be: text styles Click to edit Master

• • • •

Second level  Cleaned and disinfected before being used on another Third level patient Fourth level  Taken to the dirty utility room for cleaning Fifth level
Staff should wear full PPE when handling contaminated equipment.
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Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style
• DO NOT spray clean the room / area.

• Click to edit Master text styles Why? • Second level Because it: • Third level – Spreads droplets • Fourth level • – Spreads aerosols Fifth level
–

Is not effective as a surface disinfectant
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