This document discusses emergency response and occupational safety and health for emergency workers. It defines emergencies and public health emergencies according to WHO frameworks. It describes the roles and hazards faced by different emergency response personnel like firefighters, police, and medical staff. It emphasizes the need for better safety and health protections for emergency workers. It outlines standard precautions, transmission-based precautions, and proper use of personal protective equipment that should be followed to reduce risks to emergency workers when responding to health emergencies and outbreaks.

1. Apurv Charles Sonawane
Master’s Of Public Health –
Nutrition[student],
Dr. Shankar rao Chavan
Government Medical College,
Nanded.

2.  In the Emergency Response Framework, the World
Health Organization (WHO) has defined an
emergency as a situation that has an impact on the
lives and well-being of a large number of people or a
significant percentage of a population and requires
substantial multi-sectoral assistance.
 For a WHO response, there must be clear public
health consequences.

3.  In addition,
 under the International Health Regulations (IHR),
adopted by the World Health Assembly in 2005, a
public health emergency of international concern is
defined as “an extraordinary event which is
determined, as provided in these Regulations:
 (i) to constitute a public health risk to other States
through the international spread of disease and
 (ii) to potentially require a coordinated international
response” .
 Such events may include, inter alia, outbreaks of
infectious diseases, hazardous chemical spills or
releases of radiation.

4.  Management of such outbreaks and
emergencies involves close coordination and
cooperation between a large number of
diverse organizations.
 The emergency response personnel
associated with such organizations comprise
professional groups that include fire-fighters,
police officers, emergency medical staff
(paramedics, emergency medical
technicians, doctors and nurses) and
psychologists.

5.  Each of these categories of workers have
specific roles in managing an emergency
response that may expose them to
various health and safety hazards while
carrying out their duties.
 In view of all such events, the need for
better safety and health protection for
emergency workers is increasingly being
recognized as a major priority.

6.  Standard precautions are meant to reduce
the risk of transmission of blood borne and
other pathogens from both recognized and
unrecognized sources.
 They are the basic level of infection control
precautions which are to be used, as a
minimum, in the care of all patients.

8.  Hand hygiene is a major component of
standard precautions and is one of the
most effective methods to prevent
transmission of pathogens associated
with health care.
 In addition to hand hygiene, the use of
PPE should be guided by risk assessment
and the extent of exposure anticipated
with blood and body fluids or pathogens.

10.  Hand-washing (40–60 seconds): wet hands
and apply soap; rub all surfaces; rinse hands
and dry thoroughly with a single-use towel;
use towel to turn off faucet.
 Hand-rubbing (20–30 seconds): apply
enough product to cover all areas of the
hands; rub hands until dry.

12.  It is the 5th element of hierarchy of controls.
 The use and disposal PPE is essential for
reducing exposure.
 Policies and procedures should specify details
on selecting PPE for each job, the location of
PPE, and training on how to put on PPE –
including the order of donning,
decontamination, removal of PPE, and disposal
or storage.
 Additionally, training that includes emphasis on
a buddy system, partnering for assistance and
review, on donning, use and doffing can
increase successful use of PPE.

14.  The use of gloves does not replace the need for
cleaning hands.
 Hand hygiene must be performed when
appropriate, regardless of the indications for glove
use.
 Remove gloves to perform hand hygiene when an
indication occurs while wearing gloves.
 Discard gloves after each task and clean hands
(gloves may carry germs).
 Wear gloves only when indicated according to
Standard and Contact Precautions; otherwise they
become a major risk for germ transmission.

15.  A surgical or procedure mask and eye
protection be worn to protect mucous
membranes of the eyes, nose and mouth
during activities that are likely to generate
splashes or sprays of blood, body fluids,
secretions and excretions.
 Shoe/boot covers, hoods and aprons should
also be worn.

17.  Gowns and coveralls should be worn to
protect skin and to prevent soiling of clothing
during activities that are likely to generate
splashes or sprays of blood, body fluids,
secretions, or excretions.
 The soiled gown or coverall should be
removed as soon as possible, and hand
hygiene should be performed.

19.  Respirators protect workers from airborne
hazards.
 There are two types of respirator: air-purifying
and atmosphere-supplying.
 Respirators can also be classified as tight-fitting
or loose-fitting.
 N95 respirators or respirators with a higher
protection factor should be used when
inhalation hazards are present.
 Tight-fitting respirators include a tight seal
between the respirator and the face and/or neck
of the user.

21.  A user seal check is performed by the
wearer each time the respirator is put on.
 The check determines if the respirator is
properly seated to the face or needs to be
readjusted.
 Masks or surgical masks are NOT
respirators and do not protect the user
from exposure to airborne hazards.

22.  For effective use of PPE to protect health
workers, it is essential to follow standard
procedures for putting on and take off the
equipment.
 Donning= It refers to putting on work
clothes, gear, and equipment.
 Doffing= It means removing them.

24.  Gown:
 Fully cover torso from neck to knees, arms
to end of wrists, and wrap around the back.
 Fasten at back of neck and waist. Use duct
tape to secure.

25.  Mask or respirator:
 Secure ties or elastic bands at middle of
head and neck.
 Fit flexible band to nose bridge.
 Fit snug to face and below chin.
 Fit-check respirator.

26.  Goggles or face-shield:
 Place over face and eyes and adjust to fit.
 Gloves:
 Extend to cover wrist of isolation gown.

27.  Gloves:
 Outside of gloves is contaminated!
 Grasp outside of glove with opposite gloved
hand; peel off.
 Hold removed glove in gloved hand.
 Slide fingers of ungloved hand under
remaining glove at wrist.
 Peel off the second glove.
 Discard gloves in waste container.

28.  Gown:
 Gown front and sleeves are contaminated!
 Unfasten ties.
 Pull away from neck and shoulders, touching
inside of gown only.
 Turn gown inside out.
 Fold or roll into a bundle and discard.

29.  Goggles or face-shield:
 Outside of goggles or face-shield is
contaminated!
 To remove, handle by head band or ear
pieces.
 Place in designated receptacle for
reprocessing or discard in waste
container.

30.  Mask or respirator:
 Front of mask/respirator is contaminated
— DO NOT TOUCH!
 Grasp bottom, then top ties or elastics
and remove.
 Discard in waste container.

32.  Additional (transmission-based) precautions
are taken while ensuring that standard
precautions are maintained.
 Additional precautions, as described by
WHO in Practical guidelines for infection
control in health-care facilities include
airborne precautions, droplet precautions
and contact precautions.

33.  Airborne precautions are designed to reduce the
transmission of diseases spread by the airborne route.
 Airborne transmission occurs when droplet nuclei
(evaporated droplets) less than 5 microns in size are
disseminated in air.
 These droplet nuclei can remain suspended in the air for
some time.
 Droplet nuclei are the residuals of droplets and, when
suspended in the air, dry and produce particles in the
range of 1-5 microns.
 These particles can remain suspended in the air for long
periods of time, especially when bound to dust particles.

35.  Implement standard precautions.
 Place the patient in a separate room that has
a monitored negative airflow pressure (often
referred to as a “negative pressure room”).
 The air should be discharged to the
outdoors, or should be specially filtered
before it is circulated to other areas of the
health-care facility.
 Keep doors closed.

36.  Anyone who enters the room must wear a
special, high filtration, particulate
respirator
 (e.g. N95) mask.
 Limit movement and transport of the
patient from the room to essential
purposes only.
 If transport is necessary, minimize
dispersal of droplet nuclei by masking the
patient with a surgical mask.
 Gain the support of engineering services
to ensure that the negative airflow
pressure is maintained

37.  Implement standard precautions.
 Place the patient in a separate room (or in a
room with another patient infected by the same
pathogen).
 Wear a surgical mask when working within 1-2
metres of the patient.
 Place a surgical mask on the patient if transport
is necessary.
 Special air-handling and ventilation are not
required to prevent droplet transmission of
infection.

38.  Diseases which are transmitted by this route
include colonization or infection with multiple
antibiotic-resistant organisms, enteric
infections and skin infections.

40.  Droplet transmission occurs when there is
adequate contact between the mucous
membranes of the nose and mouth or
conjunctivae of a susceptible person and
large particle droplets (> 5 microns).
 Droplets are usually generated from the
infected person during coughing, sneezing,
talking or during medical procedures.

42.  Implement standard precautions.
 Place the patient in a separate room (or in a
room with another patient infected by the
same pathogen).
 Consider the epidemiology of the disease
and the patient population when determining
patient placement.
 Wear clean, non-sterile gloves when
entering the room.

43.  Wear a clean, non-sterile gown when
entering the room if substantial contact
with the patient, environmental surfaces
or items in the patient’s room is
anticipated.
 Limit the movement and transport of the
patient from the room.
 Patients should be moved for essential
purposes only.
 If transportation is required, use
precautions to minimize the risk of
transmission.

44.  Routine cleaning is important to ensure a clean
and dust-free hospital environment.
 Many microorganisms are usually present in
“visible dirt”, and routine cleaning helps to
eliminate this dirt.
 Administrative and office areas with no patient
contact require normal domestic cleaning.
 Most patient care areas should be cleaned by
wet mopping.
 Dry sweeping is not recommended. The use of
a neutral detergent solution improves the quality
of cleaning. Hot water (80°C) is a useful and
effective environmental cleaner.

47.  Bacteriological testing of the environment is
not recommended except when seeking a
potential source of an outbreak.
 Any areas visibly contaminated with blood or
body fluids should be cleaned immediately
with detergent and water.
 Isolation rooms and other areas that have
patients with known transmissible infectious
diseases should be cleaned with a
detergent/disinfectant solution at least daily.
 All horizontal surfaces and all toilet areas
should be cleaned daily.

48.  Linen:
 The basic principles of linen management are as
follows:
 Place used linen in appropriate bags at the point of
generation.
 Contain linen soiled with body substances or other
fluids within suitable impermeable bags and close
the bags securely for transportation to avoid any
spills or drips of blood, body fluids, secretions or
excretions.
 Do not rinse or sort linen in patient care areas (sort
in appropriate areas).

49.  Separate clean linen from soiled linen and
transport/store separately.
 Wash used linen (sheets, cotton blankets) in
hot water (70-80°C) and detergent, rinse and
dry preferably in a dryer or in the sun.
 (Heavy duty washers/dryers are
recommended for hospital laundry.)
 Autoclave linen before it is supplied to the
operating rooms/theatres.
 Wash woolen blankets in warm water and
dry in the sun, in dryers at cool temperatures
or dry-clean.

50.  Bedding:
 Mattresses and pillows with plastic covers
should be wiped over with a neutral
detergent.
 Mattresses without plastic covers should be
steam-cleaned if they have been
contaminated with body fluids. If this is not
possible, contaminations should be removed
by manual washing, ensuring adequate
personnel and environmental protection.
 Wash pillows either by using the standard
laundering procedure described above or
dry-clean if contaminated with body fluids.

51.  Develop a waste management plan which is based on
an assessment of the current situation and which
minimizes the amount of waste generated.
 Separate the clinical (infectious) waste from nonclinical
waste in dedicated containers.
 Transport waste in a trolley used only for that purpose.
 Store waste in specified areas with restricted access.
 Collect and store sharps in sharps containers. Sharps
containers should be made of plastic or metal and
have a lid that can be closed.
 They should be marked with the appropriate label or
logo – e.g. a biohazard symbol for clinical (infectious)
waste.

53.  Mark the storage areas with a biohazard symbol.
 Ensure that carts or trolleys used for the
transport of segregated waste collection are not
used for any other purpose; they should be
cleaned regularly.
 Identify a storage area for waste prior to
treatment or before it is taken to final disposal
area.
 Treatment of hazardous and clinical/infectious
waste must be carried out in accordance with
national regulations and WHO guidelines.
 This may involve transportation of infectious
waste to a centralized waste treatment facility or
on-site treatment of waste

55.  Controls hospital acquired infections
 Reduces community exposure to drug resistant bacteria
 Reduces HIV/AIDS, sepsis, hepatitis, and other diseases
transmitted by dirty needles and other improperly
cleaned/disposed medical items
 Control of zoonoses, a disease passed on to humans
through insects, birds, rats, and other animals
 Prevents illegal repackaging and resale of contaminated
needles, syringes, and medical equipment
 Avoids long term health effects from the environmental
release of pathogens and infectious bacteria and
viruses

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58. - Apurv Charles S.