of infeeinn

facilities
thes In most
reduce health
Titealto ireated or
caredcarc
124
8. Natureofinfection
practiees
ate' there re or
many microin
come into
iste
tipt
ontrod
intection
settinggs, contain
contacl
can potentially
infections belwcen p
win
practice andinclude:
health tiatprevcnt
measures
Large amountsof wa
axd
publicmcasures
1l.csC
body substances
care varsdiscasc
In
hcalth
cludes droplet
and carc setlings icrea
tnfeous
trol
spreadof
theHandWashing standard.
contact, Controlling the sp
facilily is, therefor
personsand
control
Intection
airborne of
dccontamination
precautions environment Infection control in
settings
for
Proceduresofcquipment andthe
disinfecton contacts(if
ncCessary) Infections contrac
individuals nosocomial infecti
Quarantineofexposed of all hospital patien
Prophylaxisof infction
vectors of time spent in the ho
Controlofthe procedures are many reasons n
and infections, of which is that m
Definition reters topolicies
spreading
control
Infectionminimize risk of animalhealthcare immune system
the humanor infections.This y
used to hospitalsand
especiallyin
by healthcare either by the pat
Measurestransmission&acquisition the patient. Se
facilities. practiced
Infection Control care increase the ris
spread, health
personneltoprevent
between
clients, from healthcare
to
agents into the
infection clients to hospitals bec
of clients & from
providers to agents can the
provider. care facility is the hospital work
in ahealth
Infection Controlspread microorganismsfrom:
of Threat of em
preventionofthe
Patient to patient Due to consta
member new disease
Patient to Staff
susceptible
Staffmember to patientmember
staff infectious
Staff member to have been
Ebola, ar
Purpose
infection control is to reduce the continent
The purpose of diseases. These diseases are
occurrence of infectious spread bigger co
and can be
usually caused by bacteria or viruses human contact, common
byhuman to human contact, animal to
surface, airborne known t
human contact with an infected
transmission through tiny droplets of infectious agents The en
suspended in the air, and, finally, by such common vehicles syndro
as food or water. Diseases that are spread from animals Was a
to humans are known as zoonoses; animals that carry rapidl
disease agents from one host to another are known as interna
vectors. SARS
 Foundation -I
Texthook of Nursing
Infection Control in health
Importance of
facilities
carefacilities
many
sick
Care
atc critical to reduce the In most health confined spaces. people
Tom oncperson to another,
for in
trcatcd or caredmicroorganisms prescnt.This mncansare,
Worker to a patient or vice there are many
Conc into contact
with many members
spread the
Patistaffents whowhwil
of
h practice settings, infection
can potentially
infcctions between patients. mícroorganisms and
ITes that prevent and contain contaminated with
Large amounts of waste
ie. Tl.cse Imeasures include:
body substances are
handledi and processed
in blood and
and
care settings incrcasing the
risk of infection health
ard, contact, droplet Controlling the sprcad of infections in a health
facility is, thercfore, very important. care
nination of persons and
Infection control in hospitals and other
and the environnncnt

nccessary) settings
health care
Infections contracted in hospitals are
also
approximatelycalled
widuals
nosocomial infections. They occur in
cction
ofall hospital paticnts. These infections result in 5%
increased
timespent in the hospital and, in sorne cases, death.
licies and procedures arc many reasons nosocomial infections Ther
are common,
,one
e
sprcading infections, of which is that many hospital patients havea
an or animal hcalth carc immune system whích makes them more
weakencd
weakenedto
susceptible
infections. This limmune system can be
acticed by hcalth care cither by the patient's díseases or by treatments causedto
Tission &acquisition
givencarn
the paticnt. Second, many medical procedures
.from hcalth care incrcase the risk of infection by introducing infectioue
lients to hcalthcarc agents into the patient. Thirdly, many patients are admited
to hospitals because of infectious disease. These infectious
care facility is the agents can then be transferred from patient to patient by
Organisrns frorn: hospital workers or visitors (Table - 8.1 ).
Threat of emerging infectious diseases
Due toconstant changes in our lifestyles and
new diseases are constantly appearing that environments,
people are
susceptible to, making protection from the threat of
infectious disease urgent. Many new contagious diseases
have been identified in the past 30 years, such as
is to reduce the Ebola, and hantavirus. Increased travel AIDS.
between
d can be spreai
contínents rmakes the worldwide spread of disease a
bigger concern than it once was.
hurran At, Additionally, many
Comnon infectious diseases have become
iact, arborne krwn trcatrnents. resistant to
The emergence of the
severe acute respirator'
syndrome (SARS) epidemic in Asia in February 2003
Wasa classic instance of an that spread
rapidly because of the eImerging disease
iriternational increased frequency
and intercontinental travel. In addition.the
SARS otrcak
the vulnerabilityofhospitals
 :
Introduction to Infection Control in Clinical Setting
Infection 141

fine disease organisms and Precautions

IS. Hand Hygiene
uce number of organisms and (Hand washing and use of hand Rub)
ction to others. Handwashing is the act of cleaning one's
of any liquid with or without soap for hands with the use
ical vs Surgical Asepsis the
dirt or micro-organisms. It is the mostpurpose of removing
in effective measure
ivided into two main categories reducing risk of transmitting infectious diseases.
the
is and surgical asepsis. The key Hand washing or hand hygiene is the act of cleaning one's
ical asepsis and surgical asepsis hands with or without the use of water or another liquid,
we defined. Medical asepsis is or with the use of soap for the purpose of removing soil,
: number of disease-causing dirt, and/or micro-organisms.
read. On the other hand, the It cannot be said too often that hand washing is the most
of the disease-causing agents important and most basic technique in preventing and
om the surface of an object is controlling infections. It is the single most effective
asepsis. infection control measure.
Table -8.4 Handwashing is under the umbrella of hand hygiene.
Hand hygiene is defined by the World Health Organization
cal vs Medical Asepsis asa general term that applies to handwashing, antiseptic
is the| Surgical asepsis is handwash, antiseptic hand rub or surgical hand antisepsis.
mber of complete elimination of the
the
ents and Types of Hand Hygiene
disease-causing agents and
their spores from the surface The following are the types of hand hygiene:
of an object. Routine handwash. Use of water and non
sed in the In
\ed clean surgical asepsis, sterile antimicrobial soap for the purpose of removing soil
technigues are used. and transient micro-organisms.
and
s carried Antiseptic handwash. Use of water
istration of Sterile techniques are and
followed in changing antimicrobial soap (e.g., chlorhexidine, iodine
dions, iodophors,chloroxylenol [PCMX], triclosan) for the
tubedressings of a
catheterization, wound,
and purpose of removing or
destroying transient
surgeries. micro-organisms and reduce resident flora.
an
Alcohol-based hand rub: Rubbing hands with
hand washing)
sof alcohol-containing preparation (used after
Asnessasept&c practicesindepends on the nurse's Antiseptic handrub. Use ofalcohol
-basedhandrub.

sTirst
consistency using effective aseptic Surgical antisepsis. Use of water and
Soap (e.g., chlorhexidine,
antimicrobial
iodine and iodophors,

rTesepsopnsiobnlesibil ty providing
for
to the client is to first do
the client with
chloroxylenol [PCMX], triclosan)
reduce resident flora.
transient
removing or destroyingRecommended
for the purpose of
micro-organisms and
duration is 2-6
a minutes.
key
sTeichioanibreaprhatk meoceduraseptic
al procedures. However, Indicators of Hand Hygiene
te io be steps or, when hurried, Organization (WHO).
According to the World Health

ighingale, 1859cani)culoseriously us impair client

will place the there are Five Moments for Hand Hygiene:
at 1. Before Patient Contact.
recovery. 2. Before and Antiseptic Task.
3 After Body Fluid Exposure Risk.
4. After Patient Contact.
Surroundings(Fig. 8.4).
5. After Contact with Patient
lexek ofNursing Foundation -I
 Foundation -I
Textbook of Nursing
142

2. Before
clean/asepic
procedure

1. Before 4. After
touching touching
a patient apatient

3. After body
fluid exposure
risk

5. After
touching patient
surroundings
1. Before touching
a patient When?
Why? ToCleanprotect
your hands before
2. Before cleanlaseptic the patient touching a patient
against harmful germswhen
procedure When? Clean your carriedapproachi
on yourng him/her.
3. After
body fluid
Why? To
protect thehandspatient
im media tely before hands.
exposure risk
4. After ouching
When? Clean
Why? To protyour hands
períormiincuding
against harmful germs nga cleanltheaseptic procedu his/herbody

When? Clean youryourselfimandmeditheately after an exposure risk to body

a patient ecl pateint s Own, from entering

side after health-care fluids (and after glove removal).

touching apatientenviandronment harmful patient germs. leaving
the palient's hands from
5. After touching Why? To
patient surroundings When? prolect yourself and the her/his
Clean your
hands health-c are immedi
Why? To leaving - evenafterif touching any environment from harmful patient
when ate surroundings, when

prolect yourself andthethepatient has obiect or germs.

not been furniture in the patient's Surroundings.

Equipment: Fig. 8.4 health-care touchedfrom

environment
immediate
Sink with warm and
:Y our 5
oment s for Hand
harmful patient germs.
Tissue paper or smallcold running water.
towels,
Hygiene
Trash can- nail cleaner Soap or detergent
Soap dispenser or soap and
soap dish
Warm running water
Fig. 8.5, 8.6).
(Table -8.5 & Papcr towels
Supplies Needed Aleohol
The following materials or
equipment are cutOpiicloenalst:ickAntiseptic cleaner, lingernailbrush.
perform hand washing: needed to
PrhygiBeloceoenewduraremchods:
es the
step-by-step guide for
 Unit - VIII : Introduction to Infection Control in Clinical Setting Infection 143

Table-8.5
Nursing Actions Rational
S.no
inspect hands, observing for visible soiling, breaks Poor personal hygiene and an open area of the skin provide
cuticles
and
orcuts in the skin areas in which microorganisms are able to grow
Datermine the type of hand hygiene needed Determine amount of contaminate of hands
2
Assess areas around the skin that are contaminated Prevent contarmination of hands during and after hand hyaiene
3 procedure
and watch bands: removing
Remove jewelry except plain wedding band and push Microorganisms collect in jewelry wrists
watch and long sleeves
above wrist jewelry makes it easier to wash all areas of hands and
cold can chap skin, and too much
Adiust the water to appropriate temperature and force Water is too hot or too to
5 force can cause splashing and spread microorganisms
other areas, especially your clothing
the most contaminated part of the upper
Net hands and wrist under the running water, alwaysHands are (least
elbows extremities; water should follow from the wrists
6
keeping hands lower than
contaminated areas) over the hands, and then down the drain
Soap Soap lather emulsifies fat and aids in cleaning
Lather hands with liquid
resident
Helps to loosen soil and microorganisms, both
7
Wash hands thoroughly usSing a firm, circular motion transient (acquired from
and friction:
(normaly present) and
contamination)

together
a. Rub palms
both hands
9 b. Rub the back of
hands together
10 c. Interlace and rub
back of fingers of both
11 d. Interlock fingers and rub the
clasped in right
12 e. Rotational rubbing of left thumb
palm and vice versa;

f Rotational rubbing,
backwards and forwards with
13
palm and vice
clasped fingers of right hand in left
versa;

14 q. Rub both wrists in a rotating manner;

microorganisms, and re
for 15to 30seconds, rinse thoroughly and wash Rinsing removes the loosened
Wash
lathering ensures more thoroughly cleaning the greater the
15
another minutes, using continuous friction contamination, the more needed for longer washing
wrists) over
The water should run from cleaner areas (the
16 Rinse wrists and hands completely -.- keep hands microorganisms
lower than elbowS the hands, and then down the drain, rinsing
away

Prevent chapping drying should progress from clean to

less
Uny nandsthoroughly with paper towels, start by patting
17
fingers and hands
and the cleanest areas are now your
clean,
at fingertips, then hands, then wrists and forearms
contaminated hands
18
Turn of faucets using a dry paper towels Keeps cleans hands from touching
not crack easily
14
Use hospital- approved hand lotion if desired Keeps skin soft and lubricated so it will
nails
inspect hands and nails for cieanliness Ensures cleanliness of hands and
hygiene siows down
Helps the patient understand that hand
Provide patient teaching
importance of hand hyqiene
explain to the patient the
the spread of infection
 argurnert a t
ht
sc
ioigy TextbookofNursingFoundation
sctatar/forraliotic sot
the
thxt
of
Some thoLIgtut
Asserlin
of

ch

alco
e of
144 The
Ensarejew
Back othands

Botweonfingers asper mana

Palmtopalm 3 Rubhands
4 Righe
palnn
andvice
Palmto pa
Wrists Rinse and wigs Gry
Backsof
Fingernails nteriaced
Fig.8.5
Backoffingers 7 Rotational
2 andvice
Rotationa
claspedf
Ruo the bat
7 Stepsto Rubpalnstogether of the hands Versa
Handwashing
Rubbing
5 9 continuin
product
Rub thurnb in a rotating trrey
3
Interlockfingersand followed by the arez Antiseptich
finggers finger andthurnb for brtr
Interlacefingers and rub the backof AsoknOWn2
ofbothhands
rubhandstogether toretucethe
7
1. Gathert
Rub both wrísts ín a sink
Rub fingertips on rotating manner,
hands STEP 2 Wetthe
palmforboth
STEP elbows t
3
STEP 3. Cover al
4. Withfim
and bac
wIists,
hands STEP fingers and rut harcs rete
Interlace 30 seco
STEP
Rub the back of the
Rub
STEPpalms together 5. Rinse tl
m5 fingertip
6. Pat han
upward
discard
Rub fingertips on palm for both nands 7. In the a
Interlock fingers and rub the back of Rub thumb in a rotating manner
STEP
fingers of both hands followed by the area between index clean p
7 finger and thumb for both hands Surgical A
Also know
of an oper
fromtheu
field for sL
Rub both wrists in a rotating manner,
Rinse and dry thoroughly
Fig. 8.6
 Use of Personal Protective Equipment (PPE)
ed Isolation refers to techniques used to prevent or limit the
spread of infection. Some forms of isolation has been
e used for centuries, whether to protect a high-risk person
from exposure to pathogens or to prevent the transmission
n of pathogens from an infected person to others. Barrier
S. nursing or isolation technique is intended to confine the
micro-organisms within a given and recognized area.
There are a nunber of isolation techniques and
precautions used to prevent the spread of infection.
,
or Personal protecting equipments: types, uses and
technique of wearing and removing
e According to the World Health Organization (WHO),
personal protective equipment "...consists of garments
g placed to protect the health care workers or any other
persons to get infected".
Medical PPE typically includes face protection,
goggles and mask or face shield, gloves, gown or coverall,
head cover, and rubber boots.
Thefollowing page addresses specifically medical PPE,
for the protection against possible external infectious
a
pathogens or substances.
e
 3. Eye protection
Occupational Salety and Health as goggles. Th
According to the protection of healthcare of your eyes
Administration(OSHA) the exposures in the contact with t
infectiouN discaNc
workers from enter the bod
combination ofcontrols:
workplace requies a controls: By
adninistrative 4. Clothing: Inc
I. Training and control
providing appropriate safety and infection shoe covers.
to hcalthcare professionals, and administrative Where We Sho
training applying isolation
controls such as establishing and
procedures to identify PPE is used im
policies and procedures, also
with communicable discases before the Acute Care
paticnts
exposure to thehealthcare worker. Long Term
negative pressure
2. Engineering controls: such as diseases such as Outpatient
rooms for patients with airborne Communit
Tuberculosis (TB) PPE is neede
3. Work practice control: forexample, not recapping residents, andc
ncedles.
certainly inclu
4. Personal Proteetive Equipment (PPE): Although aphysiotherar
PPE is at theend of the hierarchy of prevention, it is
very important for protecting hecalthcare workers from General PPE
disease transmission. Wear glo
Types of PPE fluids.
1. Gloves: Protects your hands from microbes and Wear sa
minimizes the possible spreading of microbes. infectio
2. Masks: Cover your mouth and nasal area. Some Wear a
masks have a see-through plastic picce, which also infectio
covers your eyes(shield). Aspecialrespiratory mask
Use a
(respirator) forms a tight scal around your nose and substar
mouth. It can be useful to minimize the
smaller microbes, such as tuberculosis inhalation of Wear h
bacteria.
cquipn
 Protectthe
Personal worket Equip
Protective

Controls includes face shiclds

Hierarchy of as welI
8.7:
Fig. protection: Thisprotcctthe mucous
and Health
Eye
3. goggles.
They can
bodily
eyes eyes, microbes within the
fron
membrmakeanes
fluids
fluids. If the

of healthcare
as
of your
withthe the mucous {luid can
membranes,
sures in the contact through th
body head
ls:
ontrols:By
enterthe Includes gowns,aprons,
Clothing:
4. shoe covers.
covering, and
ction control
PPE
dministrative Should Use
ngisolation Where We all healthcare settings:
used in all
stoidentify PPE is
before the Acute Care
Long Term Care
e pressure Outpatient Care
es such as CommunityCare
PPE is needed where contact occurs with patients,
ecapping and clients (PRC). The
The PRCs environment
residents,
certainly includes physiotherapy departments, clinicsand
Although physiotherapy treatmentroom in along term carefacility,
ion, it is a
ers from General PPE Guidelines (as outlined by OSHA)
Wear gloves, when handling chemicals and/or bod
fluids.
s and Wear safety shoes/boots/covers if hazardous or
infectious substances are likely to splash.
Some Wear an apron/gown/coveralls- if hazardous or
also infectious substances are likely to splash.
mask
Usee arespirator: when hazardous or infectious
and
nof
substances are airborne such as tuberculosIs.
suchasfru
Wear hearing pprotection: for loud noises
cquipment.
 Unit -- VIII :
Introduction to Infection Control in Clinical
PPE carefully to Setting Infection 147
avoid
Remove
contaminating at a temperature of 28°C
PPE may cause heat stresswearing a full-body
ventilated
Disposeof PPE in designated
leaingthearea,
containers before and dehydration, whereas
temperature of 22°C had no negative impact on the a
physical parameters. same
slectionoff
Appropriate PPE The WHO
recommends that airborne and contact
precautions should be followed when performing aerosol
generating procedures.
This includes the use of
gloves and gowns (ApronsN95/respirators,
should
eye
also be usedprotection.
if gowns
are not fluid-resistant) However,
follow your local
guidelines, as there are inconsistencies in the
recommendations of organizations and countries.
Different Types of Personal Protective Equipment
Medical Gloves
Fig. 8.8 Medical gloves are examples of personal protective
equipment that are used to protect the wearer and/or the
immportantto consider the following factors patient from the spread of infection or illness during
Itis PPE: medical procedures and examinations. Medical gloves
inluencing the selection of are one part of an infection-control strategy.
touch
Tipe of anticipated exposure: Such as from
volumes of Gloves should be worn if you anticipate being
or surfaces, splashes or sprays, or large
hodily fluids, which may seep through the clothing. exposed to the following situations or substances:
of PPE). is
PPE selection (and combinations Blood or body substancesfluids and solids
determined by the category of isolation of the patient Mucous membranes-oral, nasal, conjunctival, rectal,
CDC).
being treated (see the link below from the genital
PPE for
:. Durability and appropriateness of thewhether a Non-intact skin-wounds, surgical incisions
the task. Ihis will affect, for example, Indwelling device insertion site-urinary and
required, the
gown or apron is selected. If a gown is intravenous catheters, feeding tube
Does it need to be
type of gown is also important. Potentially contaminated items in the resident's
fluid resistant, fluid proof, both or neither? environnment
3. Fitting. PPE must fit the individual user (fom a proper Visibly soiled equipment, supplies, or linens that may
seal). For example: ifa glove is too large /too small have been in contact with blood or body fluids.
than the person's hand, it willcompromise the level Shared equipment moving between residents
of protection while also affecting the dexterity of the
health care provider. Types of Gloves
tendency to tear. They
Ihere are also some limiting factors to consider when 1. Polythene: Thin and have a
healthcare settings.
Wearing PPE in ahealthcare environment. It is important are not an appropriate choice for
l0 have afull understanding of the ifferent types of PPE shown to be less effective
2. Vinyl: They have been impermeable barrier
Men making your selection based on the purpose and than latex gloves in providing an also loose-fitting
goal of the protection. against micro-organisms. They are require manual
that
USing ahead or fullbody ventilated PPE suit equipped and unsuitable for procedures
gloves in healthcare is
aith powered-air-purifying-respirators was found to cause dexterity. The use of vinyl
teduced dexterity due to multiple glove layering. Back limited. Natural
pain related to the respirator of the fully ventilated suit Latex including DPNRL (De Proteinised
3. than vinyl and provide
andimpaired visibility by aflexible face shield may also Rubber Latex): Closer fitting micro-organisms.
be an barrier against
a more effectivenon-powdered and have the lowest
may alsoissue.have an impact
The temperature of the work environment
l on healthcare workers; working They should be
 lextbokofNusng boundatin-I
148
are generally
I'a healthwar 1 T'he purpose of use: Isolation gow t1s
levelofeNIractable protemavailable rot the pretemd PPE tor clothing. but aprots are
allergy, thev should OcaSIOnallv used where Iimitei contaILtaton is
worker has asUspetediatexwhen caring tora patient
anticpatei. it Contamination of the rms can be
Car latexgloves Sinilarly, an alternative
who is known to be sensitivelolatex, Healtheare anticipatd, a gown should be selected. Gows shouit
should also be available for use,
Most tully cover the torso, tit comfortably over the body
due to the allergy andhave long sleeves that tit snuggly
at the wTÌST
Netings are now bevoming latex- tiv 2. The material properties of the gown: Isolation
risk to patients and statt.
rubber either of coton or a spun syndheic
4. Nitrile (acrylonitrile): (Comparable to naturalarguably gOWns re made
wheetherthey can be laundered
latex in providing a biological barricr but material which dictutes
aflord less elasticity, Nitrile gloves are the comon must be disposed ot. Cotton and spun
and reused or deeree of:
choice of gloves for use where a latex-free Svnthetic isolation gOwTIS Vary n their
cnvironment is required. There have lhowever been factor tihat must be considered
resistance, another
reports ofhealthcare workers also developing allergie type of PPE. If!tluid peneration
the selection of this gowm should be used
is likely, a tluid-resistant
reactions to nitrile.
clean. rather than
5. Neoprene: Also have simlar properties to natural and whether a
rubber latex and are ofien a popular replacement in 3. Patient risks be used. Clean gowns are
sterile gown, can
situations when alatex-free glove is required and isolation precautions. Stenle gowns
manual dexterity is important e.g. surgery. They are generally usedfor pertorming invas1ve procedures
a more expensive alternative to natural rubber latex are only necessarv for Iine. In thIS case, a sterila
such as inserting a central
gloves. and healthcare worker
gown is best for both patient
Do's and Don 'ts of Glove Use protection.
The way you use the gloves influences the risk of Face Protection
infections and disease transmission in a healthcare setting. mouth and prevemr
The following are the most important do's and don'ts of Masks should fully cover the nose and
should fit snuggly over the
glove use: any fluid penetration. Masks tacial hair can
nose and mouth. Please note that
1. Work from clean to dirty: This refers to touching compromise the seal of a face mask. This
should be :
clean body sites or surfaces before you touch dirty or
heavilycontaminated areas. consideration for the healthcare provider if you are
regularly required to wear a tace mask in your work
2. Limit opportunities for "touch contamination" - environment.
protect yourself, others and environmental
surfaces. Examples of touch contamination include: Masks also have a flexible nose piece and can be secured
adjusting your glasses, rubbing your nose or scratching to the head with string ties or elastic. It is important to
your face with a glove that has been in contact with a understand the different types of masks and their
patient. Also, avoid unnecessarily touching recommended usage. Not all masks and filtering
environmental surfaces with contaminated gloves. facepieces (FFP) offer the same protection and it is
Surfaces such as light switches, door and cabinet important to understand the use and limitatioas of each
knobs can become contaminated if touched by soiled one. See the table below: (Table - 8.6)
gloves. N95 or FFP2 masks: N95 and surgical masks (face
3. Change gloves as needed. Always change the masks) are examples of personal protective equipment
gloves after use for cach patient, and discard them in that are
the nearest appropriate receptacle.
used to protect the wearer from airborne particles
4. The CDC does not recommend the use of double and from liquid contaminating the face. An FFP2 mask is
gloves when providing care to a suspected or adisposable dust mask, that offerS mid-range protectot
confirmed COVID-19 patient. typically used for moderate level fine dustoil or water
Gowns or Aprons? based mists,plastering. sanding and wood dust n
An
There are 3 factors
or apron: influencing the selection of a gown and important note: The Centers for Disease Controi
Prevention (CDC)does not recommend that the
general public wear N95 respirators to protect
 Table -8.6
Type
Surgical
Mask
Description
This must be worn by all
infected persons
provides protection by limiting the spread of infectious
particles from the infected person into the environnent
AS this mask has no filtering system during inhalation it
does not protect against inhalation of small particles
Should not be worn for more than 3 to 8 hours

FEP1-Respirator Mask
orWorkEnvironments These masks offer no protection against airborne pathogens
in protects against Not recommended to protect against infectious diseases
non-fibrogenicdust or poisonous substances
lypically worn by those working in the building or food
industry.
Filter up to 80 %of the particles measuringup to 0.6 um
Have up to 22% \leakage risk
N95
FFP2
or
Respirator Mask for These masks should be worn by Healthcare Professionals
WorkEnvironments to to protect against infectious Diseases
against lypically worn by healthcare professionals and those
protect working with fine dust/oil or water-based mists
deleterious and
Imutagenic particles Offer filtration protection of airborne particles up to 94%
foundin the
air Have up to 8% leakage risk
It provides a good fit (sealing around the nose and mouth)
FFP3-Respirator Mask
for Work Environments
These masks should be worn by Healthcare Professionals
to protect against Infectious Diseases especially during
|to protect against procedures that generate aerosol spread of particles
poisonous and
deleterious kinds of
Offer a minimum filtration percentage of 99%
dust, smoke, and Have a minimal leakage risk of 2% leakage to the inside
aerosols To be used in the procedures of intubation, bronchoscopy,

themselves from respiratory diseases, including the edges of the mask are not designed to form a seal
coronavirus (COVID-19). The best way to prevent around the nose and mouth
ilhess is to avoid being exposed to this virus. However, Note -Use of amask is generally insufficient to provide
8a reminde, CDC always recommends everyday complete protection and should be combined with other
meventive actions, such as hand washing, to help prevent measures and/or PPEs depending on the context.
he spread of respiratory diseases. Goggles provide barrier protection for the eyes. They
Sugical Face Mask: Surgical face masks are to be used should fit snuggly over and around the eyes. Goggles with
or ditterent purposes than the N95 mask. Asurgical face anti-fog features will help maintain clarity of vision.
hask is aloose-fitting,disposable device that creates a When skin protection, in addition to mouth, nose, and eye
PMysical barrier between the mouth and nose of the wearer protection, is required; for example, when irrigating a
dupotential contaminants in the immediate environment. woundor suctioning copious secretions, a face shield can
These are often referred to as face masks, although not be used as substitute to wearing a mask or goggles.
al ace
masks are regulated as surgical masks. Note that The face shield should cover the forehead, extend below
the chin, and wrap around the side of the face.
 halou SGit,
150 lextbook of Nursing Foundation -|

Respiratory Proteetion and particulate filters(EPA only). APAPR uses a

Kespiratory proteetion occurs through the use of tace
masks as well as respirators.
to pass contaminated air through a HEPA
removes the contaminant and supplics purificd ilter,aiarblowhiwerch
lacemask.
Common types of respirators used in healthcare settings APAPR may be sclccted for use if:
are

Filtering fucepicce respirators (FFRS) (such as thc The N95 respirator choice(s) docs not
fit or is
unavailable.
N95 respirator)
f the employce has facial hair or facial
Powered ai-purifying respirators (PAPRs).
Respirators that filter the air befiore it is inbaled should be
used for respiratory proteetion to protect healthcare
that would interfere with q mask-to-face scal
N95 respirator.
deforformity an
It is to be uscd for a high-risk
workers from hazardous or intectious aerosols, such as
Mycobacterium Tuberculosis.The nmost conmonly tused
respirators in healthcare settings are the N95, N99, or
procedure.
PAPRS can be uscd by persons who are
aerosol-generating
NI00particulate respirators.
N95 Respirator: The N95 device was designed to
certified, but who cannot wcar N95
respirators. -dismeposabldical ye
achieve avery close facial tit and very efficient filration Prior to the use, it is important to undergo a medical
of airborne particles. The 'N95 designation means that evaluation determining the safety of wearing the respirator
when subjected to careful testing, the respirator blocks fit testing to determine the appropriate size and tyne
at least 95 per cent of very small (0.3 microns) test training on how and when to use the respirator and finall
particles. If properly fitted, the filtration capabilities of fitchecking when donning to ensure aproper seal.
N95 respirators exceed those of face masks. However, Before Donning PPE
even a properly fitted N95 respirator does not completely Ensure you are hydrated and have used the bathroo
eliminate the risk of illness or death.
as the PPE may need to be worn for an extended
As outlined by the FDA "AII FDA-cleared N95 period.
respirators are labelled as "single-use," disposable Don your PPE with a colleague who can assist and
devices. If your respirator is damaged or soiled, or if provide a final check.
breathing becomes difficult, you should remove the Perform thorough hand hygiene.
respirator, discard it properly,and replace it with a new
Sequence for Donning PPE
one. To safely discard your N95 respirator, place it in a
plastic bag and put it in the trash. Wash your hands afler The order of which you put on (donning) or remove
handling the used respirator. (doffing) your personal protective equipment is essential
N95 respirators are not designed for children or people
for protecting yourself and preventing the spread of any
achieved possible contaminants or fluids. The following is the
with facial hair, because a proper fit cannot be
correct sequence for donning your PPE:
and the respirator may not provide full protection. 1, Gown or apron;
Like other types of PPE, the selection of arespirator 2. Mask or respirator;
type must consider the nature of the exposure and risk
involved. For example, N95 particulate respirators might 3. Goggles or face shields;
be worn by personnel entering the room ofa patient with 4. Gloves.
infectious Tuberculosis. However, if bronchoscopy is
performed on the patient, the healthcare worker might Keep in mind that the combination of PPE used, and the
wear a higher levcl of respiratory protection, such as a sequence for donning, will be determined by the
PAPR. precautions that need to be taken for each patient.
PAPR: APAPR should be worn for high-risk aerosol Sequence for Doffing PPE
generating procedures. It is a more complicated filtration Itis extremely important to take great care when removing
system and is battery powered. It is composed of a full and disposing of used PPE to avoid exposure to infection.
face mask, a breathing tube, a
battery-operated blower, It is important to practice before using these techniques
 VI:
Unit -
Introduction to
setting.ideally with a Itontection Control in Clincal
andtèedback. colleague provide both Seting lnfecton 151
shicldor,oggles: basic rusd,ecogni3s zed and unreognizet sOures
be level of
iminfecon
a
nim um. n
Thev are the
contthero careprcautons whrch
are to
Vaskorrespirator
; Hand
hvgiene,
Stprevent
andardon safetandy precautons are the hastcpahents
of all

tisk of control measues necear tnfectton

sequence for remOVing PPE is
for selt-contamination,intended to tra
unrecognizPrecautansmi
and s sion of
ed iunronsecogniinfectious
to mtw the
agent trom hoth
yNTtunities
The
ISIdered
the most contaminated
Thhe limit Standard
glovesand areare The tennets of
pieces ot PPE
zed sourres ntevtin
ot

theretòreremovedfirst. are Standard pretautions are that all attcnts

Locationfor Doffing PPE 0r notolonized or infectedwith mic--onganisms, whether
thene are
Thedependsonthe amount, andtype ofPPE being wom
This level of shoulå besgns or
ussd in Symptos, and that a unifom
the
sar of all atient
Hellasthe
category ofi isolation ofthe patient, The elements of
S Ifonly gloves are worn as PPE, it is safe to remOve Theelements of Standard Precautions
anddiscard them in the patient S TOOm (in the Standard PrNautions inchude
Hand hygiene.
appropriate bin or receptacle). Use of gloves and other
When a gown or ful PPE is won, PPE should be bameN (e. mask. ee
protection, face
shield. gown).
removedat the doorway or in an anteroom.
Handlingot patient carr quipment and linen.
Respirators should always be removed outside the Envionmental conl.
patientrOOm after
the door is closed. Prevention of injury om shars dev ices, and aient
Hand hygieneshould be perfomed after all PPE placement.
removed. Respiratory hygiene and cough etiquette
Thereisa risk of contamination ofskin: and clothing during Hand Hygiene
removal of contaminated gloves or gowns. It is Hand hygiene is a major elements of standard
the
inmportantto pay attention to the methodlofremoving PPE. precautions and one of the most etective methods to
avoid contamination and disease transmission. prevent ransmission of pathgens assoNiad with
in orderto health care.
Educating healthcare workers in the correct way of
removingPPE by practicein the removal of contaminated Hand hygiene is considered an important praetice n
feedback can reduce
pPE with providing immediate visual reducing the transmission of intecious agents which
removal cause HAls.
the risk of contamination of skin and clothes during
When hands are visibly dirty or contaminated with
of PPE.
biologic material trom patient care, hands should be
Hand Hygiene washed with soap and water.
preventing
Hand hygiene is the cornerstone ofperform hand
which
In intensive care units and other locations in
infection transmission. You should vìulent or sistant organisms are ikely to be prN.
PPE. Ifyour hands
hygiene immediately after removing PPE anti-microbial agents (eg. chlorhexidine gluconate.
removal, wash usa.
become visibly contaminated during iodophors, chloroxylenol, triclosan) may be
Wash your hands least I5 sonds
hands before continuing to remove PPE. Effective hand washing rquires at
if handsare not speial attentionto the ara
thoroughly with soap and warm water or, hand rub. of vigorousserubbingwith ùngers, here ther i8
alcohol-based around nail beds and between
11s1bly contaminated, use an
demonstrates the steps of hand high bacterial burden.
Below is a video that
hygiene. Hand Hygiene care pviders
visibly soiled, healthalcohol-based.
Standard precautions If hands are not
the risk of encouraged to use
Standard precautions are meant to reduce from are strongly
transmission of blood borne and other pathogens
 182

lemtaninadon
1 leiHe donnig ateile loves wini
Comparng and yglene Methods
(atheten
Hand Decontamintiom nth Alvothet Based Pvoduct
1 Alr ontact with body duds, eetions, onwou8 hat do ol toqE a sgcal pocedue
menbranos, thoniotat xkin, or wounddooxing an log 1. Aler IOOving poves
as hands an tot visbly xorled
Iund Washing
1 Aler contact with a patient' intact Nkin (an atler
taking pulse on blood prexsure or iing a paticnt | When bunds are visibly dity o
3. Aftler contactwith inaninate objccts in the paticnt' biologicnaterial from paticntee, ontatnnated
2. Whcn hcalthcate Workers do not olerate
immediate vicnity
alcohol product (Fig. 8,9) walesea
2. Before
clean/aseptle
procedure

1.Before 4, After
touching touching
a patient
a patienl

3, After b0dy
fluld exposuret
rlsk

touching patient
surrounding9

Fig. 8.9

Personal protective equipment's (PPE)

Gown Mask or Goggles or Gloves

respirator eyo shleld

Fig. 8.10: Personal Protective Equipment