Transmisión de la Influenza A y Medidas de Control

Presentación del tema: "Transmisión de la Influenza A y Medidas de Control"— Transcripción de la presentación:

1 Transmisión de la Influenza A y Medidas de Control
Dr. Néstor Sosa Centro Regional de Capacitación en Salud

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3 Gotitas pequeñas: <5μm “Doplet nuclei”
Gotas Mediana y Grandes

4 Que tan contagiosa es influenza?
Inhalación de 3 partículas infecciosas pueden transmitir infección En familias, tasas de ataque son 20%-60% En un crucero naval: 42% Avion con sistema de ventilación malogrado por 3 horas, un solo pasajero con influenza: enfermedad tipo influenza en 72% en los siguientes 3 días Más contagioso cuando no hay inmunidad presente en la población Musher. NEJM 2003;348(13):

5 ¿Cómo se Adquiere la Influenza A?
Transmisión y contagio ocurre a través del tracto respiratorio Puede tambien producirse infección conjuntival. No hay evidencia de infeccion intestinal en humanos (importante en aves)

6 Downloaded from: Principles and Practice of Infectious Diseases
© 2005 Elsevier

7 Transmisión de la influenza A
Persona a persona a través de contacto cercano Tres mecanismos: Gotas respiratorias (corto alcance) Contacto directo e indirecto Aerosoles respiratorios No se conoce la contribucion relativa y la importancia clinica de cada uno de estos modos de transmision

8 Factors Shown to Be Important in the Transmission of Common Respiratory Agents
Table 2. Factors Shown to Be Important in the Transmission of Common Respiratory Agents. Musher D. N Engl J Med 2003;348:

9 Impacto de los aerosoles
Ratones en un cuarto con un ventilador rotando lentamente. Viruses de influenza aerosolizados en el cuarto se mantuvieron infecciosos por hasta 24 h a bajos niveles de humedad. Con más humedad, infectividad fue más baja. Se necesita una dosis infecciosa 100 veces más pequeña para infectar humanos con influenza mediante aerosoles que a través de gotas nasales.

10 Procedimientos generadores de aerosol
Intubación endotraqueal Succión con circuito abierto Nebulizaciones Broncoscopía Ventilación no invasiva Resucitación cardiopulmonar Autopsias

11 Transmision a traves de contacto
Importancia como modo de transmision es desconocida. Puede ser directo tocando piel o secreciones contaminadas. Puede ser indirecto a través de superficies contaminadas con secreciones de pacientes infectados.

12 Sobrevida de influenza en superficies inanimadas
Depende de las condiciones ambientales Mayor a baja temperatura y baja humedad Hasta 48 horas en superficies no porosas como acero inoxidable 8-12 horas en superficies porosas como tela y papel Como 5 minutos en manos Bean et al. Survival of Influenza Viruses on Environmental Surfaces. Journal of Infect Dis 1982;146(1):47-51

13 Effect of Types of Contact and Living Conditions on the Likelihood of Contagion from Common Bacterial and Viral Respiratory Tract Pathogens Table 3. Effect of Types of Contact and Living Conditions on the Likelihood of Contagion from Common Bacterial and Viral Respiratory Tract Pathogens. Musher D. N Engl J Med 2003;348:

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15 Muchas Gracias ¡Buen Viaje a Todos!

16 Control de Infecciones
Metas: Prevenir la diseminación de la influenza de las personas enfermas a las sanas. -Proteger a los Trabajadores de la Salud -Proteger a los familiares Minimizar el Temor

17 Control de Infecciones
Obstáculos: Costo Tolerabilidad Disponibilidad

18 Tipos de Intervenciones en el Control de Infecciones
Controles de Ingeniería Medidas Administrativas Medidas en el área de trabajo Uso del Equipo de Protección Personal En orden decreciente de confiabilidad y eficacia.

19 Protección de los Trabajadores
Lavado de Manos Limpieza del Ambiente Hospitalario Distanciamiento Social: Reducir la frecuencia, proximidad y duración del contacto entre personas, dentro del hospital.

20 Controles de Ingeniería
Muy efectivos. Requieren recursos económicos Ejemplos: Instalación de lavamanos o mejor Dispensadores de Alcohol Gel Barreras Plásticas en áreas de Recepción o Triage. Flujo expedito de pacientes en diferentes áreas.

21 Controles Administrativos
Políticas Institucionales: Ausentismo por enfermedad Disminuir los viajes. Planes de Comunicación Trabajo a distancia

22 Medidas en el Area de Trabajo
Lavado de Manos Limpieza del Ambiente Hospitalario Distanciamiento Social: Reducir la frecuencia, proximidad y duración del contacto entre personas, dentro del hospital. Vacunación Quimioprofilaxis Protocolos de Manejo, Normas y Procedimientos (SOP)

23 Equipo de Protección Personal
Mascarillas y Respiradores Guantes Batas Protectores Oculares Botas Delantales impermeables

24 Precuaciones Estándares
Deben ser empleadas con TODOS los pacientes. Incluye: Uso de Guantes y lavado de manos para todo contacto con piel no intacta, mucosas, sangre y otros fluídos corporales. Estipulan el uso de Equipo de Protección según la tarea a desempeñar. Standard precautions include infection control practices and use of personal protective equipment recommended for healthcare personnel when having contact with all patients wherever healthcare is delivered, regardless of patient diagnoses or presumed infection status. Standard Precautions is designed to protect HCWs and patients from contact with infectious agents in recognized and unrecognized sources of infection. Standard Precautions applies to 1) blood; 2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; 3) nonintact skin; and 4) mucous membranes. The application of Standard Precautions during patient care is determined by the nature of the HCW-patient interaction and the extent of anticipated blood, body fluid, or pathogen contact. For some interactions, only gloves may be needed; in others gloves, gowns, and face shields may be required. Please click on the link and review the CDC recommendations for standard precautions

25 Lavado de Manos Washing and disinfecting your hands are the most important actions you can do to protect yourself and others. In fact, it is so important that our institution is very serious about it and mandates adherence to hand hygiene practices as described in Medical Center Policy Memorandum [INSERT LINK TO THE POLICY]. You should become very familiar with this policy, and follow its instructions carefully, as supervisors are asked to monitor adherence and report it to infection control and the medical center leadership. At our institution, we have two different manners in which hand hygiene can be accomplished. One, you can wash your hands with water and soap. We provide antimicrobial soap on all patient care areas. This method is preferred when hands are visibly soiled, before eating, and after personal toileting. It is also a good alternative during routine patient care. Two, you can use a waterless alcohol-based gel. Alcohol is a very good disinfectant, and these gels are great hand sanitizers. They tend to be easier on the skin than soap, and take no time to apply. Just squeeze some gel from the container onto the palm of your hand, and rub it until dry.

26 ¿Cuándo se debe lavar las manos?
¡SIEMPRE! Antes y después de comer.Before and after eating Después de usar el sanitario. Antes y Después del contacto con los pacientes. Cuando uno se mueve de un área contaminada a un área limpia. Después del contacto con objetos que se encuentran cercanos al paciente. Antes de cualquier procedimiento. Después de quitarse los guantes. We need to emphasize that when working at a healthcare facility, you need to wash your hands constantly. This includes before and after eating, after personal toileting, before and after direct contact with patients, when moving from a contaminated to a clean site within the same patient, after contact with objects in the immediate vicinity of patients, before performing any procedures, and after removing latex gloves. We frequently get asked: What if I wash my hands, exit one room, and go into another. Do I need to wash again to meet the required “before and after”? The answer is that if you go straight into another room, you don’t need to. However, if you go to the nursing station, type on a computer, answer the phone, or do anything else in between rooms, then you have to sanitize your hands again before entering the next room.

27 Appropriate nail care is also very important
Appropriate nail care is also very important. Our medical center’s policy, in accordance with the Center of Disease Control’s guidelines, mandates that personnel with direct patient contact keeps his or her nails trimmed neatly with a length equal or less than ¼ of an inch. Using nail polish is OK, as long as it is in good condition. Acrillic nails, and all other artificial nail extenders are expressly prohibited. The pictures show examples of appropriately-kept fingernails.

28 This is an example of hands that would be unacceptable for patient care. This person has artificial nails, which have been shown in scientific studies to harbor high amounts of bacteria and fungi, and may cause infections in susceptible patients.

29 Higiene Respiratoria/Etiqueta de la Tos
Cubrirse cuando se tose. Lavarse las manos después de toser o estornudar Colocar mascarillas quirúrgicas en los pacientes con tos. In recent years we have seen the emergence of many infectious respiratory diseases, including tuberculosis, SARS, and influenza, to name a few. To protect our patients, staff, and visitors from these diseases, we have implemented in our facility practices of Respiratory Hygiene and cough etiquette. The elements of Respiratory Hygiene/Cough Etiquette include 1) education of healthcare facility staff, patients, and visitors; 2) posted signs in language appropriate to the population served with instructions to patients and accompanying family members or friends; 3) source control measures (e.g., covering the mouth/nose with a tissue when coughing and disposing of used tissues, using surgical masks on the coughing person when tolerated and appropriate); 4) hand hygiene after contact with respiratory secretions; and 5) spatial separation, ideally >3 feet, of persons with respiratory infections in common waiting areas when possible.

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31 Precauciones Expandidas
Empleadas para proteger a los trabajadores y a otros pacientes de ciertos agentes infecciosos. Se emplean también para proteger a pacientes con inmunodeficiencias severas. Expanded precautions are used in addition to standard precautions. They are actions meant to protect patients and staff, and the medical center’s environment, from people known or suspected to carry contagious or antimicrobial-resistant microorganisms. At the Miami VA, we have several types of expanded precautions: Contact precautions; enteric precautions; contact isolation; special contact isolation; droplet precautions; airborne infectious isolation. A particular patient may be placed on one of these types of precautions, or any combination of them, depending on their diagnosis. The Infection Control manual, on section 4, describes the requirements and procedures to follow for each of the types of expanded precautions in detail. It also contains a table with the precautions required by diagnosis, organized alphabetically. Please take a moment to familiarize yourself with the section 4 of the Infection Control manual and to the disease list.

32 You will identify that a patient is on some type of expanded precautions because you will see a sign posted beside the room’s door, and a supply cart containing personal protective equipment will be outside the door. Any physician, nurse, or infection control practitioner can initiate expanded precautions in a patient, if an indication for it is identified or suspected.

33 Precauciones de Contacto
Contact isolation is the most common form of expanded precautions used inour medical center. Contact Precautions are intended to reduce the risk of transmission of contagious microorganisms lilke chickenpox or C. diff by direct or indirect contact with the patient or the patient’s environment. In addition, Contact Precautions may apply to patients known or suspected to be infected or colonized with bacteria resistant to multiple antibiotics, such as MRSA, VRE, to prevent their spread to other patients. It also is used for patients with skin infections producing large amounts of purulent drainage, or drainage too copious to be contained with a dressing. Contact isolation requires that patients are placed in private rooms. Strict hand hygiene must be observed before and after entering the room, gloves and gowns must be worn when entering the room for any reason, even if you’re not expecting to touch the patient, and discarded prior to exiting the room. Food trays will be taken in and out by nursing personnel. The trays, including all residual solid food will be bagged for pickup by Nutrition and Food Service. In general, any items that enter that room need to stay there until no longer needed, and then discarded or sent back to SPD for reprocessing. Disposable sthetoscopes and blood pressure cuffs are provided in the isolation cart. MRSA VRE Gram negativos resistentes

34 Precauciones de Gotas Respiratorias
Droplet Precautions prevent transfer of organisms via large droplets that are generated by the patient during coughing, sneezing or the performance of a procedure. Examples include influenza, other respiratory viruses, and meningococcal meningitis Patients on droplet precautions need to be placed in a private room if available. A face mask needs to worn when entering the room and removed after exiting the same. Influenza Meningococo

35 Precauciones Respiratorias
Tuberculosis, smallpox, chickenpox, SARS, Avian influenza Airborne Precautions prevent transfer of organisms via small aerosolized particles that are generated by the patient during coughing, sneezing or the performance of a procedure. Examples include tuberculosis, smallpox, SARS, and avian influenza. Patients suspected to have any of these infections need to be placed on airborne precautions until the condition has been diagnosed, treatment, and patient is no longer infectious, or it has been ruled out. Patients in airborne precautions need to be placed in a negative-pressure private room. An N95 respirator will be worn by any person entering this patient’s room. Before you are able to work with these patients, you need to be “fit tested” by our Safety manager or designee, to make sure that the mask seals adequately around your face and protects you from infection. Please review further details on airborne precautions, including those that pertain specifically to your job, in the Infection Control Manual.

36 Máscaras Quirúrgicas Protegen de gotas grandes y salpicaduras.
No están diseñadas para proteger de patógenos que se transmiten por vía áerea. No están diseñadas para ajustar al rostro del usuario. La mayoría del aire fluye alrededor de las mascarilla.

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38 Respiradores Diseñados para ajustar a la cara, proveen un sello a la entrada del aire. El aire es halado y pasa a través del filtro. Requiere una prueba de ajuste Existen diferentes grados y tipos: Purificadores Suplidores de aire

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43 Repaso del Uso de EPP This next segment will address how to safely don, use, and remove PPE. NOTE TO TRAINER: Consider having a participant demonstrate donning and removing PPE as you go through this section.

44 Puntos Claves de EPP Colocarselo antes del contacto con el paciente, idealmente antes de entrar al cuarto. Usarlo cuidadosamente: no extender la contaminación. Removerlo y descartarlo adecuadamente. Retirarse el Respirador fuera del cuarto del paciente. Realizar el lavado de manos There are four key points to remember about PPE use. First, don it before you have any contact with the patient, generally before entering the room. Once you have PPE on, use it carefully to prevent spreading contamination. When you have completed your tasks, remove the PPE carefully and discard it in the receptacles provided. Then immediately perform hand hygiene before going on to the next patient. PPE Use in Healthcare Settings

45 Secuencia para la colocación del EPP
El orden o secuencia va a depender del tipo de equipo. Lavarse las manos Colocarse la Bata primero. Colocarse la Mascara o Respirador Colocarse el protector ocular Guantes The gown should be donned first. The mask or respirator should be put on next and properly adjusted to fit; remember to fit check the respirator. The goggles or face shield should be donned next and the gloves are donned last. Keep in mind, the combination of PPE used, and therefore the sequence for donning, will be determined by the precautions that need to be taken. PPE Use in Healthcare Settings

46 ¿Cómo colocarse la Bata o Gabacha?
Seleccionar la talla y el tipo apropiado. Apertura hacia atrás. Asegurar en el cuello y cintura. Si la bata es muy pequeña se pueden emplear 2: Bata uno se amarra al frente Bata dos se amarra atrás To don a gown, first select the appropriate type for the task and the right size for you. The opening of the gown should be in the back; secure the gown at the neck and waist. If the gown is too small to fully cover your torso, use two gowns. Put on the first gown with the opening in front and the second gown over the first with the opening in the back. PPE Use in Healthcare Settings

47 ¿Cómo colocarse la Mascarilla?
Colocarla sobre la nariz, boca y barbilla. Ajustar el metal sobre el puente de la nariz Atar a la cabeza y cuello Acomodarla para que ajuste lo mejor posible Some masks are fastened with ties, others with elastic. If the mask has ties, place the mask over your mouth, nose and chin. Fit the flexible nose piece to the form of your nose bridge; tie the upper set at the back of your head and the lower set at the base of your neck. If a mask has elastic head bands, separate the two bands, hold the mask in one hand and the bands in the other. Place and hold the mask over your nose, mouth, and chin, then stretch the bands over your head and secure them comfortably as shown; one band on the upper back of your head, the other below the ears at the base of the neck. Adjust the mask to fit. Remember, you don’t want to be touching it during use so take the few seconds needed to make sure it is secure on your head and fits snuggly around your face so there are no gaps. PPE Use in Healthcare Settings

48 How to Don a Particulate Respirator
Emplear un Respirator con Ajuste Probado Colocarla sobre la nariz, boca y barbilla Ajustar el metal sobre el puente de la nariz Atar o ajustar a la cabezaSecure on head with elastic Acomodarlo para que ajuste Realice una prueba de ajuste: – Inhale – debe colapsar Exhale – revise por escapes The technique for donning a particulate respirator, such as an N95, N99 or N100, is similar to putting on a pre-formed mask with elastic head bands. Key differences, however, are 1) the need to first select a respirator for which you have been fit tested and 2) fit checking the device, as you have been instructed, before entering an area where there may be airborne infectious disease. Be sure to follow the manufacturer’s instructions for donning the device. In some instances, the manufacturer’s instructions may differ slightly from this presentation. You may also be asked to wear an elastomeric or powered air purifying respirator, or PAPR. Guidance on how to use these devices is not included in this presentation. You will need instruction locally to properly use these devices. PPE Use in Healthcare Settings

49 ¿Cómo colocarse las gafas o el escudo facial?
Cologar las gafas sobre los ojos, asegurelas sobre los oidos o con banda elástica Coloque el escudo sobre la cara y asegurelo con las tiras. Acomodelo para que ajuste confortablemente. If eye protection is needed, either goggles or a face shield should be worn. Position either device over the face and/or eyes and secure to head using the attached ear pieces or head band. Adjust to fit comfortably. Goggles should feel snug but not tight. PPE Use in Healthcare Settings

50 ¿Cómo colocarse los guantes?
Colóquese los guantes al final Selecciones el tipo y tamaño correcto Extienda los guantes SOBRE las mangas. The last item of PPE to be donned is a pair of gloves. Be sure to select the type of glove needed for the task in the size that best fits you. Insert each hand into the appropriate glove and adjust as needed for comfort and dexterity. If you are wearing an isolation gown, tuck the gown cuffs securely under each glove. This provides a continuous barrier protection for your skin. PPE Use in Healthcare Settings

51 Puntos Importantes Mantenga las manos lejos de la cara.
Evite tocar o ajustar el EPP. Retírese los guantes si estos se rompen, lávese las manos antes de colocarse otro par. Limite el contacto con superficies y objetos. In addition to wearing PPE, you should also use safe work practices. Avoid contaminating yourself by keeping your hands away from your face and not touching or adjusting PPE. Also, remove your gloves if they become torn and perform hand hygiene before putting on a new pair of gloves. You should also avoid spreading contamination by limiting surfaces and items touched with contaminated gloves. PPE Use in Healthcare Settings

52 ¿Cómo quitarse el EPP? We’ve talked about donning and using PPE. Now we’ll discuss how to safely remove PPE to protect you, your colleagues, and patients from exposure to contaminated materials.

53 Areas “Contaminadas” y “Limpias” del EPP
Contaminada – frente, parte externa -Areas que pueden haber entrado en contacto con el agente infeccioso. Limpia – parte interna, parte externa dorsal, las amarras o cintas posteriores en la cabeza, cuello y cintura. -Areas que tiene menor probabilidad de haber entrado en contacto con el agente infeccioso. To remove PEP safely, you must first be able to identify what sites are considered “clean” and what are “contaminated.” In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, respirator and face shield are considered “contaminated,” regardless of whether there is visible soil. Also, the outside of the gloves are contaminated. The areas that are considered “clean” are the parts that will be touched when removing PPE. These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield. PPE Use in Healthcare Settings

54 Secuencia para remover el EPP
Depende del tipo de equipo: Guantes Protector Ocular Bata Respirador The sequence for removing PPE is intended to limit opportunities for self-contamination. The gloves are considered the most contaminated pieces of PPE and are therefore removed first. The face shield or goggles are next because they are more cumbersome and would interfere with removal of other PPE. The gown is third in the sequence, followed by the mask or respirator. PPE Use in Healthcare Settings

55 ¿Dónde se deber remover el EPP?
Depende del tipo de sala: A la salida del cuarto, o en el antecuarto. Quitarse el respirador al salir del cuarto y cuando la puerta está cerrada. The location for removing PPE will depend on the amount and type of PPE worn and the category of isolation a patient is on, if applicable. If only gloves are worn as PPE, it is safe to remove and discard them in the patient room. When a gown or full PPE is worn, PPE should be removed at the doorway or in an anteroom. Respirators should always be removed outside the patient room, after the door is closed. Hand hygiene should be performed after all PPE is removed. * Asegurarse de tener lavamanos o dispensadores de alcohol donde se necesitan. PPE Use in Healthcare Settings

56 ¿Cómo retirase los guantes? (1)
Tome el borde a nivel de la muñeca. Hale, volteando el guante Sostengalo con la mano que aún tiene guante. Using one gloved hand, grasp the outside of the opposite glove near the wrist. Pull and peel the glove away from the hand. The glove should now be turned inside-out, with the contaminated side now on the inside. Hold the removed glove in the opposite gloved hand. PPE Use in Healthcare Settings

57 ¿Cómo retirase los guantes? (2)
Deslice un dedo debajo del guante. Hale desde adentro creando una bolsa para ambos guantes. Deseche los guantes apropiadamente. Slide one or two fingers of the ungloved hand under the wrist of the remaining glove. Peel glove off from the inside, creating a bag for both gloves. Discard in waste container. PPE Use in Healthcare Settings

58 Removiendo las Gafas o Escudo Facial
Tome los lentes por las patitas con las manos sin guantes. Retire alejandolo de la cara Coloquelo en el recipiente correspondiente Using ungloved hands, grasp the “clean” ear or head pieces and lift away from face. If goggle or face shield are reusable, place them in a designated receptacle for subsequent reprocessing. Otherwise, discard them in the waste receptacle. PPE Use in Healthcare Settings

59 Retirándose la Bata o Gabacha
Desamarre la bata Retire primero del cuello y los hombros. Voltée la bata alrevés. Dóblela Descártela Unfasten the gown ties with the ungloved hands. Slip hands underneath the gown at the neck and shoulder, peel away from the shoulders. Slip the fingers of one hand under the cuff of the opposite arm. Pull the hand into the sleeve, grasping the gown from inside. Reach across and push the sleeve off the opposite arm. Fold the gown towards the inside and fold or roll into a bundle. (Only the “clean” part of the gown should be visible.) Discard into waste or linen container, as appropriate. PPE Use in Healthcare Settings

60 Removing a Mask Desamarre o retire sin tocar el frente.
Retírelo de la cara Descártela The front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle. PPE Use in Healthcare Settings

61 Removing a Particulate Respirator
Remueva el elastico inferior primero. Luego levante el elástico inferior Descártela The bottom elastic should be lifted over the head first. Then remove the top elastic. This should be done slowly to prevent the respirator from “snapping” off the face. PPE Use in Healthcare Settings

62 Lávese las manos