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 settingsOccupational exposure and isolation precautions SummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious wardSummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious ward2024/7/29Microbials and macrobialsVirusQuasi-organismViroidSub-virusVirusoidMicrobialsVirinoProkaryoteUni-cell organismArchaeonBiosMicro-organismEukaryoteMulti-cell organism:EukaryoteProkaryoteUni-cell organismArchaeonMacrobialsEukaryoteMulti-cell organism:Eukaryote2024/7/29Symbiosis and colonizationpSymbiosis: A living organism needs to rely on another living organisms to accomplish its metabolism and reproduction.pColonization: The relatively small species carry out metabolism and reproduction on the surface or in the body of a relatively large species.pDifference between symbiosis and colonization: A living organism needs or does not entirely need another living organism to accomplish its metabolism and reproduction.2024/7/29Parasitism and infectionpParasitism: Detrimental symbiosisparasite: Dependent party in parasitic relationshiphost: independent party in parasitic relationshippinfection: Detrimental colonizationpathogen: Dependent party in infectious relationshiphost: independent party in infectious relationship2024/7/29Symbiosis and Parasitism, colonization and infectionHarmless colonization Detrimental colonization Opportunistic infectionfacultative parasitismHarmless symbiosisDetrimental symbiosisContagion / CommunicationpContagionCommunication: The thransfers of microbials or tiny organisms between symbiotic or colonized hosts.pNatural 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 effect on the natural life of the species.ptransferring 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.2024/7/29Communication: A ubiquitous natural phenomenonThree tache of communicationpSources of infectious agentspMode of transmission pSusceptible host 2024/7/29Transmitting vectorspAirborne transmission: droplet, dust pWater transmission: water-drinking, water-touching pFood transmission: food parasitic, food contaminated pSoilborne transmission: soil-eating, soil-touching pBloodborne transmission: needling, transfusionpInsect transmission: mechanical carrier, biological carrier 12Eternal infection and communicationpInfection and communication is ubiquitous in nature.pIn the case of human infectious 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.pThere is no end to the occurrence of infectious diseases and spread ofcommunicable diseases.pThere is no end to the discovery, research and practice of human infectious diseases and spread ofcommunicable diseases.SummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious ward2024/7/292024/7/29Influenza: An eternally classical, emerging and reemerging contagious disease Studies of influenza transmissionpMiceDroplets & droplet nuclei transmit influenzapHumansFomites/environment; hands - culture datapTransmission studiesHigher preexisting antibody titers require larger inocula for transmission of clinical illnessShedding correlates with severity of illness and feverSmall droplet aerosols require lower inoculumExperiments of natureReview 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 outbreak (Am J Epidemiol 1979; 110:1-6)Blumenfeld HL, et al. J Clin Invest 1959; 38:199-212.7/208/1314/29Index2ndLastBlumenfeld HL, et al. J Clin Invest 1959; 38:199-212Moser MR, et al. Am J Epidemiol 1979; 1101-6.IndexMoser MR, et al. Am J Epidemiol 1979; 1101-6.1571311SARS: An once frightening emerging contagious disease The 9th floor layout of the Hotel Metropole in Hong Kong, showing where superspreading event of SARS occurred26MERS: A lingering frightening emerging contagious disease 28Ebola viral disease: a deadly emerging contagious disease 2024/7/29 Zaire2024/7/292024/7/292024/7/292024/7/292024/7/292015SummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious ward2024/7/29SterilizationpSterilization: a process that destroys 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.DisinfectionpDisinfection: a process that eliminates many or all pathogenic microorganisms, except bacterial spores.In health-care settings, objects usually are disinfected by liquid chemicals or wet pasteurization.Factors affecting of sterilization and disinfectionCleaning of the objectOrganic and inorganic load presentType and level of microbial contaminationConcentration of and exposure time to the germicidePhysical nature of the object Presence of biofilmsTemperature and pH of the disinfection processRelative humidity of the sterilization process.Sterilization vs DisinfectionSterilization is intended to convey an absolute meaning. however, some health professionals and the technical and commercial literature refer to disinfection as sterilization and items as partially sterile.Occupational exposurepExposure: The state of being exposed to contact with somethingOccupational exposure: Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood, bodily fluids, or other potentially infectious material that may result from the performance of ones professional duties.pIsolation: 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 contagious or communicable diseases. SummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious ward2024/7/29Personal protective equipmentpRefers to protective clothing and devices worn by workers to prevent injurypEmployers often require employees with PPE to enter a worksitepEmployees often demand “safety gear” 2024/7/29Personal protective equipmentHealthcare workersEye and face protection pShatter-proof safety glassespGogglespFiltered lensespFace shieldspprescription glasses 2024/7/29Respiratory protection pMaskspRespirators2024/7/29Skin Protection 2024/7/29pGlovesDisposableRubber, neoprenevinylpProtective clothingFoot protection pBootspShoe covers2024/7/29Doning and Doffing Masks Doning the Gown Doffing the Gown Doning the glovesDoffing the gloves1234Doning and Doffing the PPE 5656789101112Donning order against EbolaStep 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 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 EbolaStep 1: take off shoe covers or boots (shoe covers inside outwards), placed in the medical waste bags, boots into 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 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 elseMoments for Hand hygiene2024/7/292024/7/292024/7/29Sharp safetypDo not recap a needle by hand：use recapping-device, only if recapping is unavoidablepReplace sharps containers when 3/4 fullpImmediately dispose of sharps in sharps containerSharp safetypDo not place a needle on a desktop pDo not insert a needle in the bottle stopperpDo not remove the syringe needle by handpDo not destroy yourselfSharp safetypTake one hand recap a needlepPut the needle into the rubber pad.pPut surgical instruments in the curved plate for transferingSharp safetypUse disposable items as soon as possiblepUse safety pin as far as possible.pUse no needle systemNeedle-less systems Needle-less systems Disposal of medical waste Method for sealing boxesDOT Regulations for biomedical wastepSharps containerspRed bagspCardboard biomedical waste disposal boxespMust be labeled with the name and location of the facility generating the wasteSummaryInfection and CommunicationThe major emerging communicable diseasesSterilization vs Disinfection, exposure vs IsolationRational application of PPELayout and facilities of the infectious ward2024/7/29 B ISOLATION ROOM Negative pressure CHANGE ROOM GENERAL ACCESS AREA A. Handwash stationB. Container for disinfection of reusable items e.g. gogglesC. Biohazard bag for used personal protective equipment disposal D. Wall-mounted alcohol hand wash dispensers E. External windows only. Keep clear of publicF. Storage for general ward clothes, new PPE C ISOLATIONWASH/TOILET General Principles of isolation unitA D D A A E E F Before you runlets 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（帽）；：戴一次性帽子（帽）； 步步骤骤2 2：戴戴口口罩罩，如如为为医医用用防防护护口口罩罩或或全全面面型型自自吸吸式式呼呼吸吸器，检查密合性（罩）器，检查密合性（罩） ； 步步骤骤3 3：戴戴上上护护目目镜镜或或防防护护面面罩罩（全全面面型型自自吸吸式式呼呼吸吸器器无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（服）：穿防护服（服） ； 步骤步骤5 5：穿上鞋套或胶鞋（鞋）：穿上鞋套或胶鞋（鞋） ； 步步骤骤6 6：戴戴上上手手套套，将将手手套套套套在在防防护护服服袖袖口口外外面面（手手） 。针对针对Ebola的的PPE脱摘顺序脱摘顺序步步骤骤1 1：脱脱下下鞋鞋套套或或胶胶鞋鞋，带带手手套套将将鞋鞋套套里里面面朝朝外外，放放入入医疗废物袋中，将胶鞋放入消毒液中（鞋）；医疗废物袋中，将胶鞋放入消毒液中（鞋）； 步步骤骤2 2：脱脱掉掉防防护护服服和和手手套套，从从里里面面往往外外翻翻卷卷，将将里里面面朝朝外，放入医疗废物袋中（服）外，放入医疗废物袋中（服） ； 步骤步骤3 3：进行手卫生（手）：进行手卫生（手） ； 步步骤骤4 4：从从后后往往前前摘摘下下护护目目镜镜或或防防护护面面罩罩，如如重重复复使使用用放放入消毒液中，否则放入医疗废物袋中（镜）入消毒液中，否则放入医疗废物袋中（镜） ； 步步骤骤5 5：从从后后往往前前摘摘下下口口罩罩，放放入入医医疗疗废废物物袋袋中中，注注意意双双手不接触口罩表面和面部（罩）手不接触口罩表面和面部（罩） ； 步步骤骤6 6：将将手手指指反反掏掏进进帽帽子子，将将帽帽子子轻轻轻轻摘摘下下，里里面面朝朝外外，放入医疗废物袋中（帽）放入医疗废物袋中（帽） ；步骤步骤7 7：洗手、消毒（手）：洗手、消毒（手） 。