Chapter One

Primary principles of Public Health

Emergency Management

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 Objectives

• Key steps in the pre-emergency preparedness

– Prevention and mitigation, Prevention measures
– Preparedness/ Readiness,
– Recovery,
– Response
• Eight pillars of the public health response

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 DEFINITIONS OF TERMS AND CONCEPTS

Hazard:
• A potentially damaging physical event, phenomenon, or human
activity that may cause the loss of life or injury, property damage,
social and economic disruption, or environmental degradation.
• Complex emergencies are situations of disrupted livelihoods and
threats to life produced by warfare, civil disturbance, and large-
scale movements of people, in which any emergency response has
to be conducted in a difficult political and security environment

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Disaster: A serious disruption of the functioning of a community or a society causing
widespread human, material, economic or environmental losses which exceed the
ability of the affected community or society to cope using its own resources.
• A disaster is a function of the risk process. It results from the combination of
hazards, conditions of vulnerability and insufficient capacity or measures to
reduce the potential negative consequences of risk.
Emergencies :are situations that arise out of disasters, in which the affected
community’s ability to cope has been overwhelmed, and where rapid and effective
action is required to prevent further loss of life and livelihood.
Emergency planning is a process that consists of determining the response and
recovery strategies to be implemented during and after emergencies (based on an
assessment of vulnerability); responsibility for the strategies; the management
structure required for an emergency; the resource management requirements
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Risk: The probability of harmful consequences, or expected losses
(deaths, injuries, property, livelihoods, economic activity disrupted or
environment damaged) resulting from interactions between natural or
human-induced hazards and vulnerable conditions.
Emergency preparedness is a program of long-term development
activities whose goals are to strengthen the overall capacity and
capability of a country to manage efficiently all types of emergencies and
to bring about an orderly transition from relief through recovery and
back to sustained development.
Emergency prevention is based on vulnerability assessment and concerns
the technical and organizational means of reducing the probability or
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Environmen t a l h e a l t h m an a ge m e n t i s t he i n t e n t i o na l
modification of the natural and built environment in order to
reduce risks to human health or to provide opportunities to
improve health.
• Extreme events are known natural or manmade events that
occur outside their normal range of intensity, energy, or size,
which often produce life-threatening hazards.
Hazards are phenomena or substances that have the potential to
cause disruption or damage to humans and their environment.
• The words threat and hazard are often used in the same way.
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 Mitigation and prevention are actions aimed at reducing or
eliminating the impact of future hazard events, by avoiding the
hazard or strengthening resistance to it
Preparedness comprises activities designed to minimize loss
of life and damage, organize the temporary removal of
people and property from a threatened location, and
facilitate timely and effective rescue, relief, and rehabilitation.

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Prevention involves activities designed to provide permanent
protection from disasters.

Resilience is a community’s ability to withstand the damage caused

by emergencies and disasters; it is a function of the various factors
that allow a community to recover from emergencies.

Susceptibility concerns the factors operating in a community that

allows a hazard to cause an emergency (disaster), e.g., proximity to
the hazard, or level of development.
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Vulnerability is the degree to which a population or an individual is unable
to anticipate, cope with, resist and recover from the impacts of disasters. It is
a function of susceptibility and resilience.

Vulnerability reduction comprises the steps taken to reduce people’s

exposure to hazards and increase their capacity to survive and recover from
disasters.

Vulnerability assessment makes it possible to anticipate problems that

specific groups will face in the event of a disaster and during the period of
recovery. This is also known as hazard assessment, risk assessment, or threat
assessment.
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 Disaster
• Some are predictable

• Some are annual or seasonal

• Some are unpredictable or sudden

ü Floods → days and weeks

ü Earthquakes → second /minutes

ü Drought → months

ü Cyclone → days

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 Disaster…
Factor influencing human vulnerability /determinants of health risk
• Poverty
• Population density
• Rapid urbanization
• Change in way of life
• Environmental degradation
• Lack of awareness and information
• War and civil strife
• Population displacement
 Characterization of disaster
Various type of disaster has been categorized under subgroups

Subgroup1: water and climate-related Subgroup2: Geology-related hazards

hazards • Earthquakes
– Flood and drain management • Landslides
– Droughts • Mudflows
– Cyclones • Dam burst/ failures
– Tornadoes • Mine fires
– Hurricanes subgroup 3: chemicals industries and
– Cloud burst nuclear-related disasters
– Snow avalanches
– Heat and cold waves
– sea erosion
– thunder and lightings
– Hailstorm

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 Characterization of disaster
subgroup 4: accident related disaster
§ Transportation accident • Subgroup5:
§ Major building collapse Biological-related
§ Serial bomb blasts disaster
§ Festival related • Biological
disaster
• Epidemics
• Cattle epidemics
• Pest attacks
• Food poisoning
§ disaster
§ Fires
§ Forest fires
§ Urban fires
§ Mine flooding
§ Oil spill
§ Electrical disasters and fires
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§ Boat capsizing
 Factor affecting Disaster
– Host factor
vAge
vImmunization status
vDegree of mobility
vEmotional stability
Environmental factor
§ Physical factor
§ Chemical factor
§ Biological factors
§ Social factor
§ Psychological factor

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 Characteristics of Disaster
Predictability

Controllability

Speed of onset

Length of forewarning

Duration of impact

Scope and intensity of impact

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 Phase of Disaster

• Pre-emergency phase: the period before the disaster strikes may be used

to assess how often a particular community is exposed to different risks

(risk mapping) and how good is their preparedness.

• Impact and flight phase: when a disaster strikes the hazard (fire,

earthquake, floods, conflicts, etc) may trigger the displacement of a large

number of people from their homes.

• Acute phase: reactive activities by many humanitarian agencies

responding to media reports of very high death rates maybe 5-60 times the

normal death rate).

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 Phase of Disaster…
• Post-emergency phase: the population movement usually slows
down.

• Repatriation phase: displaced people are expected to return to

their place of origin either on their own or with the help of relief
agencies. Repatriation may be either forced or voluntary

• Rehabilitation or reconstruction phase: shifts from relief to

development.

• The aim is to help the affected community become self-reliant.

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 Relationship between hazard, vulnerability, and disaster

• Hazard × vulnerability = disaster

• When the extent of hazard and vulnerability is low, the resulting disaster will also be of small
magnitude.

• HAZARD × vulnerability = disaster

• When the extent of hazard is high but vulnerability is low then the disaster will be of small

magnitude.

• Hazard × VULNERABILITY = disaster when a vulnerability is high but the extent of the hazard is

small then the resulting disaster will also be of small magnitude.

• HAZARD × VULNERABILITY = DISASTSER

• When the extent of the hazard is very high and the vulnerability is also high then it will result in
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a huge disaster.
 Tools for Hazard Analysis

• Hazard Mapping

• Historical Profile or Timeline

• Seasonal Calendar

• Hazard Matrix

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 Hazard Matrix
Hazard Intensity Early waring Warning Speed Frequenc Tim Duratio impact
given or not sign of onset y e n

Flood
Earthquake
Drought
Industrial
hazard

Epidemic
Any other

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 are:

Hazard x Vulnerability
Risk 
Capacity
(for response and recovery)

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 Factors of vulnerability
Physical /material vulnerability
v Hazard-prone location of community houses, farmlands,
infrastructures, basic services
v Design and construction materials of houses and buildings
v Insecure and risky sources of livelihood
v Lack of basic services education health safe drinking water shelter
sanitation roads electricity communication
v Exposed to violence domestic arms and conflicts
v Age and disability
 Physical vulnerability
• Pertaining to matters of location structure infrastructure conditions etc.
• Includes

– Building at risk
– Unsafe infrastructure transportation system, sanitation system
– Unsafe critical facilities
– Rapid urbanization
– agricultural unsafe
 Factors of vulnerability
Motivational /attitudinal vulnerability

§ Negative attitude toward change

§ Passivity fatalism hopelessness

§ Lack of initiatives

§ Dependences on external supports

§ Lack of knowledge and skills

§ extremism
 Economic vulnerability
– Determined by evaluating
• The direct loss of potential economic assists
• Indirect loss of potential
• Secondary effects
– Direct loss of potential
• Destruction of buildings plants facilities raw materials products
• Replacement costs
• Loss of employment
• Crop loss
• Damage means of production
– Indirect loss of potential
• Impact of loss of production
• Impact of loss of employment
• Loss of markets
• Loss of opportunity
• Loss of consequential income-earning activities
– Secondary effects
• Inflations
• Indebtedness
• Labor migration
 Social vulnerability
• Determined by the perception of risk and the ability of people to take measures to reduce

that risk.

• More difficult to measure than either physical or economic vulnerability

• Critical indicator of perceived risk ability of response

– Poverty, limitation of resources reserves of options

– Degree of public awareness about the immediate social and physical environments

– Prior personal experience of specific risks and consequences

• Demographic consideration

– Magnitude total population

– Concentration of densities

– Demographic distinctions, vulnerable groups social; disadvantaged people, or those

requiring special attention. This includes children disabled people, elderly people women
 Factors of vulnerability
• Social organizational Vulnerability

Weak family /kinship structures

Lack of leadership and initiative to solve problems or conflicts

Exclusion of certain groups from the decision-making or unequal

participation in community affairs

Absences or weak community organization

Social status castes ethnicity gender

Neglect from the government and civil institutions

 Vulnerability analysis
• Principal community characteristics determined in vulnerability analysis
Demography Culture Economy Infrastructure Environment`

population and Traditions Trade Communication Landforms

age distribution networks
Mobility Ethnicity Agriculture/li Transportation Geology
vestock networks
Useful skills Social values Investments Essential services Waterways

Hazard awareness Religion Industries Community assets Climate

Vulnerable groups Attitudes to Wealth Government Flora and faun

hazards structures
Health level Normal food Resource base
types
Education level Eating habits `

Sex distribution Power structures

 Tools for Vulnerability Assessment
• Transect Walk

• Problem Tree

• Livelihood Analysis

• Vulnerability Assessment

• Venn diagram

• Community drama

• Problem tree and Ranking

History Tracing
Hazard Ranking
Seasonal Calendar
Venn Diagram
Problem Tree
 Capacity
Capacity is a combination of all strengths and resources available to the community,
society and organization that can reduce the level of risks or the effect of disaster.

Capacity may include physical, institutional, social or economic means as well as

skilled personnel or collectives attributes such as leadership and management
Capacity building

Development of institutional financial political and other resources such as

technology at the d/t level and sector of society
Copy capacity
• People or organizations use available resources and abilities to face adverse
consequences that could lead to a disaster
• In general, this involves managing resources both during normal times as well
as during crises or adverse conditions.
• The strengthening of coping capacities usually builds residences to withstand
the effect of natural human-induced hazards
 Factors of capacity
Motivational /attitudinal capacity
§ Knowledgeable and self-esteem

§ Proactive attitude

§ Open to change and new ideas

§ Continual learning

§ Building on experiences

§ Positive perceptions life

 Factors of capacity

Physical and economic capacity

§ Money/cash

§ Real properties

§ Stable sources of income and livelihood

§ Safe infrastructure

§ Food security

§ Balanced natural environment

§ Limited number of hazard events

 Factors of capacity

Social/ organizational capacity

• Relationships with relatives and family

• People-centered government

• Strong civil society empowered community

• Functional community-based civic

organization

• Optimum availability of basic societal and

health services

• Strong social network and institutions

 Capacity assessment.
• Historical profiles and timelines - reveal how people cope with adverse
events in the past
• Seasonal calendar - visual presentation of economic activities, coping
strategies, availability of money and time, etc.
• Gendered resource mapping and gendered benefit analysis – show
differences in access to and control over resources between men and women
in households and in the community
• Livelihood Analysis - insights on the coping strategies of individual
households
• Institutional and social network analysis - formal and informal service
structures for delivery of community services
 Resilience
• Capacity systems of community/society are potentially exposed
to hazards to adapt by rejecting or changing in order to reach and
maintain an acceptable level of functioning and structure.

• This is determined by the degree to which the social system is

capable of organizing itself to increase its capacity from past
disasters for better future protection and to improve risk reduction
measures
 Resilience
• The three conceptual frameworks of resilience
Resistance
• Ability to stand and/or absorb the impacts of external pressures
and disturbance without experiencing long-term impacts.
Recovery
• The common interpretation of resilience examines the amount of
time it takes a community to ‘bounce back’ to the previous level
of functioning after experiencing a hazardous event.
Creativity
• More recent understanding incorporates the idea of adaptive
capacity whereby post-disaster context is seen as a window of
opportunity for increasing the functionality and resiliency of
the community.
 Human-induced hazards
1. Socio-natural hazards
– Forest denudation
– Famine
– Increased occurrences of natural hazards
2. Social political hazards
üWar
üCivil unrest
3. Technological hazards
üTransport accidents
üToxic substances poisoning
üContamination of foods and waste sources
Natural hazards
1. Geological (earthquake, volcanic activity, landslides)
2. Hydro-meteorological (floods, tropical storms, drought, typhoons)
3. Biological (epidemic diseases) origin.
4. Oceanic hazards (tsunamis, Tidal surges)
Hazards can be induced by human processes (climate change, fire,
mining of non-renewable resources, environmental degradation, and
technological hazards)
§ Hazards can be single, sequential, or combined in their origin and
effects.
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 Natural Hazards Manmade Hazards
v Earthquakes
vBuilding Collapses /Explosions
v Flooding
vCarbon Monoxide
v Severe weather
v Tornadoes vDisease Outbreak and Biological
v Winter Storms
events
v Power Outage
vChemical spills &Radiation
v Fires
v epidemic and pandemic vTerrorism
diseases Infectious
vUtility Disruption
Disease
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Bioterrorism Chemical Emergencies. Infectious Disease

§ Carbon monoxide v Cholera

§ Anthrax
§ Chlorine v E. coli infection
§ Botulism
§ Mercury v Pandemic flu
§ Brucellosis
§ Nerve agents v MRSA infection
§ Plague
§ Oil Spill v Whooping cough
§ Smallpox
§ Ricin v Salmonella infection
§ Tularemia

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Natural Disasters and Severe Radiation Emergencies
Weather q .Nuclear accident Explosions
v Earthquakes q Nuclear blast v Industrial explosions
v Floods q Radiation dispersal v Terrorist bombings
v Hurricanes device (dirty bomb) v Military strikes
v Landslides/mudslides q Transportation accident
v Tornadoes
v Wildfires
v Winter Weather

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 The Four Phases of the Disaster Cycle

• Preparedness: Preparing to
handle a disaster
s
• Response: Responding to a P repa
r ednes

Re
disaster and putting plans into

sp
on
action

se
• Recovery: Actions taken to
return to normalcy or safer

M
itig
conditions

at
ry

ion
ove
c
Re
• Mitigation: Preventing future
disasters & minimizing their
effects

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 Presidential Policy Directive (PPD) 8: National
Preparedness

Reading assignment

• All-hazards approach.

• Whole community approach

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Response Coordination: National Response
Framework (NRF)

• Save lives, protect property

and environment, stabilize
the incident, and provide for
basic human needs
• Scalable, flexible, and
adaptable
• Roles, responsibilities, and
coordinating structure
• Composed of Emergency
Support Function (ESF)
• Annexes for coordinated
federal assistance

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 Emergency Support Functions
(ESFs)
• ESF 1 – Transportation • ESF 8 – Public Health and
• ESF 2 – Communications Medical Services
• ESF 3 – Public Works and • ESF 9 – Search and
Engineering Rescue
• ESF 4 – Firefighting • ESF 10 – Oil and
• ESF 5 – Information and Hazardous Materials
Planning Response
• ESF 6 – Mass Care, • ESF 11 – Agriculture and
Emergency Assistance, Natural Resources
Temporary Housing, and • ESF 12 - Energy
Human Services • ESF 13 – Public Safety and
• ESF 7 – Logistics Security
• ESF 14 – Superseded by
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NDRF 50
 Differentiating ESF 6 and ESF 8
ESF 6: Mass Care, Emergency
Assistance, Temporary Housing, and ESF 8: Public Health and Medical
Human Services Services
• Lead Agency: HHS/ASPR
• Lead Agency: DHS/FEMA • Examples include:
• Examples include:
ü Mass Care - congregate shelters, – Public health – vector control,
feeding, emergency supplies health surveillance, safety and
ü Emergency Assistance - security of drugs & medical
devices, environmental health,
coordination with volunteers and
distribution and delivery of
donations medial countermeasures
ü Temporary Housing
ü Human Services - loans and grants, – Medical services – medical
crisis counseling, disaster case surge, patient movement,
management, disaster legal patient care, behavioral
healthcare, veterinary medical
services support, fatality management
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 HHS Office of the Assistant Secretary for
Preparedness and Response (ASPR)
• Established in 2006, in the wake of Hurricane /Katrina.
• The Public Health Service Act is the foundation of HHS’ legal authority as
amended by the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA)
and 2013 Pandemic and All-Hazards Preparedness Reauthorization Act
(PAHPRA).

• ASPR’s mission is to save lives and protect Americans from 21st century
health security threats.

• ASPR leads the nation’s medical and public health preparedness for,
response to, and recovery from disasters and public health emergencies.
• ASPR collaborates with state, local, tribal, and territorial governments,
and other partners across the country to improve readiness and response
capabilities.

• The strength of our nation’s public health and medical infrastructure and the
capabilities necessary to quickly mobilize a coordinated national
response to disasters and emergencies are vital to our national security. 52
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 HHS/ASPR Response Resources
• Regional Emergency Coordinators (RECs)
– ASPR’s representatives across the country at the regional level
– Conduct planning and facilitate coordinated preparedness and response
activities for public health and medical emergencies
• National Disaster Medical System (NDMS)
– Provide patient care, patient movement, definitive care, veterinary
services, and fatality management support when requested from States,
Tribes and Territories, or other federal departments.
– Sample missions include augmenting a hospital to decompress the
overtaxed emergency department; providing veterinary services to federal
working animals during National Security Special Events
– Disaster Medical Assistance Teams (DMATs) are composed of
professional and para-professional medical personnel that provide
medical care during a disaster or other special event
• Emergency Prescription Assistance Program (EPAP)
– Helps people in a federally-identified disaster area who do not have health
insurance to get the prescription drugs, vaccinations, medical supplies,
and equipment that they need
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 Recovery Coordination: National Disaster
Recovery Framework (NDRF)
• Provides a coordinating structure
allows recovery managers to operate
in a unified and collaborate manner
• Focuses on how best to restore,
redevelop, and revitalize the health,
social, economic, natural, and
environmental fabric of the community
and build a more resilient community
• Defines principles that guide core
capability and support activities for
recovery under the Recovery Support
Functions

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 Health and Social Services Recovery
Support Function

• Supports local efforts to restore and improve health and

social services systems to promote the resilience, health,
independence, and well-being of the whole community
• Lead coordinating agency: HHS
9 Core Capabilities:
• Public Health
• Health Care Services Impacts
• Behavioral Health Impacts
• Environmental Health Impacts
• Food Safety and Regulated Medical Products
• Long-Term Health Issues Specific to Responders
• Social Services Impacts
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 HHS/ASPR Partners
Federal Other
• DHS (FEMA) • American Red Cross
• HHS OpDivs (ACL, ACF, • National Advisory Committees
CDC, CMS, HRSA, etc.) • National Stakeholders (e.g. NACCHO,
• DoD ASTHO, NEMA, etc.)
• VA • State and local (e.g., through HHS
• Other federal agencies as cooperative agreements including
appropriate Hospital Preparedness Program & Public
Health Emergency Preparedness
Program)

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 Access and Functional Needs
• People with access and functional needs may require additional
assistance due to any condition (temporary or permanent)

• That limits their ability to take action or interfere with their ability to
access or receive medical care before, during, or after a disaster or
public health emergency.

• Cross-cutting approach to disaster planning that includes (but is not

limited to) children, older adults, pregnant women, people with disabilities,
people with chronic health conditions, etc.

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Ensure that every person in AZ, regardless of
needs, has equal access to disaster services and
information.

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 The 8 WHO strategic pillars for public health
emergency preparedness and response

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 Continuum of the phases of a pandemic
(source WHO)

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 Chapter Two

Introduction to IPC

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 Infection prevention and control (IPC)

• Infection prevention and control (IPC) is a

practical, evidence-based approach preventing
patients and health workers from being harmed by
avoidable infections (WHO)
• Effective IPC requires constant action at all levels
of the health system, including policymakers,
facility managers, health workers and those who
access health services.
• IPC is unique in the field of patient safety and
quality of care, as it is universally relevant to every
health worker and patient, at every health care
interaction.

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 Infection prevention and control (IPC)…
• Defective IPC causes harm and can kill.
• Without effective IPC it is impossible to achieve quality
health care delivery.

• IPC effects all aspects of health care, including hand

hygiene, surgical site infections, injection safety,
antimicrobial resistance and how hospitals operate
during and outside of emergencies.

• Programmes to support IPC are particularly important in

low- and middle-income countries, where health care
delivery and medical hygiene standards may be
negatively affected by secondary infections.

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 Mandatory Requirements that
keep our staff and patients safe
• Infection Control Education is a Mandatory Annual
Requirement as stated in:

• OSHA Bloodborne Pathogens Standard 1910.1030

April, 2001 and
• Guidelines for Preventing the Transmission of
Mycobacterium tuberculosis in Healthcare Facilities,
2005.
 The goal is Breaking the chain of
infection
Infectious Rapid identification,
Agent diagnosis, and treatment
Bacteria
Virus
Fungi
Susceptible
Reservoir Education
Recognition of high risk Host Environmental
patients Treatment of People
Patient Hygiene Disinfection
underlying disease Environment and Sterilization
Immunizations Staff
Equipment & Water
Visitor

HCW
Hand Hygiene, Portal of Hand Hygiene
Personal Hygiene Entry Portal of Exit Control of Excretions
Transmission Based & secretions
Mucous Membranes Excretion, secretions,
Precautions Aseptic Proper attire
Respiratory & GI Tract skin, and droplets
Technique Wound/catheter
care Broken Skin
Means of
Transmission
Direct & Indirect Hand Hygiene
Contact Transmission based
Inhalation precautions Environmental
Airborne Hygiene

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 Isolation and Precautions
- More Safety Activities
• Along with good hand hygiene, Standard Precautions
and disease specific precautions help prevent the
transmission of organisms.
• There are 6 types of precautions used :
1. Standard Precautions
2. Contact Precautions
3. Contact Precautions with Special Cleaning
4. Droplet Precautions
5. AFB Isolation
6. Airborne Precautions

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 Standard and Transmission based
precautions protect who and what?
• In healthcare organisations, we know t hat an
introduction of a pathogenic microorganism will come
from people or the healthcare environment (including
Patient equipment).
/client • The triangle on this slide, demonstrates the linking of
the healthcare environment, health worker and
patient/client.

Healthcare Health
• The connection or relationship with pathogenic
Environment workers microorganisms and healthcare, is we (patient/clients,
health workers and visitors) may potentially become
exposed to them through direct or indirect contact
within the healthcare environment.
• Protection from exposure is assisted by
understanding and practicing standard and
transmission-based precautions.

67
 Standard Precautions
• Standard Precautions – is used with all patients and
assumes that all patients are infectious.
• Protective barriers called Personal Protective
Equipment (PPE) includes gloves,
goggles/eye shields, masks and gowns are
used to prevent contact with patients’ blood or
body fluids.
• The type of activity or task determines the amount
and type of PPE to be used.
• The greater the risk of coming in contact or being
splashed with the patients’ blood or body fluids, the
more protection is needed.

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 Standard Precautions …
Personal Protective Equipment (PPE) -Masks
•Masks, eyewear and face shields protect your eyes, nose and mouth
from splashes or splatters of blood and body fluids

•Make sure to choose PPE that will protect your eyes, nose and mouth
if there is any chance of splash.

•Examples of tasks when you should wear such PPE include:

• Suctioning
• Irrigating wounds
• Cleaning contaminated equipment

•Place disposable PPE into general waste container after use.

 Standard Precautions…
Personal Protective Equipment (PPE) - Gloves
•Gloves keep potentially infectious materials away from your hands
during contact with patient’s blood, body fluids, mucous membranes,
or broken skin.

•Gloves also protect you from contact with infectious materials when
handling contaminated equipment, surfaces, linen or waste.
•Remove gloves immediately after the task is done. Dispose gloves
into a general waste container.

•Perform hand hygiene after removing and disposing gloves.

•NEVER wash gloved hands. NEVER reuse disposable gloves.

•Change gloves after each procedure; even if performing more than

one procedure on the same patient.

•Standard exam gloves are latex-free.

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Standard Precautions
Personal Protective Equipment (PPE) – Gowns

• Fluid-resistant gowns prevent blood and body fluids that

splash or spray from soaking through to your clothes and skin.

• Dispose gowns after use in general waste container, NOT

medical waste biohazard container.

• Some situations that may require wearing a gown include:

Irrigating a wound
Performing tracheostomy care
Any time blood or body fluid contamination to your
clothes skin is likely

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 Standard Precautions…
All patients, at all times
• “Standard precautions are meant to reduce the risk of
transmission of blood-borne and other pathogens from
both recognized and unrecognized sources.

• They are the basic level of infection control

precautions which are to be used, as a minimum, in all
patient care settings.“

• "Risk assessment is critical. Assess all health-care

activities to determine the personal protection that is
indicated."

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 Standard Precautions…

Ø Apply to all patients receiving care in hospitals,

regardless of their diagnosis or presumed infection
status

Ø Under standard precautions, blood and body

fluids of all patients are considered potentially
infectious

https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

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 Standard Precautions…
• (all day, everyday, every patient)
• Infection prevention actions • Standard Precautions are:
that apply to all patient/client • Performing hand hygiene
care and or interactions, • Appropriate and correct use of personal
protective equipment (PPE)
regardless of suspected or
• Use of aseptic technique
confirmed infection status of
• Safe use and disposal of sharps
the patient/client
• Performing routine environmental
• Are evidence-based practices cleaning
designed to protect and • Cleaning and reprocessing of shared
prevent spread of infection patient equipment
• If followed correctly, minimise • Respiratory hygiene and cough
etiquette
the risk of contact with blood
• Safe handling and disposal of waste
and other body substances. and used linen

74
 Standard Precautions…
• Standard Precautions combine the major features of Universal
Precautions and Body Substance Isolation and are based on
the principle that all blood, body fluids, secretions, excretions
(except sweat), nonintact skin, and mucous membranes may
contain transmissible infectious agents.
Transmission of Infectious Agents in Healthcare Settings
2007 HICPAC Guideline for Isolation Precautions: Preventing

“Standard Precautions include a group of infection prevention

practices that apply to all patients, regardless of suspected or
confirmed infection status.”

• Hand Hygiene

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

• Safe injection practices

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https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
 Standard Precaution PPE

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 What are Transmission Based
Precautions ?
• Transmission-Based Precautions are designed to
supplement standard precautions in
patients/residents with documented or suspected
infection/colonization of highly transmissible or
epidemiologically important pathogens.

• Examples of diseases spread by multiple means:

– SARS—airborne and contact plus eye protection
– Adenovirus—droplet and contact

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 Transmission-based precautions…
• Used when standard precautions alone, are not enough to
interrupt the transmission of a pathogenic microorganism
• Used in addition to standard precautions
• Know the route of transmission for the infection of
communicable disease
• There are three types of transmission-based precautions,
depending on how transmission occurs
o Contact precautions – use when caring for any patient/resident known
or suspected of being infected with a microorganism spread by skin to
skin direct or indirect contact
o e.g. Staph aureus, vancomycin-resistant enterococci (VRE). The unwashed
hands of Health workers, commonly transfer pathogenic microorganisms
in the health environment.

78
 Transmission-based precautions…

o Droplet precautions – use when caring for any

patient/resident known or suspected of being infected
with a microorganism that can be spread by the
respiratory droplet route
o e.g. coughing, sneezing, spitting, touching mouth/nose
and talking. Because they are large and heavy, droplets
will travel up to 1 metre in distance.
o Airborne precautions – used when cari n g f o r
patients/residents known or suspected of being infected
with a pathogenic microorganism transmitted by
the airborne route.
o Pathogenic microorganisms are small and float in the
air travelling a greater distance than droplets.
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 Three basic routes of
transmission
q Contact
q Direct
q Indirect

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

q Airborne
q Smaller; infective over time and distance

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 Transmission Based Precautions

• Hand Hygiene
Contact Precautions • Gown
• Gloves

• Hand Hygiene
Droplet Precautions • Mask

Airborne Precautions • Hand Hygiene

• Negative pressure room
• PAPR/N-95 Respirator mask

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 Rationale
• Transmission of infectious agents within a healthcare setting
requires three elements:
1. A source (or reservoir) of infectious agents

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

3. A mode of transmission for the agent

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 Contact Precautions
“Contact Precautions are intended to prevent transmission
of infectious agents, including epidemiologically important
microorganisms, which are spread by direct or indirect
contact with the patient or the patient’s environment.”

• Healthcare personal caring for patients on contact precautions MUST

wear an isolation gown and gloves/personal protective equipment
(PPE) for all interactions (that may involve contact with the patient
or potentially contaminated areas in the patients environment)

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

• Doffing (removing) PPE must occur immediately prior to exiting

A N Y O N E E N T E R I N G T H E PAT I E N T R O O M M U S T C O M P LY W I T H
TRANSMISSION BASED PRECAUTIONS
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 Contact precautions…

• For infections transmitted by direct or indirect contact

with an infected person or contaminated environment
• Wear gown, gloves for all contact with patient or
potentially contaminated environment
• Examples
– Norovirus
– Other GI illnesses when infected person is incontinent
– Draining wounds
– Drug-resistant organisms
• Vancomycin resistant enterococcus
• Methicillin resistant staph aureus

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 PPE Donning

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 PPE Doffing

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 What’s wrong with this picture?

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 Heightened level of precaution

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 Transport of patient on contact precautions

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 Droplet Precautions
Droplet Precautions are intended to prevent transmission of
pathogens spread through close respiratory or mucous membrane
contact with respiratory secretions.”
“Pathogens requiring droplet precaution do not remain infectious over
long distances in a healthcare facility and so do not require special air
handling and ventilation to prevent droplet transmission.”

• Don face mask (NOT N-95 respirator)prior to entering patient room

• Spatial separation ≥ 3 feet
• Place face mask on patient for transport outside of room

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 Droplet precautions…

• For infections transmitted by close respiratory or mucous

membrane contact with respiratory secretions
• Spatial separation of > 3 feet
• Use of surgical mask when within three feet of infected
person
• Examples
– Influenza
– Pertussis
– Adenovirus
– Rhinovirus
– Group A Streptococcus

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 Airborne Precautions
• “Airborne Precautions prevent transmission of infectious
agents that remain infectious over long distances when
suspended in the air (measles, chicken pox, TB)”
• Patient must be placed in an airborne isolation infection
room (AIIR): this is a single-patient room equipped with
special air handling and ventilation capacity that complies
with specific regulatory guidelines:
• Monitored negative pressure relative to the surrounding area
• 6 or 12 air exchanges/hour
• Air exhausted directly to the outside or
• recirculated through a HEPA filtration system before return
• Door MUST remain closed
• Staff must wear N-95 respirator mask or PAPR
• Visitors entering must wear surgical mask

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 Airborne precautions…

• For infections carried over long distances (up to 25 feet)

when suspended in the air
• Use of N-95 respirators is used when sharing air with
infected person
• N-95 respirators
– Must have respiratory protection plan
• Medical evaluations
• Fit testing
– Only those who are fit-tested may enter space
of the infected person

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 Airborne precautions…

• Examples
– Tuberculosis
– Measles
– Chickenpox
– Smallpox
• Non-immune persons should not be in
contact with infected persons

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 Acid-fast bacillus (AFB) Isolation
•The acid-fast stain is a laboratory test that
determines if a sample of tissue, blood, or
other body substance is infected with the
bacteria that causes tuberculosis (TB) and
other illnesses
•AFB Isolation is required for all
patients with or suspected of having
Tuberculosis (TB). TB is spread by
the airborne route.
• ALL AFB Isolation cases require:
- A private, negative air pressure room where
the air is exchanged 6-12 times per hour and
exhausted to the outside of the hospital.
- All healthcare workers must wear a N-95
particulate respirator (N-95 PR) to enter the
room. Refer to policy IC 125.
NOTE: This is a special mask that
must be fitted to each individual. Always fit-check
your mask before entering the room. Make sure you
know what size N-95 you wear.

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 Food for thought….

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 Chapter three

Hierarchy of Control Approaches

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 • Discuss hierarchy of controls
and provide overview of
systematic approach to
eliminating hazards, and
reduction or control of H2S risks.
• Discuss workplace practices
and relevant maintenance
procedures established to
protect personnel from hazards
of H2S and SO2.

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Well control procedures – is one of the most important aspects of oil and gas
operations. (read about IPC and facility design)
11/11/2024 99
 Control

Ø All steps necessary to protect workers from exposure

to a substance or system
Ø The training and the procedures required to monitor
worker exposure and their health to hazards such as
chemicals, materials or substance, or other types of
hazards such as noise and vibration.
Ø A written workplace hazard control program should
outline which methods are being used to control the
exposure and how these controls will be monitored for
effectiveness.

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 The hierarchy of controls

• Is a way of determining which actions will best

control exposures.
• The hierarchy of controls has five levels of
actions to reduce or remove hazards.
What is the hierarchy approach?

ü The hierarchy of control is a step-by-step approach to

eliminating or reducing risks and
ü it ranks risk controls from the highest level of protection
and reliability through to the lowest and least reliable
protection.
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 Common Types of Control
ü Hazard Elimination:
Avoiding risks; adapting work to workers
ü Substitution:
Replacement with less dangerous or safer material;
attacking risks at their source; integrating technical
progress
ü Engineering Controls:
Implement collective protective measures –
isolation, ventilation systems, mechanical handling,
specify appropriate construction materials

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 Common Types of Control cont’d

• Instructions to workers such as warning signs,

lockout processes, safety equipment inspections,
safety & health coordination with subcontractors,
training, licensing, and worker rotation

• Provide adequate PPE and instructions for its use

and maintenance; safety shoes, safety glasses,
self-contained and air supplied respirators
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 Industrial Operations

Controls:
• Equipment Maintenance
• Ventilation Systems
• H2S Detection Devices & Air
Testing
• Burning, Flaring, and Venting
• Understand Processes
• Work Procedures

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 Chapter 4

Hand hygiene

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The 5 critical elements(materials) to proper
hand washing:

1. Time
• Time is an important factor in any washing
procedure.
• From warewashing to sanitizing food contact
surfaces, time is key.
• The amount of time you let the cleaner do its
work, generally, the more effective it will be.
• Washing for 20 seconds rather than 5
seconds can improve the microbial reduction
by 1.5 log, or about 95%!

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 2. Mechanical Action

• Mechanical action refers to the way in which you move

your hands to scrub, lather and

• Otherwise agitate the surface of your skin, spreading

the soap around to make sure you are getting into all
the cracks and crevices of your hands.
3. Running Water
• Recent studies have suggested that the temperature of
the water no longer matters, just that you are washing
your hands with clear running water.

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 4.Drying

• Drying your hands is a step that sometimes gets

overlooked, sometimes due to lack of paper towels, but
plays a vital role in preventing re-contamination of your
hands.

• If after washing your hands you don’t dry them

thoroughly you increase the rate of bacterial transfer
from everything you touch

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 5. Surfaces

• The surfaces you touch after washing your hands can

make or break your hand hygiene routine.

• In crowded public spaces, high-touch surfaces such as

counter tops, bars, door knobs, faucets and much more
can harbor a deadly amount of bacteria

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 Hand washing using water and soap

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Antiseptic hand-rub

• Means applying a waterless antiseptic agent (i.e., an antiseptic

agent such as alcohol that does not require the use of exogenous
water) to the hands.

• The World Health Organization (WHO) defines an alcohol-based

hand rub as: "An alcohol-containing preparation (liquid, gel or foam)
designed for application to the hands to inactivate microorganisms
and/or temporarily suppress their growth.

• The FDA classifies ethanol, 60 to 95% formulations, as a Category I

agent.

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11/11/2024 120
Five Moments for Hand
Hygiene
 Session objective
• Introduce the concept of microorganism
transmission
• Identify the 5 Moments for Hand Hygiene
• Define the 5 Moments for Hand Hygiene and
related terminology
 Two Zones
•The Healthcare Zone
•The Patient Zone:
•The patient &
•The patient’s immediate
surroundings

Two Critical Sites

PATIENT ZONE

•Clean site
HEALTHCARE ZONE •Body fluid site
 Patient Zone

PATIENT ZONE

From Ontario Just Clean Your Hands Program

The science behind Just clean your hands presentation
 Patient Zone

Assumptions
• Patient flora rapidly
contaminates entire patient
zone
• Patient zone is cleaned
between patients

PATIENT ZONE
 Healthcare Zone

Assumptions
• Contaminated with
organisms foreign and
potentially harmful to
Patient X
• Transmission results in
exogenous infection
PATIENT ZONE

HEALTHCARE ZONE
 Critical sites

• Clean sites
• Have to be protected
against
microorganisms Clean site

• Body fluid sites

• Lead to hand
exposure of body PATIENT ZONE

fluids
HEALTHCARE ZONE
 The facts
• Colonised or infected patients are the main reservoir for
healthcare-associated microorganisms
• Environment in the healthcare facility contains a wide
variety of different healthcare-associated
microorganisms and represents a secondary source for
transmission to patients
• The immediate patient environment becomes colonised
by the patient flora
 The facts
• Most transmission of microorganisms results in
colonisation, not infection
• Most healthcare-associated infections, are of an
endogenous nature, and due to microorganisms already
colonising the patient before the onset of infection
 Four negative outcomes targeted by hand
hygiene

1. Cross colonisation of patients

2. Endogenous and exogenous infection in patients

3. Infection in HCWs

4. Cross colonisation of the healthcare environment

including HCWs
Moment 1 – Before Touching a Patient

Prevented negative outcome:

Patient colonisation with

healthcare microorganisms,
exogenous infection
Moment 2 – Before A Procedure
Prevented negative outcome:
Patient infection,
endogenous/exogenous

HCWs generally touch another

surface within the patient zone
before contact with a clean site
 Moment 3
After A Procedure or Body Fluid Exposure Risk

Prevented negative
outcome:
• Healthcare worker infection,
e n v i r o n m e n t a l
contamination
• Prevents transmission of
microorganisms from a
colonised to a clean body
site on patient X
Moment 4 – After Touching A Patient

Prevented negative
outcome:
Healthcare worker colonisation,
environmental contamination
Minimises dissemination to
healthcare environment
Moment 5 – After Touching A Patient’s Surroundings

Prevented negative
outcome:
Healthcare worker
colonisation, environmental
contamination
Minimises dissemination to
healthcare environment
The 5 Moments
 Moment 1
Before touching a Patient Touching a
Patient
 Patient
Refers to any part of the patient, their clothes, or
any medical device that is connected to the
patient

If the patient were to get out of bed and walk off

– what would still be attached to them?
 Moment 1
When: Examples:

Touching a patient in any way Shaking hands, Assisting a patient to

move, most Allied health interventions,
Touching any medical device connected to
the patient (e.g. IV pump, IDC)

Any personal care activities Bathing, Dressing, Brushing hair, Putting

on personal aids e.g. Glasses

Any non-invasive observations Taking a pulse, Blood pressure, Oxygen

saturation, Temperature, Chest
auscultation, Abdominal palpation,
Applying ECG electrodes, CTG

Any non-invasive treatment Applying an oxygen mask or nasal cannula,

Fitting slings/braces, Application of
incontinence aids (including condom
drainage)
 Moment 1

When: Examples:

Preparation and administration of oral Oral medications, Nebulised medications

medications

Oral care and feeding Feeding a patient, Brushing teeth or

dentures
 Key Message for Moment 1

Hand Hygiene before touching a patient

• Where possible Hand Hygiene should occur
in front of the patient so that they can
observe it
• Hand Hygiene on entering the patient’s room
 Example Moment 1

• HCW walks in ,helps patient to sit up, moves

over bed table, folds down sheets, moves the
chair into position, then assists patient out of bed

• Moment 1- prior to touching the patient

 Moment 2
Before a Procedure
 Procedure

Is an act of care for a patient where there is a

risk of direct introduction of a pathogen into the
patient’s body.
 Moment 2

When: Examples:

Insertion of a needle into a patient’s skin, Venipuncture, Blood glucose level,

or into an invasive medical device Arterial blood gas, Subcutaneous or
Intramuscular injections, IV flush

Preparation and administration of any IV medication, NGT feeds, PEG feeds,

medications given via an invasive Baby tube feeds, Dressing trolley
medical device, or preparation of a
sterile field

Administration of medications where Eye drop installation, Suppository

there is direct contact with mucous insertion, Vaginal pessary
membranes
 Moment 2

When:a Examples:

Insertion of, or disruption to, the circuit Procedures involving the following: ETT,
of an invasive medical device Tracheostomy, Nasopharyngeal airways,
Suctioning of airways, Urinary catheter,
Colostomy/ileostomy, Vascular access
systems, Invasive monitoring devices,
Wound drains, PEG tube, NGT, Secretion
aspiration

Any assessment, treatment and patient Wound dressings, Burns dressings,

care where contact is made with non- Surgical procedures, Digital rectal
intact skin or mucous membranes examination, Invasive obstetric and
gynaecological examinations and
procedures, Digital assessment of
newborns palate
 Key Message for Moment 2

Hand Hygiene immediately prior to a procedure

• Once Hand Hygiene has been done, nothing else
in the patient’s environment should be touched
prior to the procedure starting
 Example: Moment 2

HCW replaces an empty IV fluid bag

with a new IV fluid bag

• Moment 2 – prior to disconnecting the IV line

 Moment 3
After a Procedure or Body Fluid Exposure Risk
 Body Fluid Exposure Risk
Moment 3

Any situation where contact with body

fluids may occur. Such contact may pose
a contamination risk to either the HCW or
the environment
 Actual or potential contact with:

• Blood, Lochia
• Saliva or tears
• Mucous, wax, or pus
• Breast milk, Colostrum
• Vomitus
• Urine, faeces, semen, or meconium
• Pleural fluid, ascitic fluid or CSF
• Tissue samples, including biopsy specimens, organs,
bone marrow, cell samples
 Moment 3
When: Examples:

After any Moment 2 See Moment 2

After any potential body fluid exposure Contact with a used urinary bottle /
bedpan, Contact with sputum either
directly or indirectly via a cup or tissue,
Contact with used specimen jars /
pathology samples, Cleaning dentures,
Cleaning spills of body fluid from patient
surroundings, After touching the outside
of a drain
 Key Message for Moment 3
Hand Hygiene immediately after a procedure or
a body fluid exposure risk
• As hands are likely to be contaminated with
body fluid
 Example: Moment 3

HCW replaces an empty IV fluid bag

with a new IV fluid bag

• Moment 2 – prior to disconnecting IV

• Moment 3 – after reconnecting IV
 Example: Moment 3

HCW walks into the room,

empties IDC drainage bag,
disposes of urine in pan room

• Moment 2 – before opening IDC

• Moment 3 – after disposing of urine (exposure risk)
 Moment 4
After Touching a Patient
 Key Message for Moment 4

Hand Hygiene after touching a patient

• This completes the basic message of Hand
Hygiene before you enter the patient room,
and before you leave the patient room
 Example: Moment 4

HCW walks in,

helps the patient to sit up,
folds down the sheets,
moves the chair into position,
then gets the patient out of bed,
then leaves the room

• Moment 1 – prior to touching patient

• Moment 4 – after touching the patient
 Moment 5
After touching a patient’s immediate surroundings
when the patient has not been touched
Immediate Patient Surroundings

A space temporarily dedicated to an

individual patient for that patient’s stay
Includes:
• Patient furniture and personal belongings
• Medical equipment – BP machine, monitor
• Medical chart
• Anything touched by HCW while caring for that
patient
 Moment 5
When: Examples:

After touching the patient’s immediate Patient surroundings include: Bed,

surroundings when the patient has not Bedrails, Linen, Table, Bedside chart,
been touched Bedside locker, Call bell/TV remote
control, Light switches, Personal
belongings, Chair, Foot stool, Monkey
bar
 Key Message for Moment 5
Hand hygiene after touching the patient’s
surroundings when the patient has not been
touched
 Example: Moment 5

HCW walks into patient room,

moves the over bed table closer to the patient,
then leaves

• Moment 5 – after touching the patient

surroundings (without touching the patient)

If patient had been touched, then this would have

been recorded as:
• Moment 1 and Moment 4
 Chapter for practice
Chapter Five- Risk Factors Within the Patient Care Environment

• Sharp and injection safety

• Decontamination and reprocessing of medical
devices (instrument processing)
• Processing reusable textiles and laundry service
• Environmental cleaning
• Healthcare waste management
• Mortuary-infection prevention and control for
handling human remains
• Food and water safety

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Chapter Six- IPC and Facility Design
• Traffic flow and facility design
• Infection prevention and control aspects of occupational
health in health care settings
• IPC and communicable diseases in Ethiopia
• Client education on infection prevention and control
Chapter Eight: IPC management and governance
• Managing and leading infection prevention and control
program
• Monitor adherence to IPC measures using who interim
guideline
• Surveillance of healthcare associated infection
• Epidemiology and statistics for infection prevention and
control

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Chapter Six- IPC and Facility Design
• Traffic flow and facility design
• Infection prevention and control aspects of occupational
health in health care settings
• IPC and communicable diseases in Ethiopia
• Client education on infection prevention and control
Chapter Eight: IPC management and governance
• Managing and leading infection prevention and control
program
• Monitor adherence to IPC measures using who interim
guideline
• Surveillance of healthcare associated infection
• Epidemiology and statistics for infection prevention and
control

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 Chapter 7

• Advanced and Special Infection

Prevention and Control Practices

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