Personal Protective Equipment (PPE) and Practices and Influenza Pandemic preparedness

Table 1. Influenza Pandemic PPE Preparedness - Risk Categorisation matrix according to viral status, tasks and organisational preparedness.

RISK FACTOR		Risk Factor Status
	10	7	4	1
1 Virus status	Highly infective and highly transmissible	Highly infective but low transmissibility	Low infectivity but highly transmissible	Low infectivity and low transmissibility
2 Work Tasks	Involves procedures with close exposure to potentially infected droplets	Some potential exposure to infected droplets Exposure to aerosols	Work can be organised to prevent exposure to droplets (> 1 metre) Potential exposure to aerosols	No obvious exposure to droplets or aerosols (communit y risk)
3 Work Management Controls	Uncontrolled environment, No monitoring	Management controls rely on PPE without adequate training programme for its use No supervision No monitoring	Management controls a mixture of distance (designed environment) and adequate PPE programme. Monitoring of staff exists but patchy	Adequate manageme nt controls with ventilation, work practice and PPE programme . Adequate monitoring of staff
4 Training in the protection programme – including use of PPE	No effective training apart from MOH information at www.moh.govt.nz/ influenza	MOH information plus pre-epidemic “walk through”	MOH information adapted to employment circumstances and previous staff exercises	Information dissemin­ated in advance Practice use of procedures and Monitoring of staff compliance

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Table 2. Influenza Pandemic Prevention Programme Specification – Draft Schema.

Category	Definition		Protection Strategies		Monitoring
		Engineering Controls	Work practice and administrative controls	Recommended PPE
HIGH Risk of transmission to staff	At risk procedures where exposure to aerosolized secretions a very high possibility (bronchoscopy) and infection risk great Exposure to PROBABLE cases E.g. Paramedics A & E staff Primary clinicians Resuscitation staff Respiratory specialists	Negative Pressure rooms with adequate air changes and external venting Minimum acceptable air changes 6-8, preferably 12/minute OR Clean air delivered by HEPA filter units Fresh air circulating through open windows Interlock entrances with change rooms	Designated infection/influenza manager/representative Appropriate procedures manual Adequate infection control procedures (hand washing/alcohol skin wipes etc) Training in procedures and PPE Quarantine patients until diagnosed Restriction of staff rotation Preferential choice of staff who have recovered from infection IMMUNISE if becomes available Initial and isolated cases: consideration of prophylactic use of antiviral treatment for staff: object is to try and contain outbreak(s) Notification to MOH (confirmed cases)	Disposable fluid impervious suits Gloves Eye splash protection If Adequate Ventilation N95 or P2 mask, preferably ½ face & part of PPE programme If Ventilation Is Inadequate Positive pressure respirator such as an FPBR N95 or P2 and a surgical mask for patient use Avoid mask with vent valve for patient use (WOULD NOT USE ON A PATIENT)	Designated infection/influenza officer/reporting system Temperature plus clinical symptoms. Advice set as to when to consult doctors. Consideration of fitness to work based on Doctor’s certification. If no doctor available one person makes decisions according to a pre-agreed protocol
MEDIUM to High Risk of transmission to staff	DEFINITE exposure to POSSIBLE cases - in contact with potentially infected people, OR Exposure is POSSIBLE to DEFINITE cases - direct close clinical contact is possible with infected people but not undertaking procedures which expose them to high risk, as in the cell above e.g. COULD Include, depending on the circumstances GPs and clinical practice staff police arresting offenders fire services attending a MVA ambulance ditto pharmacy staff	Isolate (where possible) contact to specific areas equipped with Clean air delivered by HEPA filter units or other forms of adequate ventilation Screening to avoid droplet contamination where appropriate	Designated infection/influenza manager/representative Training in procedures and PPE Quarantine patients until diagnosis excluded Appropriate procedures manual Adequate infection control procedures (hand washing/alcohol skin wipes etc) Restriction of staff rotation Preferential choice of staff who have recovered from infection IMMUNISE if becomes available Notification to MOH (Confirmed cases)	Decision about the use of: Disposable suits or aprons Gloves Eye splash protection N95 or P2 respirator Will need to be made on a case by case basis, taking into account the circumstances and length of possible exposure. – SEE NOTE	Designated infection/influenza officer/reporting system Temperature plus clinical symptoms. Advice set as to when to consult doctors. Consideration of fitness to work based on Doctor’s certification. If no doctor available one person makes decisions according to a pre-agreed protocol
Medium Risk	In contact with potentially infected people but not undertaking procedures which expose them to (potentially) infected droplets (e.g. GP and specialist reception and non-clinical staff, police in non physical contact jobs, non-health related pharmacy staff)	Isolate (where possible) contact to specific areas equipped with Clean air delivered by HEPA filter units or other forms of adequate ventilation Screening to avoid droplet contamination Phone call triage of potentially infected persons before presentation	Training in procedures and PPE Quarantine patients until diagnosis excluded Appropriate procedures manual Adequate infection control procedures (hand washing/alcohol skin wipes etc) Restriction of staff rotation Preferential choice of staff who have recovered from infection IMMUNISE if becomes available Initial and isolated cases: consideration of prophylactic use of antiviral treatment for staff: object is to try and contain outbreak(s)	Decision about the use of: Disposable suits or aprons Gloves Eye splash protection N95 or P2 respirator Will need to be made on a case by case basis, taking into account the circumstances and length of possible exposure. – SEE NOTE	Temperature plus clinical symptoms. Advice set as to when to consult doctors. Consideration of fitness to work based on Doctor’s certification. If no doctor available one person makes decisions according to a pre-agreed protocol
LOW Risk of transmission to staff	Not exposed (more than chosen community experience) but involved in essential public services				Temperature plus clinical symptoms. Advice set as to when to consult doctors.

* Note: In some instances the level of exposure and risk will be unclear or unpredictable. In these situations a choice in the face of uncertainty will be required. Ways of informing such a choice are (a) to under-specify a level of protection (in the hope that the risks in the event will remain small); (b) to overspecify a level of protection (which runs a different risk - in this case, of inability to comply); (c) to reach an agreement – which will only be valid if there is good faith discussion (between parties with unequal power). Whichever instance is the basis for a decision, promptness and completeness of ongoing feedback, monitoring of the situation by management and review of how a situation is developing will be needed to inform about what is not working and the need to alter practices.

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