(2.5.1)--Emerging_Respiratory_Viruses_COV.pdf

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1、ModuleD:PreventingandrespondingtoemergingrespiratoryvirusesOveralllearningobjective:Todescribepreventionandcontrolstrategiesforemergingrespiratoryvirusoutbreaks(MD1)Unit1:Infectionpreventionandcontrol(IPC)andclinicalcareLearningobjective:Bytheendofthisunit,participantswillbeabletodescribetheprincipl

2、esofpreventinginfectioninthecommunityandinhealthcaresettingsModuleD:Infectionpreventionandcontrol(IPC)andclinicalcareWHO20203LearningobjectiveLearningobjectiveBytheendofthisunit,participantswillbeabletodescribetheprinciplesofpreventinginfectioninthecommunityandinhealthcaresettings.WHO20204IPCfortheg

3、eneralcommunityIPCforthegeneralcommunity 11Wenowknowthathuman-to-humanCOVID-19transmissionhashappenedinbothhouseholdandcommunitysettings.Toavoidtransmission,thegeneralcommunityneedsto:avoidagglomerationsandfrequencyofclosedcrowdedspaces maintaindistanceofatleastonemetre fromanyindividualwithCOVID-19

4、respiratorysymptoms(e.g.coughing,sneezing)WHO20205IPCforthegeneralcommunityIPCforthegeneralcommunity 22 performhandhygienefrequently,usingalcohol-basedhandrubifhandsarenotvisiblysoiled(for2030seconds)orsoapandwaterwhenhandsarevisiblysoiled(for4060seconds)ifcoughingorsneezingcovernoseandmouthwithflex

5、edelboworpapertissue,disposeoftissueimmediatelyafteruseandperformhandhygiene refrainfromtouchingmouthandnoseWHO20206IPCforthegeneralcommunityIPCforthegeneralcommunity 33Individualswithrespiratorysymptomsshould:wearamedicalmaskandseekmedicalcareifexperiencingfever,coughanddifficultybreathing,assoonas

6、possibleorinaccordancewithlocalprotocolsWHO20207Healthcareworkersmaybeatriskofinfection earlyrespiratoryinfectionsymptomscanbenonspecific;thushealthcareworkersmaynotbepromptedtoimplementadditionalprecautionstopreventtransmissionwhileprovidingcare hencetheimportanceofstandardprecautionsIPCmeasurestop

7、reventtransmissioninIPCmeasurestopreventtransmissioninhealthcaresettingshealthcaresettings1 1WHO20208UsestandardprecautionsforALLpatients,inALLsettings,atALLtimeregardlessofsymptoms.Theseinclude:handhygiene respiratoryhygieneandcoughetiquette useofpersonalprotectiveequipment(PPE)basedonriskassessmen

8、t safeinjectionpracticesIPCmeasurestopreventtransmissioninIPCmeasurestopreventtransmissioninhealthcaresettingshealthcaresettings 2 2WHO20209Standardprecautionscontinued:environmentalcleaning wastemanagement linenmanagement patientcareequipmentIPCmeasurestopreventtransmissioninIPCmeasurestopreventtra

9、nsmissioninhealthcaresettingshealthcaresettings 3 3WHO202010Attriage:earlyrecognitionofpatientwithCOVID-19;haveahighlevelofclinicalsuspicionofCOVID-19 givethepatientwithsuspectedCOVID-19amedicalmask placethepatientinseparatearea thiswillcontributetosourcecontrolanddiminishpotentialforenvironmentalco

10、ntamination SpecificIPCmeasuresforCOVIDSpecificIPCmeasuresforCOVID-1919 11WHO202011Attriage:ensureawell-equippedtriagestation:institutescreeningquestionnaireaccordingtoCOVID-19casedefinition organizethespaceandprocesstopermitspatialseparation of12metresbetweeneachpatientwithCOVID-19andotherindividua

11、ls postsignsinpublicareasremindingsymptomaticpatientstoalerthealthcareworkers ensurethattriageandwaitingareasareadequatelyventilatedSpecificIPCmeasuresforCOVIDSpecificIPCmeasuresforCOVID-1919 2 2WHO202012 Encouragerespiratoryhygiene(i.e.coveringthemouthandnoseduringcoughingorsneezingwithatissueorfle

12、xedelbow),followedbyimmediatedisposalofthetissueandhandhygiene WhenadmittingpatientstowardsensurethatonlythosewithconfirmedinfectionareplacedwithotherCOVID-19confirmedcasesSpecificIPCmeasuresforCOVIDSpecificIPCmeasuresforCOVID-1919 33WHO202013IPCmeasuresinhealthcaresettings:IPCmeasuresinhealthcarese

13、ttings:DropletandcontactprecautionsDropletandcontactprecautions 1 1SingleroomsorwardsshouldbeadequatelyventilatedPlacepatientsinsinglerooms,orwhennotavailable,grouptogetherthosewiththesameorsimilardiagnosis.Keeppatientsspatiallyseparatedbyatleastonemetre.HealthcareworkerscaringforpatientswithCOVID-1

14、9shouldapplyDROPLETandcontactprecautionstopreventtransmissionoftheviruses.Theseare:WHO202014 gloves gown amedicalmask faceshieldorgogglesHealthcareworkerscaringforpatientswithCOVID-19shouldapplyDROPLETandcontactprecautionstopreventtransmissionoftheviruses.Wheninclosecontactwithpatientsuse:IPCmeasure

15、sinhealthcaresettings:IPCmeasuresinhealthcaresettings:DropletandcontactprecautionsDropletandcontactprecautions 2 2WHO202015Afterpatientcare,appropriatedoffinganddisposalofPPEandhandhygieneshouldbecarriedout.AnewsetofPPEsisneeded,whencareisgiventoadifferentpatient.Limitpatientmovementwithintheinstitu

16、tionandensurethatpatientswearmedicalmaskswhenoutsidetheirrooms.IPCmeasuresinhealthcaresettings:IPCmeasuresinhealthcaresettings:DropletandcontactprecautionsDropletandcontactprecautions 3 3WHO202016DropletandcontactprecautionsDropletandcontactprecautions 4 4 Ifpossible,useeitherdisposableordedicatedeq

17、uipment(e.g.stethoscopes,bloodpressurecuffsandthermometers)Ifequipmentneedstobesharedamongpatients,cleananddisinfectitbetweeneachpatientuseWHO202017 Ensurethathealthcareworkersrefrainfromtouchingtheireyes,nose,ormouthwithpotentiallycontaminatedglovedorungloved hands Avoidcontaminatingenvironmentalsu

18、rfacesthatarenotdirectlyrelatedtopatientcare(e.g.doorhandlesandlightswitches)RoutinelycleananddisinfectsurfaceswhichthepatientisincontactDropletandcontactprecautionsDropletandcontactprecautions 5 5WHO202018 Ensureadequateroomventilation Usesinglerooms,orcohortpatientswiththesamediagnosis Minimizemov

19、ementortransportofpatients PerformhandhygieneDropletandcontactprecautionsDropletandcontactprecautions 6 6WHO202019AirborneprecautionsAirborneprecautions 1 1Someproceduressuchasaspirationoropensuctioningofrespiratorytractspecimens,non-invasiveventilation,highflowoxygentherapy,deliveryofnebulizers,int

20、ubation,cardiopulmonaryresuscitation,andbronchoscopycangenerateaerosols(calledaerosol-generatingprocedures).TheseareassociatedwithincreasedriskoftransmissionofCOVID-19.Healthcareworkersneedtotakethefollowingairborneprecautionswhenperformingthese.WHO202020 UsePPE,includinggloves,long-sleevedgowns,eye

21、protection,andparticulaterespirators(N95orequivalent,orhigherlevelofprotection)Useadequatelyventilatedsingleroomswhenperformingaerosol-generatingprocedures thismeansnegativepressureroomswithaminimumof12airchangesperhouroratleast160litres/second/patientinfacilitieswithnaturalventilation.Askallpeoplen

22、otrequiredforthetasktoleavetheroom.AirborneprecautionsAirborneprecautions 2 2SignsandsymptomsSignsandsymptoms 1 1Aswithothercoronavirusinfections,earlysignsandsymptomsinmoresevereinfectionsarelikely:fever chills cough shortnessofbreathRapidprogressiontoseverepneumoniaandrespiratoryfailureusuallyhapp

23、enswithinthefirstweekWHO202021Life-threateningmanifestationsofrespiratoryinfectioninclude:severepneumonia acuterespiratorydistresssyndromeEarlyrecognitionoftheseclinicalsyndromesallowsfortimelyinitiationofinfectionpreventionandcontrol(IPC)aswellassupportivetherapeutics.Lifethreateningmanifestationso

24、fLifethreateningmanifestationsofrespiratoryinfectionrespiratoryinfectionWHO202022SupportivetherapySupportivetherapy 1 1Althoughthereisoftennospecificcureforemergingrespiratoryvirusinfection,thefollowingthreesupportivetherapiesmaycounteractthesymptomsandincreasechancesofsurvival.1.Antimicrobials:suit

25、ableforlikelypathogens,includingcommunity-acquiredpneumoniaorhealthcare-associatedpneumonia(ifinfectionwasacquiredinahealthcaresetting)andsepsisWHO2020232.Oxygen:peoplewithsevereCOVID-19withsignsofrespiratorydistress,reducedbloodoxygenlevels(hypoxaemia),orshockshouldbegivensupplementaloxygentherapyi

26、mmediately3.Specifictreatmentforunderlyingconditionssuchasdiabetes,kidneyfailure withcoronavirusinfections,manypeoplewithseverecasesofinfectionhaveunderlyingconditionsandthisgroupareatgreatestriskofdyingWHO202024SupportivetherapySupportivetherapy 2 2IntensivesupportivecareIntensivesupportivecare 1 1

27、Severerespiratorydistress:notrespondingtoescalatingsupplementaloxygentherapyrequiresadvancedrespiratoryinterventionsincluding:highflowoxygen non-invasiveventilation invasiveventilationWHO202025Septicshock:treatwithintravenousfluidtherapyandvasopressorstoimprovetargetsofperfusion theseapproachesgener

28、ateaerosolssotheairborneprecautionsoutlinedinthisunitmustbefollowedWHO202026IntensivesupportivecareIntensivesupportivecare 2 2Compoundsalreadylicensedorindevelopmentforotherdiseasesmayneedtoberepurposedforemergingrespiratoryvirusinfection.TherapeuticsresearchTherapeuticsresearch 1 1WHO202027Contacts

29、ofconfirmedcasesmayidentifypeoplewhotestpositivebuthavenosymptoms.Untilmoreisknown,peoplewhoarefoundtobepositiveonRT-PCRtesting,shouldbe:isolated,followedupdailyforsymptoms,and testedatleastweekly orearlier,ifsymptomsdevelop.ManagementofpeoplewithManagementofpeoplewithasymptomaticinfectionasymptomaticinfection 1 1WHO202028Isolationshouldcontinueuntiltwoconsecutiveupperrespiratorytractsamples(e.g.nasopharyngealand/ororopharyngealswabs)takenatleast24hoursaparttestnegativeonRT-PCRWHO202029ManagementofpeoplewithManagementofpeoplewithasymptomaticinfectionasymptomaticinfection 2 2