ACSM During EVD Outbreaks - psk.or.ke Sensitization Slides Combo... · from public as rumour, myths and misconceptions about the impending outbreak increase. The public and Ebola

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ACSM During EVD Outbreaks

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ACSM During EVD Outbreaks

Disease Surveillance and Outbreak Response Unit

Communication goal and objectives

Risk Communication

Working with the Public

ACSM Strategies

Community-Based Surveillance

Using the right channel of communication

Conclusions

Presentation OutlinePresentation Outline


Goal:

To create awareness about EVD and its impact

Objectives

To increase the knowledge among the general public about EVD

To increase knowledge and information on EVD among HWs

To engage policy makers, stakeholders and opinion leaders for support of EVD awareness

To mobilize communities to take necessary actions against EVD in case of a reported outbreak

Communication Goal & ObjectivesCommunication Goal & Objectives


Definition: Exchange of information/opinion about the likelihood and consequences of adversity (John Hopkins)

It helps the public to respond to the crisis

Reduces rumours and misinformation

There is need to:

Create Trust Announce early – to avoid rumours/misinformation Be Transparent – As you make competent decisions Understand the different publics/audiences

Risk CommunicationRisk Communication


Establish if the public have their own theories about the disease

Address the public’s concerns even if unfounded

What beliefs do the public have about the severity of the disease and the risk of infection?

Respond with information about symptoms, treatment, and the low but real risk of infection

Clarify queries with what is known about transmission – based on the correct/scientific information about the disease

Understanding the PublicUnderstanding the Public


In our current state, we need to find out what the public know, believe, and feel:

About the risk About the potential precautionary measures About possible sources of stigma. About Health seeking behaviour About the public health agency and local leaders.

Be on the lookout for pressure from media and anger from public as rumour, myths and misconceptions about the impending outbreak increase.

The public and EbolaThe public and Ebola


In order to plan your communication outreach you need to address:

What is Ebola virus disease? What needs to be done? Who will do it? How should it be done? Who needs to know (identify target audience)? Who is the spokesperson?(This is always the DMS at

national level and each level to identify spokesperson)

Who needs to act?Use previous responses or what is happening in other

outbreak countries to improve risk communication?

Planning Planning


Joint planning and coordination:

Form an ACSM team at all levels comprising of government line ministries, partners, community

Advocacy:

Identify and meet leaders and decision-makers to inform and engage on the significance of EVD

Sensitize and seek their support including resources

Involve and target other decision–makers that may include National/county leaders, partners (NGO/CBOs/CSOs etc), Religious leaders

ACSM strategiesACSM strategies


Radio spots in different languages to create awareness

Use of TV spots in English and Kiswahili

Use IEC materials – posters, factsheets and FAQs

Interpersonal communication for better understanding of EVD

HW to Parents/individuals/Teachers

Pupil to pupil

Parents to pupils & vice versa

Use social media too

ACSM strategiesCommunication

ACSM strategiesCommunication


Ensure the messages are clear on: What is EVD How Ebola transmission Occurs Signs and Symptoms Prevention

To give audiences a sense of control and enable more reasoned responses about EVD messages should:

Be Simplified: not technical Be appropriate for targeted groups/audience Consider cultural differences & educational level Emphasize information on what the public can do to

make themselves safer e.g avoid behaviour that puts them at risk – burials etc

ACSM strategiesEffective Communication Messages

ACSM strategiesEffective Communication Messages


Develop Social Mobilization strategy and plans

Explain and make known the early warning system in the community like:

The dying of animals such as chimpanzees, fruit bats, antelopes or

Reporting of sick person who had travelled to outbreak areas

Identify/map out community resource persons such as community leaders, traditional healers etc and train them in community-based surveillance for Ebola Virus Disease

ACSM strategiesSocial Mobilization

ACSM strategiesSocial Mobilization


Organize regular health promotion activities in communities, especially those in risk areas and those engaged in risk activities (hunters, herders, etc).

Disseminate simplified case definitions for community use.

Engage resource persons to report any suspicion or rumours to HFs or HWs

Provide feedback to resource persons about the status of reported rumours.

Community-based Ebola-SurveillanceCommunity-based Ebola-Surveillance


Improve early case detection and appropriate treatment seeking behaviour;

Improve contact follow up and retention;

Combat stigma and discrimination;

Empower people affected by Ebola;

Mobilize political commitment and resources for Ebola.

Address community challenges to effective Ebola control such as cultural practices to greetings, patient care and burial practices.

Rationale for community mobilizationRationale for community mobilization


Use every channelUse every channel

Religious congregations: Churches/mosques etc

Barazas

Seminars

Schools

Radios

Vehicles/songs

Megaphones

Community visits

Leaflets and posters

Radio and TV

News papers

SMS

Social media

Internet

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Human behavior is complex and influenced by multiple factors over long period. It can not be changed overnight

Proactively communicate key EVD messages

Access to information alone does not translate to action;

Participation of intended beneficiaries and other players is a pre-requisite for achieving desired outcomes;

Communicate actions that are within the laws, policies, and regulations of the Country/County;

Strengthen the leadership (stewardship) role of MOH at national and county levels

ConclusionConclusion

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Practice session

Donning and Doffing of Ebola PPE

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Practice session

Donning and Doffing of Ebola PPE


IntroductionIntroduction

Main objective: to give guidance on proper donning and safe removal of PPE

PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents

Selection of PPE is based on

Nature of patient interaction

Likely mode(s) of transmission


All doctors, nurses, and health workers who provide direct patient care

All support staff: cleaners, handle contaminated supplies and equipment, laundry, and dispose of infectious waste

All laboratory staff

Laboratory support staff

Burial teams

Family members who care for EVD patients

Who should Wear PPE?Who should Wear PPE?

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Should give maximum protection while ensuring minimum discomfort to the wearer

Impermeable to fluids and provides droplet protection

Skin, hands and full face protection

Available in different brands and types

TYVEK: WHO. Can work in it for 3 – 4 hours TYCHEM: MSF. Very strong and uncomfortable.

Recommended to work in it for only 45 mins maximum

Recommended PPERecommended PPE

Personal Protective Equipment

TYCHEM TYVEK


Gloves

Disposable gown to cover clothing and exposed skin

Waterproof apron

Facial protection to prevent splashes to the nose, mouth and eyes

Face shield and mask (preferred) OR Mask and eye visor/goggles

Gum boots (preferred) or shoe covers


Some considerationsSome considerations

Medical vs. hemisphere N95 face mask

Both are safe and provide protection from droplets

The hemisphere N95 mask will last longer (will not become deformed) for long periods in humid conditions

Goggles vs. face shield

Both are safe and provide eye protection

Face shield less likely to get fogged / wet

May be harder to provide care in treatment centre with goggles


Standard precautions:

When doing routine work, full PPE is not necessary

Hand gloves and hand hygiene suffice

Ebola suspect or confirmed case

When a patient under evaluation meets the Ebola case definition, or whenever a HW is managing a suspect or confirmed EVD case, the HW MUST immediately don a full PPE

Do not use home clothes in the treatment center. Put on scrub suit in the changing room

When should I don a full PPEWhen should I don a full PPE


Wearing PPE with a full body suit Wearing PPE with a full body suit

1. Wear first layer of protective clothing

2. Put on the coverall

3. Put on rubber boots

4. Perform hand hygiene

5. Put on first pair of gloves

6. Put on the mask

7. Put on the goggles

8. Put on the hood of the coverall

9. Put on the plastic apron

10. Put on the second pair of gloves

1. Wear first layer of protective clothing

2. Put on the coverall Select the right size

Steps to Donning PPE

3. Put on rubber boots. Choose a size bigger to make it easier to take off.Pull coverall legs over the rubber boots

5.Put on first pair of gloves, ensure it goes under cuff off body suit



6. N95 Particulate Respirator •Pay attention to size (S, M, L)

•Place over nose, mouth and chin

•Fit flexible nose piece over nose bridge

•Secure on head with elastic

•Do not cross the elastic

•Adjust to fit and check for fit: Inhale –respirator should collapse Exhale –check for leakage around face

Put on face protection:7. Put on a Goggles OR face shield (preferred)


9. Put on Plastic Apron


8. Put on the hood/head cover of the coverall


Steps to Donning PPESteps to Donning PPE

10.Put on Second Pair of Gloves Pull gloves over the cuff of the body suit

Whilst wearing PPE:•Avoid touching or adjusting PPE

•Remove gloves if they become torn or damaged•Change gloves between patients

•Preform hand hygiene before donning new gloves and upon removal of used gloves

Remember!


Removing PPERemoving PPE

Remove the most exposed/contaminated first

The Outer Gloves

The Apron

Removal is from outside in

Removal is done in a way to prevent contact of HCW with contaminated parts of PPE


Sequence for Removing PPE Sequence for Removing PPE

1. Disinfect the outer pair of gloves

2. Remove the apron

3. Disinfect the outer pair of gloves

4. Remove the outer pair of gloves

5. Remove the boots

6. Disinfect the inner pair of gloves

7. Remove the coverall


9. Remove the goggles


11. Remove the mask


13. Remove the inner pair of gloves


Remove plastic apron and dispose of safely, (if the apron is to be reused, place in container with disinfectant)

Sequence for Removing PPE

If wearing protective shoe covers, please remove them with your gloves still on (if wearing gum boots see step 4).

Removing Goggles or Face Shield

•Grasp ear or head pieces with inner gloved hands

•Lift away from face

•Place in designated receptacle for disinfecting or disposal


Removing a Mask

•Lift the bottom elastic over your head first

•Then lift off the top elastic

•Discard

•Don’t touch front of mask


Remove inner pair of gloves

•Grasp outside edge near wrist

•Peel away from hand, turning glove inside-out

•Hold in opposite gloved hand


How to remove the inner glove •Slide un-gloved finger under the wrist of the remaining glove •Peel off from inside, creating a bag for both gloves •Discard


Perform hand hygiene


Proceed to the clean area of the isolation facility


Removing the rubber bootsRemoving the rubber boots

Need clean shoes in clean area of the PPE removal zone to step into

But what about walking into clean area with boots after soaking them first in 0.5% chlorine?

Not clear how long the boots need to be soaked


Spraying of PPE (including boots) before removal

Spraying of PPE (including boots) before removal

Not recommended

Risk of aerosolization of Ebola, then inhalation Won’t kill virus if body fluids covering PPE Even if you spray PPE before removal, you still

have to follow the standard procedure for removal


Uncovering wrists with wide movement, especially tall people

Fix gown with an elastic to the thumb or tape gloves above gown

Goggles

Touching goggles to adjust with contaminated gloves

Flies coming in through holes on the side of goggles Early removal during doffing increasing risk of

contaminating face Increased risk of medical glasses falling when

removing the goggles

Common PPE Mistakes and HazardsCommon PPE Mistakes and Hazards


Making thumb hole in suitMaking thumb hole in suit


Inner glovesInner gloves


Outer glovesOuter gloves


Add name of the person in PPE to easily recognize the person inside the treatment center

Important for buddy system

Distinguish who is clinician, hygienist/cleaner, etc

Recognizing Persons Providing Care in Treatment Center

Recognizing Persons Providing Care in Treatment Center


Dedicated, trained person to supervise donning and taking off of PPE 24h/7days

Supervisor should also periodically check PPE adhered to within the isolation ward

New staff trained by experienced staff

Then staff supervise each other every time they enter

If in doubt, person with authority to stop/correct clinician and other staff

PPE SupervisorPPE Supervisor


Dedicated trained staff to supervise removal of PPE to assure safe removal

Dedicated trained staff to supervise removal of PPE to assure safe removal


When taking off PPE- important toSeparate reusable from disposableSeparate reusable from disposable

Re-usable:

Face shields

Goggles

Aprons- heavy duty

Gum boots

Gowns which can be laundered

Scrubs

Disposable

Gloves

Disposable gowns

Masks

Shoe covers

Single use aprons


DemoDemo

Identify a staff to demo the process

Thank youThank you

Documents

ACSM During EVD Outbreaks - psk.or.ke Sensitization Slides Combo... · from public as rumour, myths and misconceptions about the impending outbreak increase. The public and Ebola