Public health, occupational safety and the use of PPE


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Using Personal Protection Equipment during outbreak situations is a vital part of the routines to prevent responders to an outbreak to get infected, as well as to prevent a virus to escape an infected area. This training in Egypt 2008 was provided by the European Union under the Better Training for Safer Food program.

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  • 1. HPAI is transmitted to humans by direct contact with infected birds and products. The routes of infection can be through the eyes, nose and mouth. These areas of the body need to be protected when humans are investigating or responding to an HPAI outbreak.
  • 1. Viruses are extremely small and cannot be seen with the naked eye. A special microscope has to be used to see viruses.
  • 1. Surgical masks are routinely worn in hospitals but when exposure to deadly organisms is anticipated, respirators are recommended. Surgical masks are not efficient in keeping particulate matter and microorganisms out.
  • Emphasize the fact that most respirators require fit testing and will not work adequately if the wearer has a beard.
    N-95, N-99, and N-100 refer to the percentage of airborne particles that can be filtered by the different types, e.g N-95 filters 95% etc.
  • 1. HEPA stands for “high efficiency particulate air” filter. These filters are highly efficient in removing particulates from air.
  • Taping the wrist seals glove to the PPE preventing exposure of skin during physical activity.
    Using tape with gloves is difficult and best done with a partner who can tape your gloves to the PPE for you.
    It is not essential to tape gloves.
  • 1. Trainer must emphasize that everything listed must be placed in the biohazard bag for proper disposal later on.
  • Remember that you don’t want anyone reusing the PPE. It is recommended that you bury the biohazard bag.
  • Someone at the site wearing PPE should be responsible for disposal of PPE in the biohazard bags. The bags should be buried.
  • Public health, occupational safety and the use of PPE

    2. 2. MODULE OBJECTIVES At the conclusion of this module, participants will be able to: • Practice basic infection prevention principles; • Describe the procedures for taking rest breaks, water and food when at an infected site without compromising safety; • Explain safe procedures for putting on and taking off PPE.
    3. 3. What We Will Do in This Module • Talk about personal protective equipment (PPE) • Put on PPE • Talk about protecting people from HPAI • Take a break wearing PPE, as we should in an outbreak response • Remove PPE in a safe manner so we don’t infect ourselves or carry disease home or to another location
    4. 4. Personal Protective Equipment (PPE) • • • • • • • • • Coveralls Shoe Covers N-95 Respirator Goggles Plastic Apron Gloves Germicidal Wipes Alcohol Wipes Infectious Waste Bag
    5. 5. Why Use PPEs? • You can be infected by HPAI through your eyes, nose or mouth
    6. 6. Why Use PPEs? • Virus can be carried to farms • Virus can survive in the environment • You may not be aware that it is there
    7. 7. What is the difference between a SURGICAL MASK and a RESPIRATOR? Surgical mask Respirator
    8. 8. Particulate Respirators • N-95, N-99 or N-100, dependent on particle size allowed through the mesh • Filter out most infectious agents transmissible by air • Not appropriate for persons with beards
    9. 9. Air-Purifying Respirators • • • • Half- or full-face “Gas Mask” Replaceable HEPA filters for different hazards Not appropriate for persons with facial hair
    10. 10. Air-Purifying Respirators “Powered” Air-Supplied Respirators (PAPR) • • • • Air circulates, helps keep worker cool Replaceable HEPA filters Does not require fit testing Can be used by a person with facial hair
    11. 11. Coverall: Big is good, coveralls should be 2 sizes larger than you normally wear
    12. 12. Before You Put on the PPE • Remove your watch and any jewelry • Remove extra clothing • Remove all tobacco products (cigarettes, snuff, etc.) • It is recommended to leave cell phones behind.
    13. 13. • • • • • • Before You Put on the PPE: Wash Your Hands! Wet hands with soap and water Rub all surfaces Rub for 20 seconds Rinse well Wash forearms and face Towel or air dry
    14. 14. Donning the PPE properly SEQUENCE • Coveralls • Shoe covers • Respirator • Goggles • Pull hood over head • Apron • 2 pairs of gloves
    15. 15. Take off what you don’t need (jewelry, extra clothing, cell phones) Put On Coveralls
    16. 16. Put on Shoe Covers
    17. 17. Put On Your Respirator
    18. 18. Put on Goggles and Pull Up Hood You may want to remove vent covers so that goggles don’t steam up. Don’t cover vents with
    19. 19. Put On Apron
    20. 20. Put on Inner and Outer Gloves
    21. 21. You May Also Want To: • Tape on a sample bag to carry back samples
    22. 22. Ready to Go! Leave your biohazard bag at the intersection of the clean and dirty area
    23. 23. Protecting Poultry Workers and Farm Families • Education • Personal hygiene • Prevention
    24. 24. Poultry Farm Worker: Education • If workers notice severely depressed birds or high mortality: – Immediately leave the poultry house to prevent exposure – Contact a supervisor to investigate • From outside the house if possible • Determine if problem is mechanical • Anyone entering the house should : – – – – Wear full PPE Limit exposure time Limit contact with dead or dying birds Limit contact with potentially infective manure
    25. 25. Poultry Farm Worker Protection: Hygiene • Practicing careful personal hygiene when working with poultry can greatly minimize workers’ risk of disease. • Hand-washing – One of the simplest and most effective – Hands should be lathered with soap for at least 20 seconds – An alcohol-based hand rub can be used
    26. 26. Poultry Farm Worker Protection: Hygiene • Clothing – Wear clean clothes to the farm – Change into dedicated work clothing, which never leave the farm • Coveralls, head cover, and boots. – Farm should have a changing area • Decontamination – Best practice: Shower at the end of the day, wear personal clothes home – Good practice: Change out of work clothes and shower when arrive home.
    27. 27. Poultry Farm Worker Protection: Prevention • Vaccinations – Workers should have seasonal influenza vaccinations. – Vaccination does not protect against H5N1 HPAI. – Vaccination does help prevent dual infection with AI and seasonal flu.
    28. 28. Backyard / Smallholder Poultry Owners: Education Protecting Children – Many HPAI H5N1 cases in children – Require supervision around poultry – Restrict access to reduce exposure Education is the key to protecting farm families
    29. 29. Backyard / Smallholder Poultry Owners: Hygiene • Personal hygiene to decrease their risk of infection – Hand washing – Keep poultry outside family living space
    30. 30. Backyard / Smallholder Poultry Owners: Prevention • Biosecurity to protect their birds – Covered, screened buildings – Don’t mix species in a pen – Separate shoes worn in poultry area, so manure is not carried into the house
    31. 31. Live Bird Market Worker Protection: Prevention • Birds that die in the markets are potential sources of infection. • If a worker finds a dead bird it should be: – – – – Removed from the cage Placed into a closed container Not be eaten If possible, the bird should be submitted to authorities for testing • After the bird has been handled, the worker should thoroughly wash hands with soap and water.
    32. 32. Live Bird Market Worker Protection: Prevention • Large Numbers of Dead Birds: – Limit exposure by leaving the market – Secure the market areas so others can not enter – Contact their supervisor, the market owner, or designated first responder – Monitor their own health – Consider quarantine or culling all exposed birds
    33. 33. When You Take a Break: – Remove all PPE – Or remove only • • • • • Gloves (both pairs) Boot covers Respirator Apron And then get assistance
    34. 34. Taking a Break in PPE • Moving from Red Zone (infected area) to Orange Zone (transit area) – Clean gloves with a germicidal wipe – Remove apron – Remove outer boot covers, touch only outside, so you don’t dirty the coveralls – Remove outer gloves, touch only outside of first glove, inside of second glove
    35. 35. Taking a Break in PPE • At interface of Orange Zone and Green Zone (clean area) – NEVER TOUCH YOUR DIRTY PPE – Assistant in Green Zone removes hood and respirator – Assistant gives you drink with a straw – Assistant replaces your respirator, goggles and hood – Assistant gives you new apron, gloves and boot cover – Return to Red Zone (your seat)
    36. 36. Case Definition for Suspect Human HPAI Any individual presenting with an unexplained lower respiratory tract infection with: • Fever (temperature > 38 C) • Shortness of breath or • Difficulty breathing
    37. 37. Case Definition for Suspect Human HPAI And one or more of the following exposures in the 7 days prior to symptom onset: • Exposure to poultry or wild birds or their remains or to an environment contaminated with their feces in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month • Close contact with a suspect, probable or confirmed human or animal case • Consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month • Handling animal / human samples suspected of containing H5N1
    38. 38. Surveillance of Animal Control Workers and Family Members of HPAI Affected Households • Daily symptom check of all control workers • Symptom check of all family members • Confirm temperatures of any with suspect symptoms • Referral for evaluation of any suspected cases of human HPAI • Prompt isolation for anyone exhibiting
    39. 39. Accidental Exposure of Workers to HPAI • Active daily surveillance for symptoms and fever. • Consider initiating prophylaxis; – Oseltamivir 75 mg once a day for 10 days • Refer for further evaluation and treatment if patient meets case definition of suspect human HPAI. • Consider quarantine.
    40. 40. Management of Suspect Human HPAI Case • • • • Initiate prompt infection control activities with standard and airborne precautions for all personnel in contact with suspect patient. Refer to nearest health facility capable of evaluation of patient. Maintain strict isolation of patient, either in health facility or in home: – 7 days for adults – 21 days for children If suspect human case meets case definition, start Oseltamavir 75 mg twice a day immediately pending confirmation of positive or negative Influenza A H5 test.
    41. 41. Proper Order for Doffing the PPE • Wipe off gloves with germicidal wipes • Remove: – – – – – – – Apron Shoe covers Outer gloves Coveralls Goggles Respirator Inner gloves • Tie off biohazard bag • Wash hands with soap and water
    42. 42. Removing PPE: Biohazard Bag Should Be Opened at The End Of The Donning Process in Preparation For Doffing: Clean Gloves
    43. 43. Remove Apron
    44. 44. Remove Shoe Covers
    45. 45. Remove Outer Gloves First hand touches only outside of first glove, second hand touches only inside of second glove
    46. 46. Roll down coveralls without touching outside
    47. 47. Remove goggles by the strap that was covered by hood, not by the front piece!
    48. 48. Remove Respirator: Bottom Strap first!
    49. 49. Remove gloves, tie bag, sanitize hands with alcohol wipe and wash hands
    50. 50. Clean Hands, Arms and Face with Alcohol Wipes and Wash With Soap and Water, if Possible • Wet hands with soap and water • Rub all surfaces • Rub for 20 seconds • Rinse well • Wash forearms and face • Towel or air dry
    51. 51. Do Not Reuse PPE • PPE kit contents are designed for single use only • Do not wash and reuse • Reuse could result in: – Self-contamination – Contaminating someone else – Contaminating a new location
    52. 52. Discard PPE: • Immediately if it is torn, heavily soiled or wet • Immediately after use • Change respirator if: – Dirty – Damaged – Difficult to breath through
    53. 53. Discard PPE After Use! • Use plastic bags provided – Be sure to seal the bag and disinfect the surface of the bag – Dispose of the bag appropriately by burial – Burning is not a preferred method of disposal due to the environmental implications associated with burning plastic – Proper disposal is important to prevent further disease spread and contamination
    54. 54. PPE CASE STUDY •Read the case study assigned to your table and discuss what you would say in response to the concerns raised in the cases. •Choose someone to take notes and someone to report your thinking to the larger group.
    55. 55. Case Study #1 • You have been called to a site to help with the de-population of a sick flock. When you arrive and go to the designated place to get your PPE Kit, many other workers are already there putting on their PPE. As you start to put your equipment on, you hear a worker say: • “I cannot believe all of this stuff! It is so wasteful to use it once and then throw it away. I think when I’m finished today I’m going to keep some of the equipment. After all, I am probably going to need it again.” • You notice that a couple of other workers are nodding in agreement. You know that it is important to dispose of equipment after it has been used once and want to say something, but you are not sure how to approach the worker. After all, you do not know him and you are not from his village (neighborhood).
    56. 56. Case Study #2 • A worker reports for duty, helping to clean up a chicken yard where an outbreak of highly pathogenic avian influenza is suspected, but has not yet been confirmed. He has been trained on the use of PPE, but this is his first time to put on the equipment. He opens his PPE Kit from USAID and cannot believe how many things are in it. But instead of being pleased with the PPE, he sees it as exaggerating the danger of the situation. You walk up to him and ask him if he needs help getting into his gear and he tells you, • “There is no way I am putting on all of this to clean up a chicken yard! We do not need all of this. I have on my own boots. I can cover my face with a scarf or cloth. Let’s get the job done, and get out of here. All this stuff is just a waste of time. Why is everyone being so dramatic?”
    57. 57. Questions?