The Ebola Virus: Infection Control Precautions

Transcription

1 TheEbolaVirus: InfectionControlPrecautions AbriefguideforHealthCareWorkers inwestafrica DavidMurana

2 ThepurposeofthisbriefdocumentistoprovideguidanceforHealthCareWorkersin implementinguniversal/standardinfectioncontrolprecautions,whilstcaringforand treatingpatientssuspectedoforinfectedwiththeebolavirus.inordertoprovidethemost uptodateguidance,referencehasbeenmadetotheworldhealthorganization(who) 2014publication,ClinicalManagementofPatientswithViralHaemorrhagicFever:APocket GuidefortheFrontLineHealthWorker.ThetermHealthCareWorkerhasbeenusedinthis briefdocumenttorefertodoctors,nurses,andotherworkerswhoassistdirectlywith patientcareandtreatment. Index 1. Introduction Transmissionroutes.1 2. Preventionandcontrol Patientisolation.2 4. Restrictedmovement.2 5. HandHygiene PersonalProtectiveEquipment(PPE).4 7. Preventionofinjuriesfromneedlesandothersharpinstruments.6 8. Cleaninganddisinfectionoftheenvironment Safehandlinganddisposalofcontaminatedlinensandotheritems Cleaninganddisinfectionofpatientcareequipment Other.8 CompiledbyDavidMurana FacultyofInfectiousandTropicalDiseases DepartmentofClinicalResearch LondonSchoolofHygieneandTropicalMedicine UniversityofLondon KeppelStreet LondonWC1E7HT UnitedKingdom August2014 Thisguideisforfreedistributionandnotforsale.

3 1. Introduction. There is currently no specific treatment to cure Ebola, therefore preventing and controllingitsspreadisthemostimportantwayofcombatingthedisease.healthcare WorkersarecentraltothepreventionandcontrolofEbola,theyhavetoensurethatthe diseasedoesnotspreadfrompatientstohealthcareworkers,healthcareworkersto HealthCareWorkers,andfromthepatienttotherestofthecommunity.HealthCare Workers must always remind themselves of these 3 words when preventing and controllinginfection;what,whenandhow.asweprogressyouwillseethesignificance ofthese3commonlyusedbutveryimportantwords. 1.1 Transmissionroutes. ThefirstthingthatHealthCareWorkersneedtoremindthemselvesaboutishowdoes theeboladiseasespread?whataretheroutesoftransmission?whatweknowfornow isthattheriskofinfectionincreaseswithdirectexposuretobloodorbodilyfluids(stool, urine,saliva,semen)ofadeadorlivinginfectedpersonoranimal. Afterhandlingbloodorbodyfluidsofaninfectedperson,infectioniseasilytransmitted through broken skin, or by touching certain areas such as the eyes, nose and mouth. Transmissionalsooccursbyhavingunprotectedsexualcontactwithinfectedindividuals up to seven weeks after they have recovered. The environment in which an infected personiscaredfororlivesshouldnotbeforgottenabout,thatisbecauseareaswithin that environment may be contaminated. Think about the surfaces, clothes, linen, equipment etc. If you work in the lab handling specimens, you will need to take precautionsalmostequallyashealthcareworkerscaringdirectlyforpatients. 2. PreventionandControl. Nowthatweknowhowthediseasespreadswecanprogressfurtheronhowtoprevent andcontrolthespread.listedbelowshouldbethemainfocus; PatientIsolation. Restrictedmovement. Handhygiene. Appropriate personal protective equipment (PPE) based on risk assessment at thepointofcare. Preventionofinjuriesfromneedlesandothersharpinstruments. Safewastedisposalofuseditems. Cleaninganddisinfectionoftheenvironment. Safehandlinganddisposalofcontaminatedlinensandotheritems. Cleaninganddisinfectionofpatientcareequipment. (AdaptedfromWorldHealthOrganisation(WHO),2014) 1 P age

4 3.PatientIsolation. Itisimportantthatpatientsarekeptinisolationbays,roomsorcubicles,tohelpminimise thespreadofthedisease. TheflowchartbelowtakenfromtheWHO(2014)shouldhelpyouwithsettingupandusing isolationfacilities. 4.RestrictMovement How do you restrict movement when relatives are longing to see their loved ones? It is importantthatonlyhealthcareworkerslookingafterpatientshaveaccesstotheareain whichpatientsarelookedafter.thiswillbefrustratingforrelativesbutifyouhaveatrained person(s)tobriefthemawayfromthecareareaaboutwhatisgoingonandwhyyouare takingthestepsthatyouaretaking,thatshouldhopefullylessentheiranxietiesorworries. Takeonestepbackandinyourmind,putyourselfinthepositionoftherelative(s),andnow thinkabouthowyouwouldliketobetreated.alwaystreatrelativeswithcompassion. 2 P age

5 5.HandHygiene HandHygieneisoneofthemosteffectivewaysinpreventingandcontrollingthespreadof infections in general. To ensure good hand hygiene you must have the following; Soap, runningwater(/+adequatelydilutedwithchlorine)andpapertowels(disposable). Sowhenshouldyouwashyourhands? Youshouldwashyourhands; Beforeandafteryouhavehadcontactwithaninfectedpersonorsuspectedcase. Don tforgetthatasyoumovearoundyouwillbetouchingareasorsurfaces,these maybecontaminated. Justbecauseyouhavebeenwearingglovesdoesnotmeanthatyoushouldnotwash your hands after you have taken the gloves off. You must in addition wash your handsimmediatelyaftertakingyourglovesoff. Washingyourhandsshouldbedoneinawaythatremovesanypathogenthatispresenton them.sohowshouldyouwashyourhands?letusforgetaboutwordsfornowandmove ontopictures. Donotkeeplongfingernails. Donotwearrings,watchesorbracelets. Alwaysdryyourhandsproperly. Coverallcutsorscratcheswithawaterproofplasterorcovering. 3 P age

6 6.PersonalProtectiveEquipment(PPE) Youareworkinginatropicalclimate,sowearingtoomanyitemsatthesametimeonyour head,face,bodyandfeetisnotthemostcomfortablethingtodo.youneedtobearinmind thatyoursafetycomesfirst.ifyoubecomeinfectedthenyouwillnotbeabletohelpthe patients and you yourself will become a patient.so what items do you need to protect yourself?cottontunics(scrubs),longsleevegowns,medicalfacemasks,faceshields,head cover,gloves,goggles,waterproofapronsandwellingtonboots. Wellingtonbootsscrubsapronfaceshieldgown glovesheadcovergoggles Nowwhendoyouputonthesepersonalprotectiveequipment?Itisimportantthatyoudo sobeforeyouhandleaconfirmedorsuspectedcaseofebola. Inwhatorderdoyouputonandremoveyourequipment?WhatIhavedoneagainistotake thestepsthatthewhohasrecommendedandwhichisusuallyfollowedbymanyclinical settingsaroundtheworld,inthepreventionandcontrolofinfection.thekeythingsthat youshouldrememberare: YoumustgetanothertrainedcolleaguetohelpyouputonyourPPE. Makesureyouwearcorrectlysizedgloveswhenenteringthepatientcarearea.If possibleavoidlatexglovesandusenitrilegloves.thisisbecausepeopledohaveor developlatexallergy. Makesureyouwearadisposable,impermeablegowntocoverclothingandexposed skin.ifthegownispermeablethenawaterproofapronoverthepermeablegown mustbeworn. Thefacialprotectionistopreventsplashesofbodyfluidstothenose,mouth,and eyesoryoutouchingtheseareas(medicalmaskandeyegoggleorafaceshieldand medicalmask). 4 P age

7 Don tforgetthatppemustalsobewornby;supportstaffwhocleantheisolation rooms and handle contaminated supplies and equipment, laboratory staff who handlespecimensandburialteams. Following the correct steps to put on PPE to protect yourself is important, but equallyimportantalsoistakingofftheppeafteryouhavebeenincontactwithan infectedpatient,suspectedcase,contaminateditemsordeceasedperson.becareful toavoidanycontactbetweenthesoileditems(e.g.gloves,gowns)andanyareaof theface(eyes,nose,ormouth). Before leaving the isolation area where you have cared for a patient, carefully removeanddisposeofprotectiveequipment. 5 P age

8 7.Preventionofinjuriesfromneedlesandothersharpinstruments. Infection is also possible to occur if injuries are sustained from contaminated needles or sharpobjects.toprotectyourselfandyourcolleagues,youmustpayattentiontoitemssuch asneedles,scalpelsscissorsetc.whichyouhaveusedwhilsttreatingapatient.makesure thatyoudisposeofthemsafelyafteruse,donotleaveitemslyingaroundanddonotrecap needles. Sharps must not be passed from hand to hand, or carried in your own hands, alwaysuseatray.howdoyougoaboutdisposingofneedlesandsharpitemssafely?there are specially designed containers known as sharps boxes, you must dispose of items in there.needlesandsyringesmustnotbedisassembledbyhandbeforedisposal.ifyoudo nothaveone,thenyoucanimprovisebyusingcontainersmadefromhardplastic,suchasa 6 P age

9 usedplasticgallon.makesurethatyoudonotallowsharpboxestobecometoofulland incineratethemtodisposeoftheusedneedlesorsharpitems.nowlet slookatthepictures belowandseehowtheycanhelpusindealingwithusedneedlesandsharpitems. Sharpsbin.Overfilled&dangeroussharpsbin.Safedisposalofaneedle. 8.Cleaninganddisinfectionoftheenvironment Inside the clinical environment where you are caring for infected patients needs to be cleanedanddisinfected.thisisbecausefloorsandothersurfacemayhavebloodorbody fluids on them. How often should you clean the floors and surfaces? Floors and surfaces shouldbecleanedanddisinfectedatleasttwiceadaywithchlorinebaseddisinfectantor whenevertherehasbeenanincidentsuchasbleedingorvomitontothefloororsurface.so howdoyougoaboutcleaninganddisinfectingfloorsandsurfaces? Donotsweepwithadrybroomorbrushbecauseyouwillliftpathogensintotheair, donotusedryragsorclothsbecausethesamewillhappen. Use a moistened cloth or mop to first clean. Thereafter you should use chlorine baseddisinfectanttodisinfect. Make sure that you change and dispose of cleaning items frequently, and safely becausetheywillbecomecontaminatedquickly. Ifyouhaveauxiliaryworkersdoingthecleaning,thenmakesurethatyoueducate andtrainthem. 9.Safehandlinganddisposalofcontaminatedlinensandotheritems IntheprocessoflookingafterpatientssuspectedorinfectedwiththeEbolavirus,wastewill be generated such as; cleaning items, vomit bowls, empty intra venous fluid bags, used gauzeandbandages,usedppe,soiledorwornpatientclothingandlinen,usedutensilsetc. Howdoyougetridofthesesafely? Flush urine, vomit and faecal matter down toilets. Disinfect toilets often with chlorinebaseddisinfectant.ifnormaltoiletsarenotavailablethendisposeofthese safelyandcarefullyinanyspecialfacilitythathasbeenconstructedsuchasapit.if 7 P age

10 youhavetogofardistances,thenthereistheriskofspillageandyoumustpointthis out. Itemsshouldbesegregatedbeforetheyleavetheclinicalarea.Singleuseitemsmust beplacedinseparateheavydutybrightcolouredpolythenebags,bagsmustbehalf full and not overloaded. Remove safely through specific corridors or channels avoidingthegeneralpublicorotherworkersandincineratedimmediately.ideally incinerationshouldtakeplaceonsite.ifnotwastemustbetransportedsafelyina securevehicle. Itemsforlaundryorsterilisationshouldalsobesegregatedandremovedtakingthe sameprecautionsabove. If sharp items are to be sent for sterilisation then they must be placed and transportedinrobustsealedplasticormetalcontainers. It is important that there is strong communication and coordination between the clinicalareaandthosereceivingcontaminateditems. Contaminateditemsmustbemarkedwith danger warningsigns. Ifpossibleprocureandusesingleuseitemsallthetimesuchas;cups,plates,cutlery, PPE,vomitbowls,linenandforceps.Theyareeasiertodisposeof. 10.Cleaninganddisinfectionofpatientcareequipment. Theequipmentthatyouusetomonitorpatientsshouldnotbeforgottenandmustalsobe cleaned and disinfected. Equipment such as blood pressure monitors and thermometers mustbedisinfectedeverytimetheyareusedbetweenpatients. 11.Other Allspecimensleavingtheclinicalareamustbehandledwithcare.Specimensmust becontainedinaleakproofcontainerandthenplacedinasealedpolythenebag. Ensurethattheoutsideofthecontainerisnotvisiblycontaminatedwithbloodor bodyfluids. Care must be taken in the removal process of the deceased. Leakage from any wounds or other orifice must me contained. A body bag must be used for the removalprocessviasecurecorridorstoavehicleforimmediateburialorcremation. Allvehiclesusedtotransportcorpsesmustbewashedanddisinfectedthroughoutat regularintervals,indesignatedlocationsawayfromthepublic. Conclusion Itishopedthatthisbriefdocumentwouldhelpwiththesebasicbutneverthelessimportant pointsinpreventingandcontrollinginfection,whencaringforortreatingpatientssuspected oforinfectedwiththeebolavirus.itisimportantthatwhenyouarefacedwithinfection control and prevention challenges, you should keep asking yourselfwhat should I be doing?whenshouldidoit?andhowshouldidoit? 8 P age