MERS-CoV infection control

Transcription

1 WORKING DRAFT Last Modified 26/05/ :43 Arab Standard Time Printed 26/05/ :43 Arab Standard Time INTERIM VERSION, MAY 26, 2014 PICTURES UNDER CLEARANCE MERS-CoV infection control Hospital staff training Training presentation May 26, 2014

2 Infection control is the only way to stop the spread of MERS-CoV As of the 25th of May: No vaccine No treatment High death rate Highly contagious in a hospital setting Hospital staff at high risk if not following infection control rules Strict infection control is the only way to stop MERS-CoV from spreading everyone of us is responsible and can help to stop the disease SOURCE: KSA MoH 1

3 Your 10 steps to fight MERS-CoV in your hospital 1. Maintain strict personal hygiene 2. Ensure proper use of PPE by staff and patient 3. Identify and isolate potential MERS-CoV patients early 4. Allocate adequate facilities for MERS-CoV patients 5. Follow appropriate housekeeping practices 6. Monitor staff health don t allow sick people at work 7. Implement stricter visitor policy 8. Send for home isolation under supervision, when possible 9. Ensure safe collection and handling of lab samples 10. Take precautions in the mortuary 2

4 1. MAINTAIN STRICT PERSONAL HYGIENE You already know this, you just need to DO IT EVERY DAY Hand hygiene Cough etiquette Short nails, no watches, no jewelry Other basics Avoid touching your face Avoid touching patient s items Do not share personal items Shower after work Change uniform daily Keep home clean and ventilated If you feel sick, do not come to work tell your senior over phone Avoid contact with sick colleagues SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; the Infection Control powerpoint 3

5 2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS Droplet and contact precautions required when dealing with potential MERS-CoV patients; N95 to be worn during aerosol generating procedures Potential/confirmed MERS-CoV: in patient s room/close contact contact and droplet precautions (for healthcare workers and visitors) Surgical mask (N95 for aerosol generating procedures) Eye protection (goggles/face shield) Gown (clean, non-sterile, long-sleeved) Gloves (some procedure may require sterile gloves) Impermeable apron (for procedures with expected splashes) May be considered if resources permit: Airborne precautions with all potential/confirmed MERS-CoV patients (N95) Surgical mask for all fever/respiratory patients at the ER entrance Safely remove PPE and perform hand hygiene when leaving the MERS-CoV precautions area (e.g., isolation or procedure room) SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

6 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Promptly identify symptomatic patients at the hospital entry and take MERS-CoV precautions until recovery, regardless of test results Patients with fever, ARI 1, diarrhea and other Take precautions for MERS-CoV PPE for staff and source control for patient Isolation 2 Test for other pathogens. If patient meets MERS-CoV case definition, also test for MERS-CoV MERS-CoV positive MERS-CoV negative 3 Take precautions for MERS-CoV until symptoms resolve PPE for staff and source control for patient Isolation 2 When possible Identify symptomatic patients at the hospital entrance Allocate a separate room/area in ER for symptomatic patients Allocate separate procedure rooms for symptomatic patients Restrict visitors and do not rotate personnel in high risk MERS-CoV area 1 Acute respiratory infections symptoms including runny nose, sneezing, coughing, shortness of breath 2 In hospital or home 3 And no alternative confirmed diagnosis / still suspicion for MERS for multiple reasons, negative tests do not fully rule out possibility of MERS-CoV SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

7 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS MERS-CoV case definition has to be followed when testing for MERS-CoV Suspect case (patients who should be tested for MERS-CoV) I. A person with fever and community-acquired pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence OR II. OR A hospitalized patient with healthcare associated pneumonia based on clinical and radiological evidence III. A person with 1) Acute febrile ( 38 C) illness OR IV. AND 2) Body aches, headache, diarrhea, or nausea/ vomiting, with or without respiratory symptoms AND 3) Unexplained leucopenia (WBC<3.5x10/L) and thrombocytopenia (platelets<150x10/l) A person (including health care workers) who had protected or unprotected exposure to a confirmed or probable case of MERS-CoV infection and who presents with upper or lower respiratory illness within 2 weeks after exposure A probable case is a patient in category I or II with absent or inconclusive laboratory results for MERS-CoV and other possible pathogens who is a close contact of a laboratory-confirmed MERS-CoV case or who works in a hospital where MERS- CoV cases are cared for A confirmed case is a person with laboratory confirmation of MERS- CoV infection SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

8 4. ALLOCATE ADEQUATE FACILITIES FOR MERS-CoV PATIENTS 1 Place patient in isolation aim for airborne precautions, use substitutes if not available Patient placement requirement Place patients with suspected, probable or confirmed MERS-CoV infection in adequately ventilated single rooms or airborne precaution rooms (negative pressure) if available The rooms used for isolation should be situated in an area that is clearly segregated from other patient-care areas When single rooms are not available, cohort put patients with the same lab confirmed diagnosis together (i.e., taking into consideration positive MERS-CoV and other contagious diseases ) If this is not possible, place patient beds at least 1 m apart Additional practices Use HEPA-filters when negative pressure rooms not available In shared rooms consider using physical barriers (curtains etc.) 1 Both, potential and confirmed More information: GCC Infection Control Manual GCC-ICM-III-03, 04, 05 SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

9 5. FOLLOW APPROPRIATE HOUSEKEEPING PRACTICES Housekeeping standards and rules should be followed Requirements Item sharing Housekeeping standards Areas Use disposable or dedicated equipment (e.g. stethoscopes, thermometers etc.) when possible Clean and disinfect shared equipment between patients Discard single-use devices in a hands-free waste bin Comply with the hospital s standards and GCC Infection Control Manual on all procedures (cleaning, waste etc.) Follow PPE requirements for MERS-CoV or higher Use hospital approved disinfectants with approved dilution Clean all horizontal and frequently touched surfaces (incl. medical equipment) at least twice daily/once a shift Clean isolation areas last; when possible, change mop head after each isolation room, disinfect after each use Follow hospital s terminal cleaning protocol for patient s room when vacated by the previous patient SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

10 6. MONITOR STAFF HEALTH DON T ALLOW SICK PEOPLE AT WORK Monitor staff health identify and exclude symptomatic staff from work Healthcare facility Staff Recommendations Implement flexible non-punitive sick leave policies for staff Provide staff with quick access to medical consultation and treatment Screen all staff for MERS-CoV symptoms at the beginning of the shift Exclude symptomatic staff from work Dedicate the same staff to MERS-CoV patients Track staff exposure to MERS-CoV patients If resources permit, provide separate accommodation for staff with regular exposure to potential/confirmed MERS-CoV patients In general: Monitor MERS-CoV symptoms Report to supervisor if symptomatic If symptomatic Do not come to work/stop working immediately Notify supervisor Wear surgical mask for source control Seek prompt medical evaluation Stay on leave until no longer infectious If asymptomatic but had unprotected close MERS-CoV exposure Monitor symptoms Wear surgical mask for source control (when not wearing N95) Consider exclusion from work until found non-infectious SOURCE: CDC MERS-CoV recommendations 9

11 7. IMPLEMENT STRICTER VISITOR POLICY Limit the number of visitors and train them to comply with precautions Visitor management requirement Limit the number of visitors and family members to those essential for patient support Additional practices if resources permit Screen visitors for ARI symptoms at the hospital entrance Evaluate risk to visitors health (e.g., due to underlying illness) and ability to comply with precautions Instruct visitors on hand hygiene, potentially contaminated surfaces, and use of PPE, before entry into the patient care area and supply necessary equipment (e.g., surgical masks) Track (e.g., via logbook) all visitors to MERS-CoV patient rooms Allow no visitors during aerosol-generating procedures (and if possible, for one hour after) Limit visitor movement within the facility (e.g., visitors to MERS- CoV patient rooms should not visit other areas) 1 Acute respiratory infections SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC MERS-CoV recommendations 10

12 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Patients with no shortness of breath, hypoxemia or pneumonia can be isolated at home, provided home facilities meet the requirements Assess (by phone or direct observation) whether the home is appropriate for isolating the ill person The home should have a functioning bathroom ideally, one bathroom should be designated solely for the ill person The ill person should have his or her own bed and preferably a private room for sleeping Basic amenities, such as AC, electricity, potable and hot water, sewer, and telephone access, should be available There should be a primary caregiver who can - Follow doctor s instructions for medications and care - Help the ill person with basic needs Follow MERS-CoV Home Isolation Guidelines for patient home care requirements SOURCE: KSA MoH MERS-CoV Home Isolation Guidelines, May

13 9. ENSURE SAFE COLLECTION AND HANDLING OF LAB SAMPLES MERS-CoV testing practices and lab procedures should follow strict PPE Responsibilities Swabbing 3 Transport Swabbing should be done based on MERS-CoV case definition Swabbing personnel 1 should be properly trained on the technique and wear PPE appropriate for aerosol generating procedures Use well-ventilated 2 (min 6-12 air changes/hour) separate room in line with aerosol generating procedures requirements Fill the test form completely Ensure that healthcare facility laboratories adhere to appropriate biosafety practices and transport requirements Personnel who transports specimens should be trained in safe handling practices and spill decontamination Use leak-proof plastic biohazard specimen bags that have a separate sealable pocket for the specimen Maintain the temperature requirement (+4 degrees Celsius) for keeping the sample valid from collection till processing Notify the lab that the specimen is being transported All samples should be sent for testing to one of the 5 regional MoH labs 4 unless otherwise specified (e.g., unless your hospital lab has acknowledged capabilities to run the PCR test for MERS-CoV) 1 Physicians or nurses, based on the hospital policy 2 When resources permit, negative pressure 3 Video on how to take nasopharyngeal swab: 4 Jeddah, Riyadh, Dammam, Makkah, Medina SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

14 10. TAKE PRECAUTIONS IN THE MORTUARY Ensure adequate level of PPE in the morgue and follow strict visitor policy Morgue staff PPE Hand hygiene Gloves N95 respirator Impermeable/water resistant protective gown Boots/shoe covers Deceased bodies pose a potential MERS-CoV infection risk General requirements Body should be placed in appropriately sized plastic body bag Body washing must be done at the hospital morgue If the family members wish to perform the body washing, they must adhere to the same precautions as body washers Inform the family members about the risks associated with removing the body from the body bag Eye protection (if the body needs to be embalmed) More information: GCC Infection Control Manual GCC-ICM-VIII-10 SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May

15 More information sources KSA MoH website about MERS-CoV KSA General Directorate for Infection Prevention and Control GCC Infection Prevention and Control Manual CDC on MERS-CoV WHO on MERS-CoV KSA MoH call center (toll free) suggestions about this presentation to 14