[MUSIC] Hello, This is Alice Bonner. I am adjunct faculty at the Johns Hopkins University School of Nursing. Today, we're going to be talking about some infection prevention strategies. We have a few learning objectives. We want after the presentation for you to be able to review at least two aspects of workplace safety. You're going to learn about donning and doffing, that's putting on and taking off, personal protective equipment, or PPE. You're going to hopefully be able to understand techniques for infection prevention, several of which are listed here. And you'll be able to discuss a least two ways to communicate with residents and between staff or service providers and management about infection management practices during COVID-19. So the best way to prevent the spread of COVID-19 is to keep it out. Keep it out of your assisted living residents. Keep it out of your senior housing campus. Some of the principles of prevention and infection management and workplace safety are to wear a mask. And we're going to talk more about types of masks in a little bit. You want to wear either gloves or full PPE when it's indicated. You want to post clear signage throughout the center or campus so that residents, staff, visitors, contractors, or vendors. Everyone who is on that campus or in that center understands the principles of preventing the spread of COVID-19. You want to keep a social distance, and that's 6 feet or more from other individuals. You want to avoid places with more than 10 people gathering, so you want to avoid big crowds. And if you develop symptoms, you need to stay home and see your health care provider and get tested. Very, very important. And finally, we cannot say this enough, we all need to wash our hands. So I want to talk for a couple of slides about mask selection and use. There are several types of masks. And not all of them are recommended for use in either health care settings or places such as assisted living. Or campuses with senior housing where there's vulnerable individuals. Centers or campuses must each have policies for mask wearing by staff, by residents, and visitors. So, basically, anyone who's going to be on the campus or in the center. Types of masks you may have heard about includes surgical masks, N95, and KN95 masks. They are not the same. And there are a few others that you may hear about. And each of these are used in specific circumstances. So cloth or vented masks should not be worn in nursing homes, assisted living or senior housing. They don't provide adequate protection. Many people will wear them out and about in the community. But they're not appropriate for staff or visitors, or anyone in our settings that we're talking about today. Surgical masks should be worn once and then thrown away in the trash if they are disposable surgical masks. Some types of masks, like the KN95s or the N95s require something called fit testing. And there are CDC and other videos that demonstrate the proper techniques for fit testing. And we would strongly encourage you to look for those CDC videos. They're very, very helpful. So the fit testing refers to these masks, as I said, the N95 or KN95s which is sometimes called respirators. And the respirator is a type of personal protective device. It's worn over the face, covers at least the nose and mouth. And it's used to reduce the wearer's risk of inhaling hazardous airborne products. The N95 respirators are certified by NIOSH, which is a part of CDC. And the KN95s are approved by a different agency in the United States, the FDA. Respirator use must be in the context of a complete respiratory protection program. And we listed some of the federal regulations here. It's important to note that health care personnel should be medically cleared and fit tested if they're using respirators, because these have tight fitting face pieces. And so you need to be trained in the proper use of respirators, the safe removal and disposal. And if there's any medical contraindications that someone might have to respirator you. It's important to know that ahead of time. You might see the term filtering facepiece respirators or FFRs, and these are disposable half-facepiece respirators that filter out particles. Of note, there are some counterfeit respirators on the market now, and these are not NIOSH approved. So we gave you a website here, if you're not sure and you don't see the markings right on the mask itself and in the packaging, there is a place, a website you can go to to see if they've listed the mask that you're looking at or the respirator that you're looking at. So just wanted to talk for a moment about the adequate supplies of PPE. There are still areas in the United States that are struggling to obtain adequate and appropriate PPE. So who's in the supply chain for your community, your assisted living or senior housing residents? How do you know how to escalate urgent requests, if you're starting to think you're getting low on some of the PPE that you need? There's something called a PPE burn rate calculator, and that's a tool that lets you look at how much PPE you have, the number of residents for whom you might need it, the number of staff. And it shows you how long that PPE will last and when you need to start to reorder before you run out. So you need training in how to use that or a similar tool. You need to know what to do if it's the middle of the night and you're there and you need to contact someone, so telephone numbers and emails to reach the right people. And again, just want to reemphasize the proper and safe disposal after use of PPE, and there's lots of resources on that. So I don't think anyone will be surprised to see some of these challenges to using PPE or personal protective equipment. But some of the things that are often a barrier would be inadequate or absent training, lack of supervision, lack of time, not having enough staff. And the most important one on this slide is team members thinking that it's not a priority, and that's something we can change. In terms of training in the proper use of PPE, what if a new staff person comes onto the campus? How would you determine if they knew how to put on and take off PPE appropriately? We talked about mask fit testing, and as we said it's really important for certain types of masks. Some organizations hire a company to do fit testing and some train their own staff. It's critical to prioritize who should be fit tested, you're not going to do that for everyone. But consulting with the CDC or the Department of Public Health for updated guidance is often helpful. And there are videos or sets of videos that you and your team can access, and these short videos by the CDC are really helpful. And you should be given time to watch them and practice putting on and taking off PPE. There are a few principles or fundamentals related to personal protective equipment. For example, check for the availability of all the needed PPE and other supplies for each person before you go into their room. You want to limit the number of times you go in and out of people's rooms. You want to make sure that there's waste receptacles available both inside and outside of a tenant or resident's room. It's helpful to arrange with coworkers if you're going into a room, in case you need somebody's assistance, this is like a buddy system, so that is a part of promoting workforce safety. And you definitely need to know the principles of the proper and safe PPE storage and disposal after use, because after use these items could be contaminated. So we're now going to show a couple of slides about donning and doffing, putting on and taking off PPE, and the order is really important. So putting on PPE, here's the order, and let me just say ahead of time, all of this is on the CDC website and we're going to show you where you can find this information if you need it in the future. First, as we said, you're going to identify and gather all the appropriate PPE and any other supplies that you need. Hand hygiene is always a critical step, and it needs to happen at this point in the order of things, so hand hygiene is critical. The third step is the isolation gown or similar covering, and you may need help tying some of the ties from another staff member or you may be able to do it on your own. The fourth step, the mask or the respirator, again, as we've said, the fit and type of mask is important for certain aerosolized procedures and other aspects of care, if there's going to be. Splashes are sprays N95 or higher is generally recommended. You may not need that. But again, it's important to know the policies and the procedures in the assisted living or senior housing campus where you're working. The eye protection might be either a face shield or a set of goggles. The last step is the gloves and you want to be sure to cover the gown at the wrist. And now, as a health care professional, you're set and you may enter the person's room. Taking off PPE again the steps are critical because you want to avoid contamination. So, you're going to remove the gloves first and just keep in mind the outside of the gloves may be contaminated. You want a second remove and roll the gown and you want to roll it so that the outside of the gown that might be contaminated is on the inside of the rolling process. And now after disposing of the gown and the gloves, you may exit the person's room. As we always say, hand hygiene is critical. So either using an alcohol based hand sanitizer or soap and water for 20 seconds. Now you can remove the face shields or goggles and put them in a designated place if they're going to be reused after some sort of process to decontaminate them. In some cases, they may be disposable. You want to then Remove and discard the respirator or the face mask appropriately. And finally, as we've said, hand hygiene is always a critical step. This is an example and I know you cannot see the type because it's very small but this is an example of a poster or a flyer. That is on the CDC website and available for you to download. So you can download this poster you can put these up around your assisted living residence in common areas and break rooms, anywhere that you think it will be useful and the same thing in a senior housing campus. Where you think people will read it who need this information and it goes through all of the steps that we just went through on putting on and taking off pp. These posters come in English, Spanish, Portuguese and several other languages. So please take a look on the CDC, the Centers for Disease Control website wanted toe speak for a minute or two about cleaning and disinfecting, so cleaning and disinfecting are not the same thing. Cleaning means removing any soil or dirt on the We do that first and then disinfecting is applying anti microbial products to kill viruses, or other potentially harmful pathogens. There's something you may have heard of called dwell time or contact time. That's the amount of time a disinfectant must remain visibly wet on a surface in order to kill pathogens. So this is a common error that sometimes made. It's critical because it may take up to 10 minutes in some cases and the area should not be wiped out. Dry it needs to dry on its own it needs to air dry and it needs to take as much time as required for that to happen. And proper procedures depend on the actual product. So you always want to follow the manufacturer's instructions for each product that you're using. Either for cleaning or for disinfecting and this is a critical point do not mix products. Cleaning and disinfecting products or multiple products in either category should not be mixed together and we provided a CDC Center for Disease Control set of guidelines on disinfection and sterilization for healthcare facilities. So cleaning and disinfecting for SARS COVID-2 the virus that causes the illness that we see with COVID-19. So the Environmental Protection Agency or EPA has resources at a link and you can find this updated information including lists. And, and that's really critical. So take a look at list and you can go to the website and you'll find that all the products are there that are recommended for the settings. You also want to think about higher risk surfaces. So time maybe an issue just getting around to all of the areas that need to be cleaned or disinfected, so faucets door handles. Light switches, any place that people are touching frequently with their hands, toilet sink areas, etc. These are high risk areas. You also want to consider tools that people are using in the centre or on the campus, you want to think about handling different chemicals that may be used. Trash removal and high traffic and common areas and in your policies and procedures for the organization that you. working with. All of this should be spelled out as much as possible. The frequency and the schedule for who is responsible for each of the tasks we're talking about here really should be detailed. So having a list of the individual resident or tenant rooms, common areas, break rooms, etcetera. Very important that staff common areas like the cafeteria or the lounge are addressed in terms of the frequency that will be used for cleaning and disinfecting. And always think about safe storage of thes products. You want them in a lockable storage area, certainly away from anyone who could misuse them. So a few more notes about disinfecting resident rooms, tenant rooms you want to start with surfaces that air cleanest first and then go from a top to bottom approach. So areas that air higher up closer to the ceiling and do the floor areas and areas near the floor. Last cleaning cloth should only be used in one room, and you would never put the cleaning cloth back into the cleaning bucket after you've used it. And the mop heads, ideally, should be changed after each room. And, you know, maybe it's possible to designate a mophead for use in a individual room a few times, but you would not want to use the same mophead in different rooms with different tenants or residents. And as much as possible, you want to prevent your isolation gown from touching specific resident care items that they might pick up afterwards because that could be a source of contamination. And this is a summary slide that just reminds us all that there are federal and state regulations and re sources that are available. So on the left side of the slide, you see the C. D. C. Infection prevention website resource is, and they do include guidance for assisted living. Residence is not so much for senior housing, but you're going to hear some additional lectures about senior housing environments. There are state resource is that may include a strategic plan for your state. This is an example from Texas, and your state may have a similar strategic plan. S so be sure to check out your state website and look for a state plan for covert 19 specific for nursing facilities for assisted living or for senior housing. They may all be together, or they may be in separate documents. Thank you very much for listening
