Personal Protective Equipment, Hand Hygiene and Surface Cleaning in the context of Ebola This publication and the information it contains is intended for distribution to, or use by, people in the following geographies only: Europe, Africa, The Commonwealth of Independent States (CIS) and Middle East.
As the Ebola crisis continues to evolve, the CDC, WHO and other health organisations around the world continue to issue guidelines and recommendations on best practices to use when potentially coming into contact with people having contracted the Ebola virus. When faced with situations dealing with the Ebola virus, the current guidelines and recommendations from the CDC and WHO ( Health Organisations ) should be consulted and followed to ensure you are using the most current recommended practices. Product selection must be based on evaluation of the hazards faced and the task to be performed. However the products referred to in this publication, used alone or in combination with other products, may be suitable for consideration to meet the guidance published currently by the Health Organisations as of the date of this publication. How do people get infected with Ebola virus? Ebola virus disease is a severe, often fatal illness, with a death rate of up to 90%. 1 Infection occurs from direct contact through broken skin or mucous membranes with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a person come into contact with environments that have become contaminated with an Ebola patient s infectious fluids such as soiled clothing, bed linen, or used needles. 2 Symptoms of Ebola virus disease 3 Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. The incubation period, or the time from infection to the onset of symptoms, is from two to 21 days. Patients become contagious once they begin to show symptoms. They are not contagious during the incubation period. WHO recommends that Personal Protective Equipment (PPE) is worn when in direct contact with patients (e.g. healthcare workers, visitors, family members, volunteers), as well as by those potentially exposed to the virus through contact with the environment (e.g., cleaners, laundry, housekeepers, security). The recommendation applies to the following activities: 4 Providing patient care in isolation facilities and elsewhere e.g moving a patient or in anticipation of contact with blood and bodily fluids (caring for a vomiting or bleeding patient) Cleaning environment & handling waste - e.g. when undertaking cleaning activities with increased risk of splashes or in which contact with blood and body fluids Managing linen - linen that has been used on patients can be contaminated with body fluids (e.g. blood, vomit) and contamination may result during handling Managing waste - when handling infectious waste (e.g. solid waste or any secretion or excretion with visible blood) Laboratory diagnostics - for procedures to safely collect blood or other samples from persons suspected or confirmed to be infected Movement & burial of human remains Post-mortem examinations. 2
Personal Protective Equipment (PPE) is the most visible control used to prevent transmission. It must be correctly selected and used in a safe manner; this is especially important when putting on and removing PPE, and decontaminating PPE components. 5 Respirator page 5 Hood page 4 Face Shield page 5 Inner & Outer Gloves page 6 Coveralls page 4 Apron page 4 Hand Hygiene page 7 Over-shoes & Over-boots page 4 Surface Cleaning page 8 3
Body Protection Coveralls While working in PPE, healthcare workers caring for Ebola patients should have no skin exposed 6 Health Organisations recommend single-use (disposable), fluid-resistant or impermeable coveralls. 7 KLEENGUARD* A80 CE CAT III Type 3 & 5 EN14126:2003 KLEENGUARD* A71 CE CAT III Type 3 & 5 EN14126:2003 Coverall with welded seams, constructed of impermeable basesheet. Meets ISO 16603 class 3 & ISO 16604 class 2 exposure pressure. Coverall with taped seams, constructed of impermeable base sheet. Meets ISO 16603 class 3 & ISO 16604 class 2 exposure pressure. 96510-96550 96760-96800 Secondary Body Protection 96510 96760 Health Organisations advise using a disposable impermeable coverall and impermeable apron as well as a head cover that covers the head and neck while providing clinical care for patients with filovirus (Ebola) disease in order to prevent virus exposure. 8 Note: the below products are classed CE CAT 1 and therefore ARE NOT impermeable. Product Title KLEENGUARD* A40 Sleeves CE CAT I KLEENGUARD* A40 Apron CE CAT I Code 98730 44481 KIMTECH PURE* A5 Hood 88807 98730 44481 88807 Foot Protection Health Organisations advise that all health workers should wear waterproof boots (e.g rubber/ gum boots) while caring for patients with filovirus (Ebola) disease in order to prevent virus exposure. Only if boots are not available, health workers should wear closed shoes (slip-ons without shoelaces and fully covering the dorsum of the feet and ankles). Shoe covers, nonslip and preferably impermeable, should ideally be used over closed shoes to facilitate decontamination. 9 Note: the below products are classed CE CAT 1 and therefore ARE NOT impermeable. KLEENGUARD* A40 Over-shoe with Sole CE CAT1 KLEENGUARD* A40 Over-boot with Sole CE CAT 1 Single-use over-shoe constructed using the anti-static base sheet with robust sole, protects against water-based splashes & liquids. Single-use over-boot constructed using the anti-static base sheet with robust sole, protects against water-based splashes & liquids. 98710 (M/L) 98720 (XL/XXL) 98820 98710 98820 4
Protection of Eyes & Face Protection of Eyes and Face All health workers should use either a face shield or goggles while providing clinical care for patients with filovirus (Ebola) disease in order to prevent virus exposure. Face shields should comply with EU directive 86/686/EEC and EN standard 166/2002. 10 Meets EN166 level B for Medium Impact Protection (120 m/s) and EN166 level 2 for Intermittent Use Product Title JACKSON SAFETY* F20 Face Shield JACKSON SAFETY* JMAXX BROWGUARD Code 28650 28640 28650 28640 Respirators Health Organizations recommend ASTM F1862 Level 3 fluid protection face masks. The product below meets this requirement: JACKSON SAFETY* R10 N95 Respirators -fluid resistant, meets ASTM F1862 Level 3 One size 64250 Health Organisations advise that if used together with a compliant face shield fluid resistance is not required for FFP2 particulate respirators. The product below meets this requirement: 64250 KLEENGUARD* R20 FFP2 RD Respirator, unvalved, meets EN149 FFP2 One size 62940 62940 5
Hand Protection Double gloving is recommended compared to using single gloves to decrease the potential risk of virus transmission to the health worker due to glove holes and damage to gloves from disinfectants such as chlorine; double gloving may also reduce the risk from needle-stick injuries and contamination of hands when removing PPE. Nitrile gloves are recommended by Healthcare Organisations for health workers providing clinical care for patients with filovirus (Ebola) disease in order to prevent virus exposure. 11 Under Glove KIMTECH SCIENCE* PURPLE NITRILE* 24cm length Glove KLEENGUARD* G20+ 24cm length Glove KLEENGUARD* G20 ATLANTIC GREEN NITRILE* 24cm length Glove CE PPE Category III, EN374-2 Level 3, ISO16604. 90625-90629 PPE Cat III, EN374-2 Level 2. Compliant with AQL 1.5 for pinholes, 12mm thickness. PPE Category III (CE Complex), EN374-2 Level 3. Compliant with AQL 0.65 for pinholes. 38706-38710 90090-90094 Heavy Duty - Outer Glove KIMTECH SCIENCE* PURPLE NITRILE*-XTRA 30cm length Glove KIMTECH SCIENCE* STERLING NITRILE* -XTRA 30cm length Glove CE PPE Category III, EN374-2 Level 3, ISO16604. 97610-97614 CE PPE Category III, EN374-2 Level 3, ISO16604. 98341-98345 JACKSON SAFETY* G80 NITRILE* Glove green CE PPE Category III, EN374-3 Level 3. Marking AJK. AQL 0.65. 94445-94449 JACKSON SAFETY* G80 NITRILE* Gauntlet green 90625 38706 90090 CE PPE Category III. Compliant with AQL 0.65 for pinholes. EN374-3 Level 3. Marking AJK. 25622-25625 97610 98341 94445 25622 6
Hand Hygiene Hand Hygiene should be performed: 12 Before donning gloves and wearing PPE on entry to the isolation room/area Before any clean/aseptic procedures being performed on a patient After any exposure risk or actual exposure with the patient s blood and body fluids After touching (even potentially) contaminated surfaces/items/equipment in the patient s surroundings After removal of PPE, upon leaving the care area. Neglecting to perform hand hygiene after removing PPE will reduce or negate any benefits of the protective equipment. Clean your hands by rubbing them with an alcohol-based formulation, as the preferred means for routine hygienic hand antisepsis if hands are not visibly soiled. Wash your hands with soap and water when hands are visibly dirty or visibly soiled with blood or other body fluids. 13 Hand Washing Hand Drying Product Title Code KLEENEX* Frequent Use Hand Cleanser liquid 6333 KLEENEX* Antibacterial Hand Cleanser Liquid 6336 KLEENEX* Luxury Foam Everyday Use Hand Cleanser 6340 KLEENEX* Luxury Foam Antibacterial Hand Cleanser 6348 KLEENEX* Foam Hand Cleanser 50ml 6375 6333 6375 KLEENEX* Ultra Pop Up Folded Hand Towel 18 boxes x 70 sheets 1126 KLEENEX* Ultra Folded Hand Towels 30 clips x 124 sheets 6777 KLEENEX* Ultra Folded Hand Towels 15 clips x 124 sheets 6778 KLEENEX* Ultra Folded Hand Towels 5 x 124 sheets 7979 SCOTT* Performance Folded Hand Towels 15 x 212 sheets 6663 SCOTT* Rolled hand Towels 6 x 304 rolls 6667 Hand Disinfection 6777 6667 7979 Hand Conditioning KLEENEX* Alcohol Hand Sanitiser 50ml 6356 KLEENEX* Alcohol Hand Sanitiser 480ml 6357 KLEENEX* Alcohol Hand Sanitiser 1l 6358 KLEENEX* Alcohol Hand Sanitiser 1.2l 6359 KLEENEX* Alcohol Hand sanitiser contains 70% ethanol. The product meets 6356 6357 6358 EN1500 30s; EN14476 60s (only Influenza A H1N1, Murine Norovirus, Rhinovirus type 1A). KLEENEX* Hand Moisturiser 480ml 6372 KLEENEX* Hand Moisturiser 1l 6373 6373 6372 7
Surface Cleaning PPE should be worn for performing cleaning tasks Environmental surfaces or objects contaminated with blood, other body fluids, secretions or excretions should be cleaned and disinfected as soon as possible using standard hospital detergents/disinfectants (e.g. a 0.5% chlorine solution or a solution containing 5,000 ppm available free chlorine). Application of disinfectants should be preceded by cleaning to prevent inactivation of disinfectants by organic matter. 14 Do not spray (i.e. fog) occupied or unoccupied clinical areas with disinfectant. This is a potentially dangerous practice that has no proven disease control benefit. 15 Cleaning Tasks WYPALL* X50 Cleaning Cloths Wrapped in a splash-proof, water-repellent polybag, for hygienic cleaning in washrooms and patient areas. 7441 blue, 7442 green 7443 yellow, 7444 red WYPALL* X80 Cleaning Cloths Wrapped in a splash-proof, water-repellent polybag, for tougher cleaning in clinical and patient areas. 7565 blue, 7566 green 7567 yellow, 7568 red WYPALL* L20 10 Rolls Individually wrapped for maximum hygiene. 7412, 7413 SCOTT* Surface Cleaning Wipes 24 x 15 sheets 7785 SCOTT* Surface Cleaning Wipes 6 x 100 sheets 7786 7785 7786 Surface Disinfection Health Organisations recommend first washing all organic contamination from the surface and then disinfecting the surface using a disinfectant that carries a label claim for efficacy against a non-enveloped virus (e.g: norovirus, rotavirus, adenovirus, poliovirus). 16 Refillable, compact, self-contained wet wiping system to help reduce the risk from cross-infection. Compatible with a broad range of common cleaning and disinfecting solutions. Product Title Code WETTASK* Dispenser Bucket 7919 WETTASK* Wiper 7767 WETTASK* Roll 7764 WETTASK* Bucket Small 7732 7919 7732 8
References: (1),(2),(3) WHO, Frequently Asked Questions on Ebola virus disease, 8th August, 2014; http://www.who.int/csr/disease/ebola/faq-ebola/en/ (5) CDC; Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) 20th October 2014 - http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html (4),(8),(9),(10),(11),(13) WHO; Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, September 2014 (7),(12) WHO; Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response; Rapid Advice Guideline, October 2014 (5) WHO; Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response; Rapid Advice Guideline, October 2014 (6) CDC; Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) 20th October 2014 - http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html (7) CDC; Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) 20th October 2014 - http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html (8) CDC; Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) 20th October 2014 - http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html (9) WHO; Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response; Rapid Advice Guideline, October 2014 (10) WHO; Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response; Rapid Advice Guideline, October 2014 (11) WHO; Personal Protective Equipment in the Context of Filovirus Disease Outbreak Response; Rapid Advice Guideline, October (12) WHO; Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, September 2014 (13) WHO; Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, September 2014 (14) WHO; Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, September 2014 (15) WHO; Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, September 2014 (16) Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing); 20.10.2014 /* Trademarks of Kimberly-Clark Worldwide. Inc KCWW Publication Code ID5015.01 GB 11.14 9