Dealing with the Swine Flu and other dangerous viruses
Wednesday, 29. April 2009, 02:03:41
First of all be prepared.
Get a supply of N-95 disposable face masks, disposable surgical gloves, splash-proof plastic goggles, and garments that you can dispose of or decontaminate. They should secure at the wrist, neck, and ankles. These are available from many sources on the Internet. Beware cheaply-prices products, especially the face masks, as they can be faulty. The N-95 will fliter sub-micron-sized infectious viruses of all kinds. Have on hand a gallon or two of bleach for disinfecting purposes. You can make an aqueous solution of 50% bleach and 50% water. This will kill all viruses (many can live up to 72 hours on most surfaces). Common sense is the best tool to use when considering the level of protection required for a specific outbreak of infectious viruses and microbes.
Routes of entry and infection
There are three primary routes of entry: inhalation, ingestion, and direct contact. Inhalation occurs when a caregiver breaths in viruses or microbes that are floating in the air. This dispersion of infectious organisms may originate from the victim expelling them in coughs and sneezes, or may simply drift in air currents that have an unknown origin. An example is an open window or heating/air conditioning vent. Respirators are designed to protect the wearer from contamination by inhalation but they must be worn properly and fit-tested frequently to ensure continued protection. A simple dust mask type filter does not provide protection against most microbial and viral infectious pathogens.
Ingestion usually is the result of a caregiver transferring hazardous materials from his or her hands or clothing to the mouth. This can occur unwittingly when an individual wipes the mouth with a hand or sleeve, eats, drinks, or smokes tobacco. Direct Contact refers to contact with the skin or eye. Skin is protected by garments, and the N-95 filter mask and indirect vent goggles protect against ingestion and direct eye contact. Mucus membranes in the mouth, nose, throat, inner ear, and respiratory system may be affected by more than one of these routes of entry.
Response to infectious pathogens may differ among individuals because of the physiological variability present in the population.
a.Age
b.Preexisting medical conditions
c.Prior exposure
d.Medications
e.Concurrent injury
f.Pregnancy
Donning Procedures:
Use a room as far as possible from the victim, with privacy and plenty of sitting space to facilitate donning of Personal Protective Equipment.
1.If possible, wear pajamas in lieu of regular street clothes. Clothing should be suitable for preserving comfortable body temperature.
2.Remove all jewelry and leather material. Persons needing to wear glasses or with beards or mustaches must insure a tight seal of the Face mask all over the face. If possible, it is better that someone else use the protective items.
3.Persons with long hair should apply a bouffant hairnet or place hair up in a braid.
4.Hydrate with 8–16 ounces of fluid.
5.If time allows have blood pressure (BP), pulse, respiration rate, and temperature taken and recorded to have a baseline record of the health of the caregiver.
6.Unpack appropriately sized garments as listed above, if available. Otherwise adapt what you have by folding and taping with duct tape.
7.Layout all of the pieces and confirm they are right size and especially the mask. Insure that it is tightly in place with no gaps between the filter and the cheekbones, etc.
8.Follow the instructions provided with the filter mask for donning. Position the headband for best fit & facial seal.
9.Put on latex or plastic inner glove if available—consider placing a light circular band of tape around top of glove to lessen chance of premature removal during doffing.
10.While sitting, remove shoes and place on foot covers, if available, otherwise improvise (foot protection should not present tear risk to the suit nor be heelless).
11.Pull on chemical/biological protective suit to waist.
12.Place outer booties/boots on over the foot portion of the suit.
13.Using duct tape, seal top of booties (boots) to protective coverall (use a flap of tape at the end and place facing front to ease removal).
14.For best biological protection, use taped under-gloves with the nitrile surgical gloves.
15.Seal seam of protective suit and gloves with duct tape (use a flap of tape at the end and on the front of the wrist area to ease removal of tape).
16.Zip up protective suit to neck and close zipper securing and covering zipper seal.
17.Position indirect vent goggles over the eyes and adjust headbands to ensure full visibility and comfortable fit. Tighten all bands in pairs by pulling them backwards & then tying off the slack, if any. Confirm tight seal of the face mask by covering filter opening with hand and taking deep breaths—face shield should pull tight against face. If faulty seal is found, then retighten all bands and repeat seal test. If tight seal cannot be obtained, then seek second provider assistance or use hooded device that covers the head with eyehole cutouts.
18.Pull suit hood up (if hooded model) and over the head maximizing the coverage of the head, neck, and ears and covering the mask seal edge around the face—ensure the suit is pulled up and fully under the chin and zipper is closed and covered. There should be NO EXPOSED SKIN.
19.Make sure you can see and breathe comfortably.
20.Have someone check for any exposed skin or air gaps in clothing and tape seals.
Ambulatory Victim Decontamination
•Children should be kept with their parents if at all possible; if no parent or older sibling is available then the caregiver should provide needed assistance to a child.
•Victim should be given Personal Decon items such as a strong bleach solution for wiping down clothing and shoes, and microbial hand & face cleaner or bleach solution (Pumped into a cup) or towelettes as soon as it is available and be given rapid instructions on their use. The idea is to make them as germ-free as possible.
The ambulatory patient may be directed by the caregiver to self-decon in the shower (best) or bathtub if available, thereby sparing the caregiver from involvement (though the caregiver should remain dressed and ready in an adjacent room if intervention is needed). If the situation involves multiple patients requiring simultaneous decontamination, this process will occur repetitively. Be sure to sanitize the shower or tub afterwards with heavy bleach.
1.After the clothing is sanitized as much as possible, then and only then it is removed prior to the shower or tub Decon.
2.Have patient remove all valuables and place in the small plastic bag.
3.Clothing is removed and placed in the larger plastic bag. Place both bags into the red biohazard plastic bag(s). Place identifying tag with unique victim name on bag and seal off top. Place outside of the dwelling for future disposition and/or disposal by authorities.
4.Victim will do head-to-toe gross decontamination wash using mild soap and water.
5.Special attention should be paid in the washing process to hair and all body crevices. Wash time cycle should be 5 (five) minutes per person under a single stream of water.
6.Water temperature should be tepid.
7.Washing should be gentle to avoid abrading skin.
8.Open wounds should be washed first with sterile water and covered with occlusive dressing prior to remainder of body decontamination.
9.Upon completion of wash cycle, patient should step away from the immediate wash area, towel dry, and put on a supplied protective coverall if available.
10.All towels and wash cloths used by patients in the showering process should be placed in a marked contaminated container for later clean up and decontamination.
11. The Victim is then ready for further treatment and/ or bed rest. If possible, have them don a pair of nitrile gloves and a face mask if coughing and sneezing. Have them cleanse the skin on the face and hands as frequently as required using the waterless hand cleaner or towelettes soaked in bleach solution. All tissues, wipes, towelettes, etc. must be placed by the victim in a biohazard red bag or marked plastic garbage bag immediately after use. If the nitrile gloves are to be reused, they should go though Decon (by the victim) in a solution of strong bleach for several hours prior to reuse. Again, it is all a matter of common sense. The foregoing procedure is based on a worst case scenario as regards the degree of infectiousness of the organism in question. For a non-ambulatory victim the caregiver will have to perform all of the above mentioned procedures.
Caregiver Decon
Prior to leaving the victim’s decon room the caregiver must undergo decontamination.
1.All equipment used by the caregiver that can be cleaned and reused must be placed in appropriate biohazard or marked garbage bags. Decon and clean by immersion in a strong bleach solution for two hours.
2.The caregiver will undergo a technical decontamination wash from a container of strong bleach solution from head-to-toe involving the outer garments, gloves, and boots.
3.After the wash is complete, the caregiver should remove protective clothing in the following sequence:
a.Remove outer gloves, turning them inside out as they are removed and place in bio-hazard trash container.
b.Remove tape from wrist and boot tops.
c.Remove boots.
d.Remove suit, turning inside out and avoid shaking.
e.Remove Face mask while wearing inner gloves, and if needed for reuse, decontaminate with bleach solution. Refer to clean-up and recovery protocol.
f. Rinse the exterior of the inner gloves in bleach solution prior to removal. Remove inner glove and discard into bio-hazard trash container, or if required for reuse, in a marked plastic bag for the soaking decon procedure.
g.Isolate all potentially contaminated materials until level of contamination is established and arrangements for cleaning and handling of trash and equipment can be determined.
h.Post-exposure medical monitoring should be initiated and new data recorded on the primary form.
i.The caregiver should then remove pajamas or other underclothing and shower and dress in replacement garments if providing continuous periodic treatment of the victim(s).
Lastly, use common sense and think your moves out ahead of time. I hope the foregoing covered all of the bases. Please leave any questions in the comment section, and I'll be glad to answer them.























