职业暴露与隔离防护2015.ppt

1、上海市公共卫生临床中心上海市公共卫生临床中心 张占卿张占卿 in healthcare settings Occupational exposure and isolation precautions Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilities of the infectious w

2、ard Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilities of the infectious ward 2020/4/10 Microbials and macrobials Virus Quasi-organism Viroid Sub-virus Virusoid Microbials

3、 Virino Prokaryote Uni-cell organism Archaeon Bios Micro-organism Eukaryote Multi-cell organism: Eukaryote Prokaryote Uni-cell organism Archaeon Macrobials Eukaryote Multi-cell organism: Eukaryote 2020/4/10 Symbiosis and colonization Symbiosis: A living organism needs to rely on another living organ

4、isms to accomplish its metabolism and reproduction. Colonization: The relatively small species carry out metabolism and reproduction on the surface or in the body of a relatively large species. Difference between symbiosis and colonization: A living organism needs or does not entirely need another l

5、iving organism to accomplish its metabolism and reproduction. 2020/4/10 Parasitism and infection Parasitism: Detrimental symbiosis parasite: Dependent party in parasitic relationship host: independent party in parasitic relationship infection: Detrimental colonization pathogen: Dependent party in in

6、fectious relationship host: independent party in infectious relationship 2020/4/10 Symbiosis and Parasitism, colonization and infection Harmless colonization Detrimental colonization Opportunistic infection facultative parasitism Harmless symbiosis Detrimental symbiosis Contagion / Communication Con

7、tagionCommunication: The thransfers of microbials or tiny organisms between symbiotic or colonized hosts. Natural host: The species living in symbiosis with the given microbials or tiny organisms (including parasitism); the symbiosis of the given microbials or tiny organisms have no significant effe

8、ct on the natural life of the species. transferring host: The species living in non-symbiotic colonization with the given microbials or tiny organisms (including infection); in which the infection of the given microbials or tiny organisms have significant effect on the natural life of the species. 2

9、020/4/10 Communication: A ubiquitous natural phenomenon Three tache of communication Sources of infectious agents Mode of transmission Susceptible host 2020/4/10 Transmitting vectors Airborne transmission: droplet, dust Water transmission: water-drinking, water-touching Food transmission: food paras

10、itic, food contaminated Soilborne transmission: soil-eating, soil-touching Bloodborne transmission: needling, transfusion Insect transmission: mechanical carrier, biological carrier 12 Eternal infection and communication Infection and communication is ubiquitous in nature. In the case of human infec

11、tious diseases and communicable diseases. The pathogens species changes due to their living environment. The type of disease is also changed by the natural, social and medical environment of human existence. There is no end to the occurrence of infectious diseases and spread ofcommunicable diseases.

12、 There is no end to the discovery, research and practice of human infectious diseases and spread ofcommunicable diseases. Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilitie

13、s of the infectious ward 2020/4/10 2020/4/10 Influenza: An eternally classical, emerging and reemerging contagious disease Studies of influenza transmission Mice Droplets hands - culture data Transmission studies Higher preexisting antibody titers require larger inocula for transmission of clinical

14、illness Shedding correlates with severity of illness and fever Small droplet aerosols require lower inoculum Experiments of nature Review of 12 acute-care nosocomial outbreaks (Lancet Infectious Diseases 2002; 2:145-55) 1957 flu pandemic (J Clin Invest 1959; 38:199-212) Homer, Alaska Airplane outbre

15、ak (Am J Epidemiol 1979; 110:1-6) Blumenfeld HL, et al. J Clin Invest 1959; 38:199-212. 7/20 8/13 14/29 Index 2nd Last Blumenfeld HL, et al. J Clin Invest 1959; 38:199-212 Moser MR, et al. Am J Epidemiol 1979; 1101-6. Index Moser MR, et al. Am J Epidemiol 1979; 1101-6. 15 7 13 1 1 SARS: An once frig

16、htening emerging contagious disease The 9th floor layout of the Hotel Metropole in Hong Kong, showing where superspreading event of SARS occurred 26 MERS: A lingering frightening emerging contagious disease 28 Ebola viral disease: a deadly emerging contagious disease 2020/4/10 Zaire 2020/4/10 2020/4

17、/10 2020/4/10 2020/4/10 2020/4/10 2015 Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilities of the infectious ward 2020/4/10 Sterilization Sterilization: a process that dest

18、roys or eliminates all forms of microbial . Physical methods: Steam under pressure, dry heat. Chemical methods: Ethylene oxide gas, hydrogen peroxide gas plasma, and liquid chemicals. Disinfection Disinfection: a process that eliminates many or all pathogenic microorganisms, except bacterial spores.

19、 In health-care settings, objects usually are disinfected by liquid chemicals or wet pasteurization. Factors affecting of sterilization and disinfection Cleaning of the object Organic and inorganic load present Type and level of microbial contamination Concentration of and exposure time to the germi

20、cide Physical nature of the object Presence of biofilms Temperature and pH of the disinfection process Relative humidity of the sterilization process. Sterilization vs Disinfection Sterilization is intended to convey an absolute meaning. however, some health professionals and the technical and comme

21、rcial literature refer to “disinfection“ as “sterilization“ and items as “partially sterile.“ Occupational exposure Exposure: The state of being exposed to contact with something Occupational exposure: Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood, bodily fluids

22、, or other potentially infectious material that may result from the performance of ones professional duties. Isolation: The process of separating, or the state of being alone. Isolation precautions: Special precautionary measures, practices, and procedures used in the care of patients with contagiou

23、s or communicable diseases. Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilities of the infectious ward 2020/4/10 Personal protective equipment Refers to protective clothing

24、 and devices worn by workers to prevent injury Employers often require employees with PPE to enter a worksite Employees often demand “safety gear” 2020/4/10 Personal protective equipment Healthcare workers Eye and face protection Shatter-proof safety glasses Goggles Filtered lenses Face shields pres

25、cription glasses 2020/4/10 Respiratory protection Masks Respirators 2020/4/10 Skin Protection 2020/4/10 Gloves Disposable Rubber, neoprene vinyl Protective clothing Foot protection Boots Shoe covers 2020/4/10 Doning and Doffing Masks Doning the Gown Doffing the Gown Doning the gloves Doffing the glo

26、ves 1 2 3 4 Doning and Doffing the PPE 5 6 5 6 7 8 9 10 11 12 Donning order against Ebola Step 1: wear a disposable hat. Step 2: wearing masks, or full type self-priming respirator, check sealing. Step 3: wear goggles or face shield (full type self-priming respirator without wearing goggles or face

27、shield). Step 4: wear protective clothing. Step 5: put on shoe covers or boots. Step 6: put on gloves, the gloves will be set in the protective clothing cuffs. Doffing order against Ebola Step 1: take off shoe covers or boots (shoe covers inside outwards), placed in the medical waste bags, boots int

28、o the disinfection liquid. Step 2: remove protective clothing and gloves (inside outwards), into the medical waste bags. Step 3: hand hygiene. Step 4: pick goggles or face shield, repeated use into the disinfection liquid, or into the medical waste bags. Step 5: remove the mask from the back and put

29、 it in the medical waste bag. Step 6: finger dig into the hat, the hat gently picked, inside out, into the medical waste bags. Step 7: hand washing, disinfection. Everything you touch has been touched by someone else Moments for Hand hygiene 2020/4/10 2020/4/10 2020/4/10 When Do Needlesticks Happen?

30、 Sharp safety Do not recap a needle by hand：use recapping-device, only if recapping is unavoidable Replace sharps containers when 3/4 full Immediately dispose of sharps in sharps container Sharp safety Do not place a needle on a desktop Do not insert a needle in the bottle stopper Do not remove the

31、syringe needle by hand Do not destroy yourself Sharp safety Take one hand recap a needle Put the needle into the rubber pad. Put surgical instruments in the curved plate for transfering Sharp safety Use disposable items as soon as possible Use safety pin as far as possible. Use no needle system Need

32、le-less systems BIOHAZARD Phlebotomy needle with “Self-Blunting” safety feature Blunted protected position Phlebotomy needle with “Self-Blunting” safety feature Blunted protected position Hypodermic syringes with “Self-Sheathing” safety feature Self-sheathed protected position Hypodermic syringes wi

33、th “Self-Sheathing” safety feature Self-sheathed protected position Hypodermic syringes with “Retractable Technology” safety feature Retracted protected position Hypodermic syringes with “Retractable Technology” safety feature Hypodermic syringes with “Retractable Technology” safety feature Retracte

34、d protected position Needle-less systems BIOHAZARD Before During After Before During After Retracting lancets with safety features In use After use Disposal of medical waste Method for sealing boxes DOT Regulations for biomedical waste Sharps containers Red bags Cardboard biomedical waste disposal b

35、oxes Must be labeled with the name and location of the facility generating the waste Summary Infection and Communication The major emerging communicable diseases Sterilization vs Disinfection, exposure vs Isolation Rational application of PPE Layout and facilities of the infectious ward 2020/4/10 B

36、ISOLATION ROOM Negative pressure CHANGE ROOM GENERAL ACCESS AREA A. Handwash station B. Container for disinfection of reusable items e.g. goggles C. Biohazard bag for used personal protective equipment disposal D. Wall -mounted alcohol hand wash dispensers E. External windows only. Keep clear of pub

37、lic F. Storage for general ward clothes, new PPE C ISOLATION WASH/TOILET General Principles of isolation unit A D D A A E E F Before you run lets review 手卫生的指征手卫生的指征 接触患者之前；接触患者之前； 接触患者之后；接触患者之后； 医疗操作之前；医疗操作之前； 医疗操作之后；医疗操作之后； 接触患者体液之后；接触患者体液之后； 接触患者环境之后。接触患者环境之后。 避免锐器伤害方法避免锐器伤害方法 不可用双手套针帽，可用单手套针帽；不可

38、用双手套针帽，可用单手套针帽； 不可将针头插入瓶塞，可将针头插入胶块；不可将针头插入瓶塞，可将针头插入胶块； 不可用手去除针头，应连带注射器直接放入锐器桶；不可用手去除针头，应连带注射器直接放入锐器桶； 不可直接传递锐器，应将锐器置入弯盘传递；不可直接传递锐器，应将锐器置入弯盘传递； 不可将锐器放置台面，应将锐器直接放入锐器桶；不可将锐器放置台面，应将锐器直接放入锐器桶； 尽可能使用一次性锐器、无针和无刀系统；尽可能使用一次性锐器、无针和无刀系统； 锐器桶中锐器不可满置更换，达到锐器桶中锐器不可满置更换，达到3/43/4之前应及时更换；之前应及时更换； 不可采取人工进行锐器毁形，应采用机器进行

39、集中毁型。不可采取人工进行锐器毁形，应采用机器进行集中毁型。 针对针对Ebola的的PPE穿戴顺序穿戴顺序 步骤步骤1 1：戴一次性帽子：戴一次性帽子（帽帽）； 步骤步骤2 2：戴口罩：戴口罩，如为医用防护口罩或全面型自吸式呼吸如为医用防护口罩或全面型自吸式呼吸 器器，检查密合性检查密合性（罩罩） ； 步骤步骤3 3：戴上护目镜或防护面罩：戴上护目镜或防护面罩（全面型自吸式呼吸器无全面型自吸式呼吸器无 需佩戴护目镜或防护面罩需佩戴护目镜或防护面罩） （镜镜） ； 步骤步骤4 4：穿防护服：穿防护服（服服） ； 步骤步骤5 5：穿上鞋套或胶鞋：穿上鞋套或胶鞋（鞋鞋） ； 步骤步骤6 6：戴上手套

40、：戴上手套，将手套套在防护服袖口外面将手套套在防护服袖口外面（手手） 。 针对针对Ebola的的PPE脱摘顺序脱摘顺序 步骤步骤1 1：脱下鞋套或胶鞋：脱下鞋套或胶鞋，带手套将鞋套里面朝外带手套将鞋套里面朝外，放入放入 医疗废物袋中医疗废物袋中，将胶鞋放入消毒液中将胶鞋放入消毒液中（鞋鞋）； 步骤步骤2 2：脱掉防护服和手套：脱掉防护服和手套，从里面往外翻卷从里面往外翻卷，将里面朝将里面朝 外外，放入医疗废物袋中放入医疗废物袋中（服服） ； 步骤步骤3 3：进行手卫生：进行手卫生（手手） ； 步骤步骤4 4：从后往前摘下护目镜或防护面罩：从后往前摘下护目镜或防护面罩，如重复使用放如重复使用放 入消毒液中入消毒液中，否则放入医疗废物袋中否则放入医疗废物袋中（镜镜） ； 步骤步骤5 5：从后往前摘下口罩：从后往前摘下口罩，放入医疗废物袋中放入医疗废物袋中，注意双注意双 手不接触口罩表面和面部手不接触口罩表面和面部（罩罩） ； 步骤步骤6 6：将手指反掏进帽子：将手指反掏进帽子，将帽子轻轻摘下将帽子轻轻摘下，里面朝外里面朝外， 放入医疗废物袋中放入医疗废物袋中（帽帽） ； 步骤步骤7 7：洗手：洗手、消毒消毒（手手） 。