APPENDIX 19
Medway Community Health Care
Infection Prevention and Control Policy for
Pandemic Influenza: PCT and Provider Services
Version 1
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APPENDIX 19
Version: 1.0
Ratified by:
Date ratified:
Name of originator/author:
Infection Control Advisor
Name of responsible committee/individual:
Pandemic Influenza Committee
Date issued:
Review date:
Target audience:
PCT Commissioning
Provider Services
Local Authority Agencies
Primary Care
Version 1
Page 2 of 27
Document Status
Approved
Policy ref / Version (if
Version 2.
appropriate)
DOCUMENT CHANGE HISTORY
Version
Date
Comments (i.e. viewed, or reviews, amended,
approved by person or committee)
2.0
New
Policy
Version 2
3
Groups or individuals who have been consulted with in production of document:
Pandemic Flu Committee
Director of Provider Services
Assistant Director for Clinical Standards
Assistant Directors
Heads of Services
Operational Managers
Infection Control Link Practitioners
Document reference:
Review date for approved
December 2009
document:
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Contents
Paragraph
Page
1 Policy
Statement
6
1.1
Scope and Purpose
6
1.2
Responsibilities
6
2
Overview of Pandemic Influenza Infection Prevention and Control
7
2.1
Key
Points
7
2.2
Influenza Clinical Features and Transmission
8
3
Principles of Containment and Infection Prevention and Control
9
3.1
Occupational Health and Deployment of Staff – Key Points
9
3.2
Staff
Deployment
10
3.3
Bank and Agency Staff
11
3.4
Workers at Risk of Complications
11
3.5
Infection Control Precautions
11
3.6
Droplet
Precautions
11
3.7
Patient Placement, Segregation and Cohorting
3.7.1
Inpatient
12
3.7.2 PCT Health Care Clinics and Primary Care Clinics
12
3.8
Management of a Coughing and Sneezing Patient
12
3.9
Hand
Hygiene
13
3.10
Personal Protective Equipment (PPE)
3.10.1
Aprons
18
3.10.2
Gowns
18
3.10.3
Eye
Protection
19
3.10.4 Fluid Repellent Surgical Masks
19
3.10.5 Putting on and Removing PPE
20
4
Aerosol Generating Procedures
22
5 Environmental
Infection Control
5.1
Clinical and Non-clinical Waste
24
5.2
Linen and Laundry
24
5.3
Staff
Uniforms
25
5.4
Crockery and Utensils
25
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Paragraph
Page
5.5
Environmental Cleaning and Disinfection
25
5.6
Medical and Nursing Equipment
26
5.7
Furnishings
26
Appendices
Appendix A
National Patient Safety agency Clean
yourhands Poster
15
Appendix B
Pandemic Flu Personal Protective Equipment Poster
16
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1 POLICY
STATEMENT
1.1
SCOPE AND PURPOSE
This policy forms part of the Medway PCT Pandemic Influenza Policy and
should be read in conjunction with the operational plans and Human
Resources Policy for a Major Incident.
The policy will provide guidance and information on Infection Prevention and
Control (IPC) procedures for PCT and Provider Services staff, Local Authority
partners, Independent Contractors, patients, relatives and visitors.
This policy is based on the Department of Health Pandemic Influenza:
Guidance for Infection Control in Hospitals and Primary Care (November
2007).
1.2 RESPONSIBILITIES
The Director of Public Health is responsible for the co-ordinated, multi-agency
Pandemic Influenza Plan.
The Emergency Planning Committee is responsible to ensure that the
preparation, plans and policies are in place.
The PCT Board is responsible to ratify and issue The Pandemic Influenza
Plan and policies.
Heads of Services and Operational Managers are responsible to ensure that
staff have access to the IPC Policy, training and communication.
PCT and Provider Services staff have a responsibility to understand this
policy and be aware of the implications to their area of responsibility.
The Lead for IPC during the Pandemic is the Director of Infection Prevention
and Control (DIPC)
The Infection Control Advisor (ICA)/Team (Provider and Commissioning) will
be responsible for the annual review of the policy annually, to provide advice,
support and training to Provider services and PCT staff.
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2
OVERVIEW OF PANDEMIC INFLUENZA AND INFECTION PREVENTION
AND CONTROL
2.1 Key
points
Health impacts of an influenza pandemic in the UK
All age groups are likely to be affected, but children and otherwise fit adults could
be at relatively greater risk.
Clinical attack rate may be of the order of 25% to 35%, but up to 50% is possible.
Between 55,000 and 750,000 deaths are possible.
Substantial demand for healthcare services is likely, in both primary care and
hospital settings.
Clinical features of influenza
The most significant features are rapid onset of cough and fever.
Headache, sore throat, a runny or stuffy nose, aching muscles and joints, and
extreme tiredness are other symptoms.
People are most infectious soon after they develop symptoms, although typically
they can continue to excrete viruses for up to five days (seven days in children).
How influenza is spread
The virus is transmitted from person to person through close contact.
The balance of evidence points to transmission by droplet and through direct and
indirect contact as the most important routes.
Aerosol transmission may occur in certain situations, e.g. during aerosol
generating procedures.
Prevention of influenza transmission
Transmission of the influenza virus can be prevented through:
Strict adherence to infection control practices, especially hand hygiene,
containment of respiratory secretions and the use of PPE.
Adherence to standard infection control principles and droplet precautions.
Administrative controls such as separation or cohorting of patients with influenza.
Instructing staff members with respiratory symptoms to stay at home and not
come in to work.
Restriction of symptomatic visitors.
Environmental cleaning.
Education of staff, patients and visitors.
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2.2
Influenza Clinical Features and Transmission
Influenza is a respiratory illness characterised by sudden onset of fever and
cough, with other possible symptoms being chills, headache, sore throat and
aching muscles and joints.
There is a wide spectrum of illness, ranging from minor symptoms through to
pneumonia and death.
The most common complications of influenza are bronchitis and secondary
bacterial pneumonia.
The typical incubation period for non-pandemic influenza is one to four days,
with an average of two to three days.
People are most infectious soon after they develop symptoms, although they
can continue to excrete viruses for up to five days (although longer periods
have been found).
The period of communicability is longer in children – typically seven days.
It is well established that influenza is transmitted from person to person
through close contact with an infected coughing or sneezing person.
Transmission almost certainly occurs through multiple routes, including
droplets and direct and indirect contact.
Aerosol transmission may also occur in certain situations.
Droplet and contact transmission is the most important and likely route.
Experimental studies of survival of the influenza virus suggest that it can
survive for limited periods of time in the environment, depending on the
surface contaminated.
It can be transferred from contaminated surfaces onto hands, and is easily
inactivated by commercially available alcohol handrub.
Influenza viruses are easily deactivated by washing with soap and water or
alcohol handrub and by cleaning surfaces with normal household detergents
and cleaners.
Careful and frequent hand hygiene and environmental cleaning are important
to help control spread through contact.
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3
PRINCIPLES OF CONTAINMENT AND INFECTION PREVENTION AND
CONTROL
Limiting the transmission of influenza in the healthcare setting requires:
Timely recognition of influenza cases.
Instructing staff members with respiratory symptoms to stay at home and
not come in to work.
Segregating staff into those who are dealing with influenza patients and
those who are not.
Consistently and correctly implementing appropriate infection control
precautions to limit transmission (standard infection control principles and
droplet precautions).
Using PPE appropriately, according to risk of exposure to the virus.
Maintaining separation in space and/or time between influenza and non-
influenza Patients.
Restricting access of ill visitors to the facility and posting pertinent signage
in clear and unambiguous language (including in languages other than
English).
Environmental cleaning and disinfection.
Educating staff, patients and visitors about the transmission and
prevention of influenza.
Treating patients and staff with antiviral drugs that can reduce infectivity
and the duration of illness.
Vaccinating patients and staff.
3.1
OCCUPATIONAL HEALTH AND DEPLOYMENT OF STAFF
Refer to the PCT
Human Resources Policy in the case of a Major Incident for full guidance.
Key points
Prompt recognition of cases of influenza among healthcare workers is essential to
limit the spread of the pandemic.
Healthcare workers with influenza should not come to work.
As a general principle, healthcare workers who provide care in areas for pandemic
influenza patients should not care for other patients, although exceptions may be
necessary.
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Healthcare workers at high risk of complications from influenza should not provide
direct patient care.
Bank and agency staff should follow the same deployment advice as permanent
staff.
The PCT Human Resources Department will lead on the implementation of
systems to monitor staff illness and absence.
The PCT will facilitate staff access to antiviral treatment where necessary and
implement vaccination of the healthcare workforce when required.
3.2 Staff
Deployment
Healthcare workers who are assigned to care for patients with influenza or
who work in areas of a facility that have been segregated for patients with
influenza should not be assigned to care for non-influenza patients or work in
non-influenza areas.
Exceptions to this include:
In community hospitals, hospice and nursing home, workers in
occupations with a limited number of staff, e.g. medical staff and AHPs,
although segregation of staff should be maintained as much as is
practical y possible.
Situations in which the care and management of the patient would be
compromised.
Staff who have fully recovered from pandemic influenza.
In some work settings in primary care such staff segregation may not be
feasible.
Consideration should be given to developing approaches that are similar to
those in hospital settings; for example, one general practitioner (GP) or district
nurse could be designated to see all the patients with symptoms of influenza
in a session.
In PCT in patient/residential areas, healthcare workers from a non-influenza
area may be redeployed in an area that is segregated for the care of influenza
patients. However, once redeployed, such workers cannot return to their
original non-influenza area for the duration of the pandemic, apart from the
exceptions listed above.
Healthcare workers who have recovered from influenza, or who have received
a full course of vaccination against the pandemic strain and are therefore
considered unlikely to develop or transmit influenza, should be prioritised for
the care of patients with influenza.
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In exceptional circumstances these workers may be moved within a period of
duty, but this is not desirable.
3.3
Bank and Agency Staff
Bank and agency staff must not work across different clinical environments.
Bank and agency staff should follow the same deployment advice as
permanent staff.
3.4
Workers at risk of complications from pandemic influenza
Healthcare workers who are at high risk of complications of influenza (e.g.
pregnant women and immunocompromised workers) should be considered for
alternate work assignments, away from the direct care of patients, for the
duration of the pandemic or until they have been vaccinated if it is clinical y
appropriate for them to be vaccinated.
They should not provide care to patients who are known to have influenza,
and neither should they enter parts of the facility segregated for the treatment
of patients with influenza.
3.5 Infection
Control
Precautions
Infection Control precautions will minimise exposure to and transmission of
micro-organisms.
Infection control precautions should be applied by
all healthcare practitioners
to the care of
all patients
all of the time.
Infection Controls precautions are:
Hand Hygiene
Use of Personal Protective Equipment (PPE)
- Gloves
- Masks
- Aprons
and
gowns
- Eye
protection
Safe use and disposal of sharps
Disposal of clinical waste
Safe handling of linen
Placement of patients
Transport of patients
Managing coughing and sneezing
3.6
Droplet Precautions required for pandemic influenza
In addition to the standard infection control principles, droplet precautions
should be used if a patient is known or suspected to be infected with influenza
and is at risk of transmitting droplets while coughing, sneezing or talking and
during some procedures. These are segregation/cohorting and the
management of coughing and sneezing patients.
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3.7
Patient placement, segregation and cohorting
3.7.1
In patient
Ideally patients with influenza should be placed in single rooms, but
during a pandemic this will not be possible.
Therefore patients should be ‘cohorted’ (grouped together with other
patients who have influenza and no other infection) in a segregated
area.
Where patients are cohorted on the basis of epidemiological and
clinical information rather than on laboratory-confirmed diagnosis, beds
should be at least one metre apart.
Special ventilation is not necessary, and the doors of segregated areas
can remain open (unless a patient is being isolated for another reason
in addition to influenza that requires the doors to be shut).
3.7.2
PCT health care clinics and primary care clinics
Patients with influenza from those without should be separated within a
designated self-contained area.
The area should:
Be
fully
self-contained
Include reception and waiting areas that are separated from
non-influenza patients
Have a separate entrance/exit door
Not be used as a thoroughfare by other patients, visitors or staff.
To control entry, signage should be displayed warning of the
segregated influenza area.
3.8
Management of a coughing and sneezing patient
Patients, staff and visitors should be encouraged to minimise potential
influenza transmission through good hygiene measures. These will be
advertised by the DH through a media campaign:
Cover nose and mouth with disposable, single – use tissues when sneezing,
coughing, wiping and blowing noses.
Dispose of use tissue in a lined, lidded waste bin.
Wash hands after coughing, sneezing, using tissues or contact with
respiratory secretions and contaminated objects.
Keep hands away from the eyes, mouth and nose.
Assist patients with the management and containment of used tissues by
supplying a plastic bag and hand wipes.
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In common waiting areas, coughing and sneezing patients should wear a
surgical mask.
3.9 Hand
Hygiene
Hand hygiene is the single most important practice needed to reduce the
transmission of infection in healthcare and patients home settings.
Hands must be decontaminated immediately before each and every episode
of direct patient contact or care and after any activity or contact that potentially
results in hands becoming contaminated, e.g. contact with the patient’s
immediate environment, handling of linen or waste.
Hands that are visibly soiled or potentially grossly contaminated with dirt or
organic material, e.g. after removal of gloves, must be washed with liquid
soap and water.
Hands should be decontaminated between caring for different patients and
between different care activities for the same patient. For convenience and
efficacy, an alcohol handrub is preferable unless hands are visibly soiled.
Hands should be washed with soap and water after several consecutive
applications of alcohol handrub.
Before a shift of clinical work begins, all wrist and, ideally, hand jewellery
(stoned rings) should be removed. Plain wedding bands are permitted.
All staff working in a clinical area will be bare below the elbows to ensure
effective hand hygiene.
Cuts and abrasions must be covered with waterproof dressings.
Fingernails should be kept short, clean and free of nail polish. False nails and
nail extensions must not be worn by clinical staff.
An effective hand washing technique involves three stages: preparation,
washing and rinsing, and drying.
Wet hands under tepid running water
before applying the recommended
amount of liquid soap.
The hand wash solution must come into contact with all the surfaces of the
hand.
The hands must be rubbed together vigorously for a minimum of 10–15
seconds, and particular attention should be paid to the tips of the fingers, the
thumbs and the areas between the fingers.
Hands should be rinsed thoroughly prior to drying with good-quality paper
towels.
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When an alcohol handrub is used to decontaminate hands, hands should be
free of dirt and organic material.
The handrub solution must come into contact with all surfaces of the hand.
The hands must be rubbed together vigorously, with particular attention paid
to the tips of the fingers, the thumbs and the areas between the fingers, until
the solution has evaporated and the hands are dry.
Clinical staff should be aware of the potentially damaging effects of hand
decontamination products. They should be encouraged to use an emollient
hand cream regularly, e.g. after washing hands before a break, or when going
off duty and when off duty, to maintain the integrity of the skin.
If a particular soap, antimicrobial hand wash or alcohol-based product causes
skin irritation, review the methods described above before consulting the
occupational health team.
Alcohol handrub should be made available at the point of care in al
healthcare facilities or carried personally by staff.
See Appendix A.
See Appendix B.
3.10 PERSONAL PROTECTIVE EQUIPMENT (PPE)
PPE is worn to protect staff from contamination with body fluids and to reduce
the risk of transmission of influenza between patients and staff and from one
patient to another.
Care must be taken to ensure that PPE is worn and removed correctly, in
order to avoid inadvertent contamination.
All staff must remove contaminated clothing – surgical masks or respirators
being removed last – and dispose of it appropriately as clinical waste, also
known as infectious waste, before staff leave a patient care area.
Appropriate PPE for staff who care for patients with pandemic influenza is
summarised in Table 1.
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SE
PATIENT
A
Wherever possible, aerosol-generating procedures should be performed in
side rooms or other closed single patient areas with minimal staff present (see
section 4).
B
Gloves and apron should be worn during certain cleaning procedures (see
section 5.5).
C
Gloves should be worn in accordance with standard infection control
principles. If glove supplies become limited or come under pressure, this
recommendation may need to be relaxed. Glove use should be prioritised for
contact with blood and body fluids, invasive procedures and contact with
sterile sites.
D
Consider a gown in place of an apron if extensive soiling of clothing or contact
of skin with blood or other body fluids is anticipated (e.g. during intubation or
when caring for babies).
E
If non-fluid-repellent gowns are used, a plastic apron should be worn
underneath.
F
Surgical masks (fluid repellent) are recommended for use at all times in
cohorted areas for practical purposes.
If mask supplies become limited or come under pressure, then in cohorted
areas their use should be limited to close contact with a symptomatic patient
(within one metre)
3.10.1
Aprons
Disposable plastic aprons should be worn whenever there is a risk
of personal clothes or a uniform coming into contact with a patient’s
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blood, body fluids, secretions (including respiratory secretions) or
excretions or during activities that involve close contact with the
patient (e.g. examining the patient).
AEROSOLGENERATINWITHIN ONEMETRE)
Plastic aprons should be worn as single-use items for one
procedure or episode of patient care and then discarded and
disposed of as clinical waste.
In cohorted areas, aprons must be changed between patients.
3.10.2
Gowns
Gowns are not required for the routine care of patients with
influenza.
Healthcare workers should wear gowns if they anticipate extensive
soiling of their personal clothing or uniform with respiratory
secretions, or if there is risk of extensive splashing of blood, body
fluids, secretions or excretions onto their skin.
Aerosol-generating procedures such as intubation and activities that
involve holding the patient close (such as in paediatric settings) are
examples of when a gown may be needed.
Fluid repel ent gowns are preferable, but if non-fluid repellent gowns
are used a plastic apron should be worn beneath.
Gowns should:
Ful y cover the area to be protected
Be worn only once and then placed in a clinical waste or laundry
receptacle, as appropriate.
Hand hygiene should be performed immediately after removal
of the gown.
3.10.3
Eye protection
Eye protection should be worn when there is a risk of contamination
of the eyes by splashes and droplets, e.g. by blood, body fluids,
secretions or excretions.
Individual risk assessments should be carried out at the time of
providing care to patients to identify those at risk and decide on
reasonable precautions to reduce the risk.
Eye protection should always be worn during aerosol-
generating procedures. This requirement extends to all those
present in the room during a procedure that has the potential to
produce an aerosol.
Eye protection can be achieved by using any one of:
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● a surgical mask with integrated visor
● a full-face visor
● polycarbonate safety spectacles or equivalent.
Disposable single-use eye protection is recommended.
If non disposable eye protection is used it must be decontaminated
after each use following the manufacturers instructions.
3.10.4
Fluid repellent surgical masks
Surgical masks should be fluid repellent and should be worn by
healthcare workers for any close contact with patients (i.e. within
one metre).
The mask will provide a physical barrier and minimise
contamination of the nose and mouth by droplets.
Surgical masks should:
Cover both the nose and the mouth
Not be allowed to dangle around the neck after or between each
use
Not be touched once put on
Be changed when they become moist
Be worn once only and then discarded in an appropriate
receptacle as clinical waste.
Hand hygiene must be performed after disposal is complete.
When influenza patients are cohorted in one area and several
patients must be visited over a short time or in rapid sequence (e.g.
in cohorted areas of a hospital or nursing home, an “influenza clinic’
or a GP surgery session for influenza patients), healthcare workers
are to wear a single surgical mask upon entry to the area and to
keep it on for the duration of the activity or until the surgical mask
requires replacement.
This also minimises hand-to-face contact and reminds healthcare
workers that they are working in a high-risk area.
However, other PPE (e.g. gloves and apron) must be changed
between patients and hand hygiene performed.
Although it may be more practical to wear a surgical mask at all
times in a cohorted area, if surgical mask supplies become limited
during a pandemic, surgical masks will be prioritised for use when
healthcare workers are in close contact (within one metre) with a
symptomatic influenza patient.
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All contaminated PPE must be removed before leaving a patient
care area.
Surgical masks or FFP3 respirators should be removed last,
and removal should be followed by thorough hand hygiene.
3.10.5
Respirators
A disposable respirator that provides the highest possible protection
factor available (i.e. an EN149:2001 FFP3 disposable respirator,
(FFP3) should be worn by healthcare workers when they perform
procedures that have the potential to generate aerosols.
If an FFP3 disposable respirator is not immediately available, the
next highest category of respirator available should be worn (i.e.
FFP2).
Every user should be fit tested and trained in the use of the
respirator. In addition to the initial fit test carried out by a trained
fitter, a fit check should be carried out each time a respirator is
worn.
The respirator must seal tightly to the face, or air will enter from the
sides.
A good fit can be achieved only if the area where the respirator
seals against the skin is clean shaven. Beards, long moustaches,
and stubble may cause leaks around the respirator.
FFP3 respirators should be replaced after each use and changed if
breathing becomes difficult, if the respirator becomes damaged,
distorted or obviously contaminated by respiratory secretions or
other body fluids, or if a proper fit to the face cannot be maintained.
Respirators should be disposed of as clinical waste.
Putting on and removing PPE
The level of PPE used will vary according to the procedure being
carried out, and not all items of PPE will always be required.
Standard infection control principles apply at all times.
Putting on PPE
Healthcare workers should put on PPE before they enter a single
room or cohorted area.
The order given here for putting on PPE is practical, but the order
for putting on is less critical than the order of removal.
1. Gown or apron if it is not an aerosol-generating procedure
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Ful y cover the torso from the neck to knees and the arms to the
end of the wrists, and wrap around the back.
Fasten at back of neck and waist.
2. Surgical mask (or FFP3 respirator if it is an aerosol-
generating procedure)
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 the respirator.
3. Goggles or face shield (in aerosol-generating procedures
and as appropriate after risk assessment)
Place over face and eyes and adjust to fit.
4. Disposable gloves
Extend to cover wrist of gown if a gown is worn.
Removing PPE
Healthcare workers should remove PPE upon leaving the room or
cohorted area in an order that minimises the potential for cross-
contamination
.
If a single room has been used for an aerosol-generating
procedure, those involved in the procedure should,
before leaving
the room, remove their gloves, gown and eye goggles (in that order)
and dispose of them as clinical waste.
After they leave the room they can remove the respirator and
dispose of it as clinical waste.
Hand hygiene should be performed after all PPE has been
removed.
The order for removing PPE is important to reduce cross-
contamination. The order outlined as follows always applies, even if
not all items of PPE have been used.
1. Gloves
Assume that the outside of the glove is contaminated.
Grasp the outside of the glove with the opposite gloved hand;
peel off.
Hold the removed glove in gloved hand.
Slide the fingers of the ungloved hand under the remaining
glove at the wrist.
Peel off second glove over first glove.
Discard
appropriately.
2. Gown or apron
Assume that the front and sleeves of the gown or apron are
contaminated.
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Unfasten or break the ties.
Pull the gown or apron away from the neck and shoulders,
touching the inside of the gown only.
Turn the gown inside out.
Fold or roll it into a bundle and discard appropriately.
3. Goggles or face shield
Assume that the outside of the goggles or face shield is
contaminated.
To remove, handle by head band or ear pieces.
Discard
appropriately.
4. Respirator or surgical mask
Assume that the front of the respirator or surgical mask is
contaminated.
Untie or break the bottom ties, followed by the top ties or elastic,
and remove the respirator or mask by handling the ties only.
Discard
appropriately.
Perform hand hygiene immediately after removing all PPE.
4
Aerosol generating procedures
Several medical procedures have been reported to generate aerosols, and it
has been suggested that some of these are associated with an increased risk
of pathogen transmission.
The risk associated with many aerosol-generating procedures is not yet well
defined, and the understanding of the aerobiology involved in such
procedures may change as further studies in this area are carried out. In a
recent (2007) revised WHO document,
Infection prevention and control of
epidemic-and pandemic-prone acute respiratory diseases in healthcare,
based on epidemiological studies on tuberculosis (TB) and/or SARS, the
following aerosol-generating procedures were considered to be associated
with a documented increase in risk of pathogen transmission in patients with
acute respiratory disease
Intubation and related procedures, eg manual ventilation and
suctioning
Cardiopulmonary
resuscitation
Bronchoscopy
Surgery and post-mortem procedures in which high-speed devices are
used.
Other controversial/possible procedures that may be associated with an
increased risk of pathogen transmission are non-invasive positive pressure
ventilation, bi-level positive airway pressure, high frequency oscillating
ventilation and nebulisation.
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Infection control and personal protective equipment in aerosol-
generating procedures
Only essential aerosol-generating procedures should be carried out.
Aerosol-generating procedures should be carried out in well-ventilated single
rooms with the doors shut.
Only those healthcare workers who are needed to perform the procedure
should be present.
A gown, gloves and eye protection must be worn during such procedures.
An FFP3 respirator should be worn for:
Intubation and related procedures, e.g. manual ventilation and
suctioning.
Cardiopulmonary
resuscitation.
Bronchoscopy.
For procedures with only a ‘controversial/possible’ increase in risk of
pathogen transmission, use of an FFP3 respirator instead of a surgical mask
may be considered prudent until data are available that al ow better
assessment of the risk associated with different procedures.
These include nebulisation and chest physiotherapy and emergency dental
procedures.
5
Environmental Infection Control
5.1
Clinical and non clinical waste
The Department of Health has published guidance on the safe disposal of
healthcare waste:
Health Technical Memorandum 07-01: Safe management
of healthcare waste.
No special procedures beyond those required to conform with standard
infection control principles are recommended for handling clinical waste (also
known as infectious waste) and non-clinical waste that may be contaminated
with influenza virus.
All items contaminated with secretions or sputum e.g. paper tissues and
surgical masks, will be treated as infectious clinical waste.
Gloves and aprons wil be worn to remove waste bags.
All waste col ection bags should be tied and sealed before removal from the
patient area.
Hand hygiene will be performed after removing the apron and gloves.
5.2
Linen and laundry
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Linen used during care of patients should be managed safely to reduce the
risk of contamination to staff, the environment and patients.
Linen should be categorised as ‘used’ or ‘infected’ as per the NHS Executive’s
Health Service Guideline (95) 18: Hospital laundry arrangements for used and
infected linen
Both used and infected linen must be handled, transported and processed in
a manner that prevents exposure to the skin and mucous membranes of staff,
contamination of their clothing and the environment, and infection of other
patients.
Linen should be placed in appropriate receptacles immediately after use and
bagged at the point of use.
If linen appears to be heavily soiled with body fluids, including respiratory
secretions, it should be treated as potential y infected and put into alginate
bags.
Linen bags must be closed before removal from the influenza patient care
area.
Gloves and aprons should be worn when handling all contaminated linen
Hand hygiene should be performed after removal of gloves that have
been in contact with used linen and laundry.
Paper sheeting should be used on patient examination couches. It should be
changed after each patient has been examined and the couch cleaned with
detergent.
5.3 Staff
Uniforms
During a pandemic, healthcare workers should not travel to and from work or
between remote hospital residences and places of duty in uniform.
Community staff will be required to use PPE at the entrance to each patients
home and remove before leaving the property. At the end of the shift staff will
be required to change out of their uniform and transported as detailed below.
Changing rooms or areas where staff can change into uniforms upon arrival at
work will be provided.
Uniforms should be laundered in a domestic washing machine at the optimum
temperature recommended by the detergent manufacturers that is appropriate
to the maximum temperature the fabric can tolerate, then ironed or tumbled
dried.
Uniforms should be transported home in a tied plastic bag and washed
separately from other linen in a load not more than half the machine’s
capacity, in order to ensure adequate rinsing and dilution.
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5.4 Crockery
and
utensils
The usual mode of cleaning with detergents and hot water is appropriate.
5.5
Environmental Cleaning and disinfection
Freshly prepared neutral detergent and warm water should be used for
cleaning the hospital or other healthcare environment.
As a minimum, areas used for cohorted patients should be cleaned daily. This
includes surfaces and patient bed area equipment.
Clinical rooms should be cleaned at least daily and also between clinical
sessions for patients with influenza and those for patients not infected with
influenza, if the same clinical room is used.
Frequently touched surfaces such as medical equipment and door handles
should be cleaned at least twice daily and when known to be contaminated
with secretions, excretions or body fluids.
Domestic staff should be allocated to specific areas and not moved between
influenza and non-influenza areas.
Domestic staff should wear gloves and aprons when cleaning general areas.
Domestic staff should wear gloves, aprons and masks when cleaning the
immediate patient environment in cohorted areas
Dedicated or single-use/disposable equipment should be used when possible.
Non-disposable equipment should be decontaminated or laundered after use
in line with the manufacturers instructions.
Any spillage or contamination of the environment with secretions, excretions
or body fluids should be treated in line with the PCT spillage policy.
5.6
Medical and nursing equipment
Gloves should be worn when handling and transporting used patient care
equipment.
Heavily soiled equipment should be cleaned with neutral detergent and warm
water before being removed from the patient’s room or consulting room.
Reusable equipment (eg stethoscopes and patient couches in treatment and
consulting rooms) must be scrupulously decontaminated between each
patient; equipment that is visibly soiled should be cleaned promptly. Where
applicable, follow local and manufacturers’ recommendations for cleaning and
disinfection or sterilisation of reusable patient care equipment.
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External surfaces of portable equipment used for procedures in the patient’s
room or consulting room should be cleaned with neutral detergent and warm
water upon removal from the room.
In addition to these standard practices, non-critical patient equipment should,
whenever possible, be dedicated to the use of influenza patients only.
Use of equipment that re-circulates air (such as fans) should be avoided.
5.7
Furnishings
All non-essential furniture, especially soft furnishings, should be removed from
reception and waiting areas in hospitals, clinic rooms and GP consulting and
treatment rooms.
The remaining furniture should be easy to clean and should not conceal or
retain dirt and moisture.
Toys, books, newspapers and magazines should be removed from the waiting
area.
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Appendix A
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Appendix B
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