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Aerosol Transmissible
Diseases
Overview
Interactive exercises
Resources in packet
Portal(s) of exit:
Respiratory tract
GI tract
Genital/urinary tract
Breaks in skin
Portals of entry
Susceptible hosts
Modes of Transmission
Direct Transmission
Direct Contact
Droplet
Indirect Transmission
Vehicle-borne
Vector-borne
Airborne
Infectious Aerosols
Transmission of Infections by
Respiratory Aerosols
Infection Control in a
Health Care Setting
Review
Basic Principles
All body fluids are potentially infectious
(except sweat)
Standard Precautions in
Health Care Settings
1. Appropriate hand hygiene
2. Barrier protective equipment:
Standard Precautions in
Health Care Settings
4. Proper environmental cleaning and disinfection
5. Proper Handling of Linen
6. Adherence to Bloodborne Pathogens Standards
7. Proper patient placement
8. Respiratory Hygiene/Cough Etiquette
9. Safe injection practices
Contact Precautions
Droplet Precautions
Airborne Precautions
Transmission-Based
Precautions: Contact
Precautions
Transmission-Based
Precautions: Contact
Precautions
Transmission-Based
Precautions:
Droplet
Precautions
Single room preferred, no special ventilation
Transmission-Based
Precautions: Airborne
Precautions
Airborne Infection Isolation Room (AIIR) if available
Seasonal Influenza in
Healthcare Settings
CDC and CDPH guidelines updated 2010
Multi-faceted approach
Flu vaccine for HCWs
Implementation of respiratory hygiene and
cough etiquette
HCWs with ILI stay home
Source Control
Seasonal Influenza in
Healthcare Settings: Isolation
Precautions
Droplet precautions for all patients with
suspect influenza (ILI)
ILI Temp >37.8 C (100 F) plus new cough or
sore throat
Ideally, place patients in single room
Surgical mask for close patient contact
Employer may allow N95 during routine care as
option
Seasonal Influenza in
Healthcare Settings: Isolation
Precautions
For aerosol-generating procedures: N95
respirator + standard precautions (gown,
gloves, goggles for spray/splash)
Vaccination of HCWs
Protect patients, protect yourself and other HCWs
CDC recommends
Measles, mumps, rubella (MMR): vaccinate unless
documentation of immunity or previous vaccination
Varicella: vaccinate unless documentation of immunity
or previous vaccination
Tdap
Yearly influenza vaccination
Hepatitis B: vaccinate unless documentation of
previous vaccination
Vaccination of HCWs
Cal/OSHA ATD & Bloodborne Pathogen
Standard
Employer must offer to those who are not
vaccinated or immune:
No cost to employee
Employer must maintain on file: records of
immunity, vaccine, or declinations
Tuberculosis Screening
for Health Care Workers
Title 22 and Cal/OSHA ATD Standard
TB screening at hire and then annually for
all licensed healthcare facilities in CA (e.g.,
acute care hospitals, skilled nursing
facilities, primary care clinics)
2. Mask or Respirator
www.cdc.gov/ncidod/dhqp/ppe.html
4. Gloves
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
www.cdc.gov/ncidod/dhqp/ppe.html
N95 respirator
www.cdc.gov/ncidod/dhqp/ppe.html
Meningococcal
meningitis
Pertussis
Mumps
Rubella (German
measles)
Strep pharyngitis
Influenza
Airborne
Tuberculosis
Varicella
(chickenpox)
Measles
SARS
Avian influenza
Smallpox
Influenza
Protects
most
people
Engineering Controls
Administrative
Controls
PPE
Protects
only the
wearer
Hierarchy of Control
Technologies
Goal is to reduce exposures to a hazard
Order in which these elements are
selected to control exposure is important
Elimination of Potential
Exposures
Example: patients with mild influenza like
illness stay home
Engineering Controls
Physically separates the employee from the
hazard
Does not require employee compliance to be
effective
Examples:
physical barriers at triage
airborne infection isolation room for patients
with known or suspect airborne infectious
diseases
Administrative Controls/
Workplace Practices
Policies, procedures, and programs that
minimize intensity or duration of exposure
Examples:
signs on door of an airborne isolation room
triage, mask symptomatic patient
provide tissues/ masks/hand sanitizer to public
Personal Protective
Equipment
Lowest level of hierarchy - requires employee
compliance for efficacy
Means higher elements of hierarchy fail to
adequately protect employee
May involve use of gowns, gloves, eye/splash
protection or respirators
Last line of defense
protect HCW
droplet precautions
Mask + goggles for
anticipated spray/splash
N95
Aerosol-Generating
Procedures
Sputum induction, bronchoscopy, elective
intubation and extubation, autopsies
CPR emergent intubation, open suctioning of
airways
Aerosol Transmissible
Diseases
Breaking
the
Chain
Source control
stay home, isolate or separate mask patient
References
CDC
2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in
Healthcare Settings
http://www.cdc.gov/hicpac/2007IP/2007isolation
Precautions.html
Guideline for Hand Hygiene in Health-Care
Settings MMWR 2002; vol. 51, no. RR-16
http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
References
Cal/OSHA
Aerosol Transmissible Disease Standard
http://www.dir.ca.gov/Title8/5199.html
Appendix A
http://www.dir.ca.gov/Title8/5199a.html
References
Seasonal Influenza Infection Control
Guidelines 2010
CDC:
http://www.cdc.gov/flu/professionals/infectionco
ntrol/index.htm
CDPH
http://www.cdph.ca.gov/programs/immunize/Do
cuments/CDPHGuidanceFluPreventionHCS2010
1105.pdf
Cal/OSHA http://www.dir.ca.gov/dosh/CalOSHA_influenza_guidance_11-5-10.pdf
Questions?