Knowing your PPE for your outbreak
In the realm of long-term care homes during outbreaks, the appropriate selection of Personal Protective Equipment (PPE) stands as a cornerstone of defense against infectious agents especially as we enter the critical fall seasonal cold/flu/COVID time. PPE, as a first line of defense, serves as both armor and shield, reducing the risk from potential sources of infection. However, PPE chosen must address the specific mode of transmission exhibited by the microorganism responsible for the outbreak and must be used appropriately. This paper will explore how important it is to choose the right protective gear in long-term care homes during outbreaks and emphasize how essential it is to match the PPE with the way the microorganism spreads.
Firstly, I would like to advise that for the purpose of this paper, we will be differentiating COVID-19 and Influenza as airborne/droplet transmitted illnesses. This is with the understanding that truly airborne transmitted diseases (i.e., tuberculosis, measles) are not seen in long-term care homes unless a negative-pressure isolation room is used.
As we know, the world of infection prevention and control is ever-evolving, and with the introduction of the COVID-19 virus 3 years ago into the human population, and with further understanding of how it can spread, we began to require healthcare staff don N95 respirators for protection from COVID-19. This is due to the understanding that the small viral particles can attach to particles in the air which can then float and remain in the air for hours. With this change in recommendation, we also required the donning of N95’s for those infected with influenza. Why it took the COVID-19 pandemic to finally recommend the appropriate PPE to protect healthcare workers from the Influenza virus, I am unable to answer. But I digress.
Understanding the modes of transmission is pivotal to effective preventive measures:
- Contact Transmission: Direct or indirect physical contact with contaminated surfaces or infected individuals. As such, the recommended PPE consists of gloves and gowns. However, additional PPE may be donned based on a personal risk assessment. Hand hygiene assumes added significance in this context to prevent the transmission of contact-based infections.
- Droplet Transmission: Dissemination of larger respiratory particles that travel relatively short distances. In response, the recommended PPE includes surgical masks, eye protection, gowns, and gloves. Notable examples of pathogens transmitted via droplets include Norovirus (stomach flu) and Rhinovirus (common cold).
- Airborne/Droplet Transmission: Certain microorganisms can remain suspended in the air for extended periods and can travel over more considerable distances. To guard against this, healthcare workers are advised to employ N95 respirators along with eye protection, gowns, and gloves. Microorganisms that exploit this transmission mode include COVID-19 and influenza.
- Vector-Borne Transmission: This mode involves the intermediation of vectors such as rodents, mosquitoes, ticks, bedbugs, and scabies in transmitting diseases. PPE requirements in these scenarios depend on the specific organism and may encompass measures to cover exposed skin, pest control measures, the application of insect repellents, or medications such as ointments. Gown and gloves should be worn when necessary and minimal contact with the affected environment is recommended.
Understanding these modes of transmission and the corresponding PPE recommendations is fundamental in providing effective protection to both healthcare workers and residents in long-term care homes during outbreaks.
Let’s take a look at a real-world example and response based on the microorganism:
Norovirus Outbreak
In a long-term care facility I recently visited, an outbreak of norovirus occurred. This virus is primarily transmitted through the fecal-oral route and via contaminated surfaces. During this outbreak, staff donned PPE that included gloves and gowns to prevent the spread of the virus through direct and indirect contact. Additionally, proper hand hygiene practices were enforced. The effectiveness of this PPE and infection control measures was notable, as the outbreak was contained within a relatively short period. Swift isolation of affected residents and adherence to PPE protocols played a crucial role in preventing further transmission of the virus. This example highlights how PPE, when used in conjunction with other preventive measures, can effectively control outbreaks in long-term care homes, including those involving fecal-oral transmission.
Within the realm of infection control in long-term care homes, various challenges and considerations arise when it comes to Personal Protective Equipment (PPE) selection. These encompass issues such as shortages, N95 fit-testing, and staff compliance. Moreover, there is a strong emphasis on the significance of ongoing training and education for healthcare workers. These aspects are vital not only for addressing the obstacles associated with PPE usage but also for ensuring the proper utilization of PPE.
In conclusion, the selection of the appropriate PPE, aligned with the mode of transmission, stands as a fundamental pillar in safeguarding long-term care homes during outbreaks. PPE serves as the armor that shield healthcare workers can use against infectious microorganisms. As the healthcare landscape continues to evolve, understanding the nuances of PPE selection remains in high importance in the ongoing battle against infectious diseases.
