Prevention ofDroplet / AirborneTransmitted Diseases: Prevention of Droplet / Airborne Transmitted Diseases Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals 504-568-5005 *** 800-256-2748 www.oph.dhh.state.la.us Your taxes at work


Individual Protection: Individual Protection


Masks: Masks Surgical masks


Masks: Masks Tb respirators with HEPA filters, N95 Hardware store masks Powered Air Personal Respirators PAPR


Masks: Masks And others …


Extended Precautions: Extended Precautions


Confined Spaces& Ventilation: Confined Spaces & Ventilation


Confined Spaces: TB Transmission in Bus: Confined Spaces: TB Transmission in Bus


Air Travel: Air Travel Risk factors for transmission of respiratory tract infections Space confinement, Limited ventilation, Prolonged exposure times, Recirculating air Recirculation: Older systems: 100% fresh air, compressed, humidified and cooled Newer airplane recirculate ~ 50% of cabin air


Air Travel: RTI: Air Travel: RTI Zitter JAMA 2002;288:483-486. San Francisco - Denver, 2hrs Postflight respiratory symptoms Cold 20%, runny nose & cold, 10% Aggregation of 8 URI symptoms: 3% No differences between aircraft types Attack rate = 3%, - consistent w previous epi studies of URI incidence in people who were not traveling by airplane Jackson score (consisting of the sum of 8 respiratory symptoms, including headache, sneezing, chilliness, sore throat, malaise, nasal discharge, nasal obstruction, and cough, each measured from 0 to 3) that was higher than 13. Jackson GG, Dowling HF, Spiesman IG, Boand AV. Transmission of the common cold to volunteers under controlled conditions. Arch Intern Med. 1958;101:267-278


Air Travel: TB: Air Travel: TB CDC 1995. MMWR March 03, 1995 / 44(08);137-140 January 1993 - February 1995 6 instances of TB exposures in commercial flights 1-Flight Attendant: May-Oct 1992: Cough  Pm TB dg 11/92 25% infected in exposed coworkers Aug-Oct 4.1% infected in exposed coworkers May-Jun 1.6% infected in 247 never exposed coworkers 2-Apr 94: Honolulu-Chicago, 7hrs/50mn, -Baltimore 2 hrs, return flight: 4/257 converted 3- No infection Dec 92: London-Minneapolis, 9-hr Mar 93: Frankfurt-New York City, 8½ hrs …


Air Travel: SARS: Air Travel: SARS WHO 2003: 35 flights w probable symptomatic SARS among passengers or crew 4 flights w possible transmission For example: Cathay Pacific flight, 72 year old Beijing M infected after visiting daughter in Hong Kong Infected  9 tourists from Hong Kong 3 Taiwan business men 2 Chinese government officials 2 flight attendants 1 Singaporean woman Later a group of HCW in a Beijing hospital


Health care:IsolationPrecautions: Health care: Isolation Precautions


Precaution System CDC 1996: Precaution System CDC 1996 IS AN EXPANSION OF UNIVERSAL PRECAUTIONS


Standard Precautions: Standard Precautions Same concept as UNIVERSAL PRECAUTIONS Precautions should be taken for any contact with Blood and Body Fluid (UP) AND for any contact with - secretions and excretions, - mucous membranes, - damaged skin, - contaminated environment and equipment If it is wet, red or dirty Take Precautions


Hand washing: Hand washing 10-15s Wash hand Alcohol based hand rubs


Surgical Masks, Eye ProtectionFace Shields: Surgical Masks, Eye Protection Face Shields For Personnel - protect from splashes /sprays of BBF/ S E - to prevent large droplets (<5m) on/from patient For patients - to prevent emission of droplet (large and droplet nuclei)


Airborne Precautions: Airborne Precautions ROOM WITH VENTILATION CONTROL - Negative air pressure - >6 air exchange /hour - HEPA filtered or exhaust out PERSONAL RESPIRATOR PATIENT wears surgical mask if coughing & when transported Small droplets (<5m) emitted when coughing, & performance of procedures


Airborne PrecautionsPersonal Respirator: Airborne Precautions Personal Respirator For Personnel In AIRBORNE ISOLATION ONLY To prevent inhalation of droplet nuclei Main leak comes from poor fit around face


Keep Air Flowing: Keep Air Flowing


Airborne Precautions During Travel: Airborne Precautions During Travel


Car: Car


Flight: Flight


Prevention: Prevention Stop Breathing