Planning and Preparing

for Emerging Infectious

Diseases
AN EXERCISE BASED WORKSHOP FOR
RURAL AND CRITICAL ACCESS
HOSPITALS
Introductions and Welcome!
• Deb French
• Colorado Hospital Association, Hospital Emergency Preparedness

• Teri Hulett
• Infection Prevention Consultant

•Ashley Baker
• Colorado Hospital Association, Hospital Emergency Preparedness
 Why a Workshop on Exercising Emerging
Infectious Disease for Rural Hospitals?
•Lessons learned from Ebola and other
infectious disease threats
•Unique challenges facing rural hospitals
•Best line of defense – testing and evaluating
capacity and capabilities for infectious
disease prevention
 Why a Workshop on Exercising Emerging
Infectious Disease for Rural Hospitals?
•Required to test every three years.
 State Board of Health Rule 6 CCR 1009-5
Preparations for a Bioterrorist Event,
Pandemic Influenza, or an Outbreak by a
Novel and Highly Fatal Infectious Agent or
Biological Toxin
Objectives
•Review best practices for transmission-
based precautions
•Review exercise design made easy
concepts
•Identify positive planning aspects and/or
identify gaps in planning through tabletop
exercise
A Special Thank You!
•Linda Navrkal, Parkview Medical •Dave McGraw, Spanish Peaks
Center
•Dee Ann Sierra, Rio Grand
Hospital
•Julie Zangari, St. Anthony
Summit Medical Center
•Laura Wilson, Southeast
Colorado Hospital District
•Mary Rasmusson, Montrose
Memorial Hosp
•Toni Foos, Colorado Hospital
Association
Regional Medical Center
•Mary Pancheri and Melissa
Miccio, Longmont United
Hospital
•Karri Knight, Denver Health
•Brigitte French, Penrose and St.
Francis Health Services
•ASPR, Colorado Department of
Public Health and Environment,
Hospital Preparedness Program
Grant
Infection Prevention:
Best Practices for
Transmission-Based
Precautions
TERI HULETT, RN, BSN, CIC, FAPIC
INFECTION PREVENTION CONSULTANT
Objectives
• Review the Chain of Infection
• Discuss Hand Hygiene Basics
• Identify Routes of Transmission
• Differentiate Categories of Transmission-
Based Precautions
• Discuss the role of Environmental Services
in Infection Prevention
Where do we start?
The Chain of Infection
Infectious Agent
Bacteria
Virus
Fungi

Susceptible Host Reservoir

Patient People
Staff Environment
Visitor Equipment & Water

HCW
Portal of Entry Portal of Exit
Excretion, secretions, skin, and
Mucous Membranes
droplets
Respiratory & GI Tract
Broken Skin

Means of Transmission
Direct/Indirect Contact
Inhalation
Airborne
Breaking the chain of infection
Infectious Agent Rapid identification, diagnosis,
and treatment
Bacteria
Virus
Fungi

Susceptible Host Reservoir Education

Recognition of high risk patients
Environmental Hygiene
Treatment of underlying disease Patient People
Disinfection and
Immunizations Staff Environment
Sterilization
Visitor Equipment & Water

HCW
Hand Hygiene, Hand Hygiene
Personal Hygiene
Portal of Entry
Portal of Exit Control of Excretions &
Transmission Based Precautions Mucous Membranes
Excretion, secretions, skin, secretions
Aseptic Technique Respiratory & GI Tract
and droplets Proper attire
Wound/catheter care Broken Skin

Means of
Transmission
Direct & Indirect Contact Hand Hygiene
Inhalation
Transmission based precautions
Airborne
Environmental Hygiene
Three basic routes of transmission
 Contact
 Direct
 Indirect

 Droplet
 Larger; don’t travel long distances, not infective over time
 Spatial separation (≥ 3 feet)

 Airborne
 Smaller; infective over time and distance

https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
 Hand Hygiene
“Hand Hygiene (HH) has been cited frequently as the single most important
practice to reduce the transmission of infectious agents in healthcare settings and
is an essential element of Standard Precautions.”

The term “hand hygiene” includes:

 Handwashing with soap and water
 Use of alcohol-based products that do not require the use of water (>60% alcohol)
 No artificial nails for those having contact with (high-risk) patients

“CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that

artificial fingernails and extenders not be worn by healthcare personnel who have contact
with high-risk patients due to the association with outbreaks of gram-negative bacillus and
candida infections.”
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
What are Transmission Based Precautions ?

Transmission-Based Precautions are designed

to supplement standard precautions in
patients/residents with documented or
suspected infection/colonization of highly
transmissible or epidemiologically important
pathogens.

http://www.mass.edu/mcncps/orientation/m2Transmission.asp
Transmission Based Precautions

• Hand Hygiene
Contact Precautions • Gown
• Gloves

• Hand Hygiene
Droplet Precautions • Mask

Airborne Precautions • Hand Hygiene

• Negative pressure room
• PAPR/N-95 Respirator mask
https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
 Rationale
Transmission of infectious agents within a healthcare setting requires three
elements:
1. A source (or reservoir) of infectious agents

2. A susceptible host with a portal of entry receptive to the agent

3. A mode of transmission for the agent

https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
Breaking the chain of infection transmission

Equipment cleaning Hand Hygiene Compliance w/ Precautions

 Contact Precautions
“Contact Precautions are intended to prevent transmission of
infectious agents, including epidemiologically important
microorganisms, which are spread by direct or indirect contact with
the patient or the patient’s environment.”
Healthcare personal caring for patients on contact precautions MUST wear an isolation gown and
gloves/personal protective equipment (PPE) for all interactions (that may involve contact with the
patient or potentially contaminated areas in the patients environment)

Donning (putting on) of PPE must occur immediately prior to entry

Doffing (removing) PPE must occur immediately prior to exiting

ANYONE ENTERING THE PATIENT ROOM MUST COMPLY WITH TRANSMISSION BASED PRECAUTIONS

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
PPE Donning
State Board of Health Rule 6 CCR 1009-5
Preparations for a Bioterrorist Event, Pandemic
Influenza, or an Outbreak by a Novel and
Highly Fatal Infectious Agent or Biological Toxin

6) Added wording that will ensure the training

of staff on the personal protective equipment
purchased. Ensuring the safety of staff by
having sufficient supplies and by being
properly trained with those supplies. This
inconsistency has been witnessed with recent
Ebola response

file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/E9B9P01K/PPE-Sequence.pdf
PPE Doffing

file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/E9B9P01K/PPE-Sequence.pdf
What’s wrong with this picture?
Heightened level of precaution
Transport of patient on contact precautions
 Droplet Precautions
Droplet Precautions are intended to prevent transmission of pathogens
spread through close respiratory or mucous membrane contact with
respiratory secretions.”
“Pathogens requiring droplet precaution do not remain infectious over long
distances in a healthcare facility and so do not require special air handling and
ventilation to prevent droplet transmission.”
• Don face mask (NOT N-95 respirator)prior to entering patient room
• Spacial separation ≥ 3 feet
• Place face mask on patient for transport outside of room

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
 Airborne Precautions
“Airborne Precautions prevent transmission of infectious
agents that remain infectious over long distances when
suspended in the air (measles, chicken pox, TB)”
Patient must be placed in an airborne isolation infection room (AIIR):
this is a single-patient room equipped with special air handling and
ventilation capacity that complies with specific regulatory guidelines:
• monitored negative pressure relative to the surrounding area
• 6 or 12 air exchanges/hour
• Air exhausted directly to the outside or
recirculated through a HEPA filtration system before return
• Door MUST remain closed
• Staff must wear N-95 respirator mask or PAPR
• Visitors entering must wear surgical mask
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
But what’s missing in the discussion?
Standard Precautions
 Apply to all patients receiving care in hospitals,
regardless of their diagnosis or presumed infection
status
 Designed to reduce the risk of transmission of
microorganisms from both recognized and
unrecognized sources of infections
 Under standard precautions, blood and body
fluids of all patients are considered potentially
infectious
https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
 Standard Precautions
Standard Precautions combine the major features of Universal Precautions and Body
Substance Isolation and are based on the principle that all blood, body fluids,
secretions, excretions (except sweat), nonintact skin, and mucous membranes may
contain transmissible infectious agents. 2007 HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare Settings

“Standard Precautions include a group of infection prevention practices that apply to

all patients, regardless of suspected or confirmed infection status.”

• Hand Hygiene

• Use of gowns, gloves, face shields, eye protection

• Safe injection practices

https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
STATE BOARD OF HEALTH REGULATIONS PERTAINING TO PREPARATIONS
FOR A BIOTERRORIST EVENT, PANDEMIC INFLUENZA, OR AN OUTBREAK BY
A NOVEL AND HIGHLY FATAL INFECTIOUS AGENT OR BIOLOGICAL TOXIN

B) Having sufficient supplies, training

for staff using personal protective
equipment, and a process for the
provision of personal protective
equipment to employees who are
assigned to work in areas where they
may be exposed to ill and contagious
persons or to infectious agents and
waste.

Personal protective equipment shall,

at a minimum, be the equipment and
supplies used to achieve standard
precautions against bacterial and viral
infections;
Standard Precaution PPE
Food for thought….
References
CDCs Donning and Doffing Guidelines
file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/4I0EW6R
G/PPE-Sequence.pdf

CDCs 2007 Isolation Guidelines

file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/E9B9P01
K/Isolation2007.pdf

CDCs Guideline for Hand Hygiene in Health-Care Settings

file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/E9B9P01
K/rr5116.pdf
Thank you