Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response Rapid advice guideline Summary of the recommendations October 2014 1.Introduction This document provides a summary of recommendations for personal protective equipment (PPE) to be used by health workers providing clinical care for patients with filovirus infection (Ebola and Marburg). The recommendations have been developed in accordance with the WHO Rapid Advice Guideline procedures.The technical specifications accompanying these recommendations are available separately (available at apps.who.int/iris/bitstream/10665/137411/1/WHO_EVD_Guidance_SpecPPE_14.1_eng.pdf?ua=1). 2. Principles guiding PPE use 1.Preventing virus transmission in health-care settings requires the application of procedures and protocols referred to as “controls”. These are, in order of Infection Prevention and Control (IPC) effectiveness: administrative controls, environmental and engineering controls, and personal protective equipment(PPE). Although PPE is the most visible control used to prevent transmission, it must be used in conjunction with administrative and engineering controls (such as facilities for barrier nursing and work organisation, water and sanitation, hand hygiene infrastructure, waste management and ventilation). PPE must be correctly selected and used in a safe manner; this is especially important when putting on and removing PPE, and decontaminating PPE components. 2.Standard Precautions. It is not always possible to identify patients with filovirus infection because early symptoms are non-specific. For this reason, it is important that health workers use Standard Precautions consistently when providing care to all patients, regardless of their diagnosis. Their rigorous implementation is crucial for the control of outbreak situations. Standard Precautionsinclude: hand hygiene point-of-care risk assessment for appropriate selection and use of PPE to avoid direct contact with patients’ body fluids (including blood, stool, amniotic fluid, urine and respiratory secretions), mucous membranes and non-intact skin respiratory hygiene(cough etiquette) prevention of needle-stick or sharps injuries safe waste management 4 cleaning, disinfection (and sterilization, where applicable) of patient -care equipment and linen cleaning and disinfection of the environment. Details on standard precautions and best practices for infection prevention and control of filovirus infection in health care settings can be found in the WHO 2014 Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola(available at who.int/csr/resources/publications/ebola/filovirus_infection_control/en/). 3.Health and wellbeing of workforce. Safeguarding the health and wellbeing of health workers at the work place, including the provision of hand hygiene and appropriate PPE, is a priority for, and the responsibility of policy-makers, employers, managers and the health workers themselves. Making optimum provisions for protecting the health and safety of the work force is considered a basic responsibility of the employer: i.A risk assessment of the work place must be carried out by competent experts appointed by the employer. ii.All health workers at risk must be provided with adequate, effective and sustainable control measures which are commensurate to the risk. iii.Health workers should be informed of the risks they may face, and the mitigating effects of PPE when used consistently and correctly. Compliance with all control measures is the responsibility of the health worker. iv. Policymakers and managers need to consider issues such as climate conditions and cultural norms to ensure uptake of protection measures and maximise compliance. v. The recommended PPE must be available and accessible to health workers. 4.Implementation. Implementing these recommendations will require training that is suitable for different categories of health workers(including supervisors), and takes into account, where necessary, local customs and cultural acceptability. Adequate resources (human, material and financial) must be made available. 5.Resource management. Resource management includes stockmanagement, availability of different sizes and shapes of PPE, placement of items for easy access, quality of items purchased andline management for reporting shortages. Written protocols need to be in place for the management of used and potentially contaminated medical devices, including safe discard and decontamination and re-use if recommended by the manufacturer. Methods of guideline development Development of these recommendations included: development of a scoping document for approval by the WHO Guideline Review Committee; development of key questions; a systematic review of the literature; a literature review and an online survey on the values and preferences of expatriate health workers; an evidence-to- recommendations exercise using the GRADE framework; and an expert consultation. The research question for the systematic review was: What are the benefits and harms of double gloves, full face protection, head cover, impermeable coveralls, particulate respirators, and rubber boots as PPE when compared with alternative less robust PPE for health workers caring for patients with filovirusdisease? The systematic review yielded no comparative evidence for the different types of PPE. An in-depth literature review on the values and preferences of health workers regarding PPE, but not specifically focusing on filovirus disease, was carried out. An online survey was also conducted among expatriate health workers with experience caring for patients with Ebola virus disease to obtain information on their values and preferences regarding PPE. The responses to the survey included aspects such as comfort, ease of use, and sense of protection (safety). A thorough mandatory training on the use of PPE followed by mentoring for all users before engaging in any clinical care is considered fundamental for preventing filovirus disease among health workers. In addition, based on experience in the field, the ready availability of PPE items, along with their familiarity and acceptability were considered important when selecting PPE. The use of disposable, rather than reusable, items was generally preferred.
Posted on: Tue, 04 Nov 2014 13:42:43 +0000
Trending Topics
Recently Viewed Topics
© 2015