Script for Audio-Visual Training Module for “Infection Prevention and Control for Severe acute

Respiratory Infections”
Associated Documents/Interactions:
 Pre/post-Test
General Guidance: Give a 3 second pause between bullet points. Where the sentence at the end of the slide
narrative ends with an ellipsis, transition between slides without pause. Otherwise, give 3-4 second pause
between slides. Lay emphasis on words in bold
Slide # Script Actions/Demonst
rations/Direction
etc.
1  Hello, my name is………and I will be taking you through this module  The session
on “Infection Prevention and Control (IPC) for Severe Acute begins after
Respiratory Infections (SARI)” the
 But before we proceed, please complete the pre-test in a few minutes. participant
completes the
pre-test
2  Welcome back and good job attempting the pre-test questions!  Ellipses
 In the course of this module, you are expected to be able to; signify
o Describe the general principles of IPC when caring for patients with transition
Acute Respiratory Illnesses (ARI). while the last
o Describe specific measures to take in the hospital when caring for sentence is
patients with SARI, including those with pandemic or epidemic still being
potential. spoken
o Describe how administrative and engineering controls facilitate the
implementation of IPC.
Now Let’s take a look at the general principles that should guide you
when handling suspect patients with SARI…
3  You must recognize suspect patients early, rapidly and apply 
appropriate source control.
 Ensure application of routine standard IPC across all patients,
 Remember to take additional precautions in selected patients depending
on presumed diagnosis, and finally,
 Always collaborate and communicate with the health care facility’s IPC
infrastructure.
4  According to the World Health Organization (WHO), there are some 
ARIs prone to cause epidemics and/or pandemics. Such ARIs are thus
classified has having the ability to constitute a public health
emergency of international concern otherwise known as PHEIC.
5  These ARIs include: 
o Severe Acute Respiratory Syndrome (SARS) - a viral illness thought
to be an animal virus that first infected humans in China in 2002.
o Middle East Respiratory Syndrome (MERS-CoV) - fatal viral
respiratory illness which was first observed in 2012.
o Human influenza caused by a new subtype such as the H1N1 (Swine
flu), and H1N5 (Avian flu).
o Zoonotic influenza that causes disease in humans such as the
Monkey pox.
o Emerging and Re-emerging ARIs that cause large outbreaks or
outbreaks with high mortality and morbidity, such as the 2019 novel
 corona virus COVID-19
 It is important to have a high index of suspicion when faced with
suspect/ill person with symptoms suggestive of any of the ARIs
mentioned.
6  Major epidemiological clues include:  Ellipses
o History of travel to area(s) with known circulation of the pathogen signify
of concern with such person still within the incubation period. transition
o Unprotected contact with patient with ARI of concern within while the last
incubation period. sentence is
o Part of rapidly spreading cluster of patients with ARI of unknown still being
cause spoken
 Clinical clues are of utmost importance as well:
o Patient with or dying from unexplained cause of ARI illness with
history of exposure as already mentioned above.
 Immediate notification of appropriate health officials is essential!
 It is very crucial to suspect COVID-19 if the patient has any of these
epidemiological/clinical history.
Now let’s take a glance at the case definition for COVID-19…..
7 A Suspect is said to be: 
 First, any patients with SARI (with symptoms of fever, cough, and
requiring admission to hospital), AND with no other aetiology that fully
explains the clinical presentation AND at least one of the following:
o a history of travel to or residence in a location reporting community
transmission of COVID-19 disease during the 14 days prior to
symptom onset, OR
o Patient is a health care worker who has been working in an
environment where SARI of unknown aetiology are being cared for.
 Secondly, patients with any ARI AND at least one of the following:
o close contact with a confirmed or probable case of COVID-19 in the
14 days prior to illness onset, OR
o Worked or attended a health care facility in the 14 days prior to
onset of symptoms where patients with hospital associated COVID-
19 infections have been reported.
A Probable case is;
 Suspect case for whom testing for COVID-19 virus is inconclusive
(result of test reported by the laboratory), OR
 Suspect case for whom testing could not be performed for any reason.
Lastly, a Confirmed case is
 A person with laboratory confirmation of COVID-9 infection,
irrespective of clinical signs and symptoms
 Note: for confirmed asymptomatic cases, the period of contact is
measured as the 2 days before through the 14 days after the date on
which the sample was taken which led to confirmation.

Worthy of note is who a Contact is?

A contact is a person who experienced any one of the following exposures
during the 2 days before and the 14 days after the onset of symptoms of a
probable or confirmed case:
1. Face-to-face contact with a probable or confirmed case within 1
metre and for more than 15 minutes;
 2. Direct physical contact with a probable or confirmed case;
3. Direct care for a patient with probable or confirmed COVID-19
disease without using proper personal protective equipment1; OR
4. Other situations as indicated by local risk assessments.
8  Infection Prevention and Control is a necessary component of safe and  Ellipses
high quality care essential for everyone’s well-being. signify
 Bearing in mind that transmission is not one-way and does not transition
discriminate! It is important to ensure standard IPC measures at all while the last
times, when caring for all patients. These standard precautions include; sentence is
o Hand Hygiene which could be with soap and water or alcohol still being
based hand rub (ABHR) spoken
o Respiratory Hygiene otherwise called Cough Etiquette
o Personal Protective Equipment (PPE) based on risk assessment
o Safe injection practices, sharps management and injury
prevention
o Safe handling, cleaning and disinfection of patient care
equipment
o Environmental cleaning
o Safe handling and cleaning of soiled linen
o Safe waste disposal and management
o Cleaning and disinfection
Now let’s discuss these measures one after the other, starting with Hand
Hygiene
9 Hand hygiene is the act of cleaning the hands for the purpose of removing  Highlight
soil, dirt and microorganisms. This should be done by using appropriate ‘image of
product and technique either; hand hygiene
 An alcohol-based hand rub (ABHR) product for 20–30 seconds! If on the slide’
hands are not visibly soiled. OR
 Washing of the hands for 40–60 seconds with soap, under running water
and single-use (preferably disposable) towel for drying, when visibly
dirty or contaminated with proteinaceous material
Let’s take some minutes to watch this instructional video on hand-rub
and handwashing
10  Welcome back! Now that we have established the how, let’s talk about  Ellipses
the when. According to WHO, there are 5 moments when hand hygiene signify
should be performed; transition
o before contact with patients while the last
o after any contact with patients sentence is
o before any clean procedure still being
o after body fluid exposure risk spoken
o after contact with patient surrounding/contaminated items
 Proper handwashing is the single most effective way to prevent or
reduce spread of infection, and do not rinse your hands, clean or wipe
sanitizer off.
 Summarily, hand hygiene should be performed anytime and always.
Remember, clean hands saves lives!
11 The next IPC measure we will be discussing is the appropriate use of  Highlight
Personal Protective Equipment (PPE) PPE Use
 PPE are specialized clothing, equipment or other garments used alone
or in combination for protection against infectious materials. PPE use is  Ellipses
 important to be able to minimize direct unprotected exposure to blood signify
and body fluids. transition
 The choice of PPE is guided by your assessment of the risk the suspect while the last
poses. Here are some basic scenarios to guide you: sentence is
o Before and after patient contact, and after contaminated environment still being
– perform hand hygiene spoken
o For Everyone – gloves. You should use gloves for every suspect/ill
person assessment you do.
o If direct contact with blood and body fluids, secretions, excretions,
mucous membranes, non-intact skin - add medical masks
o If there is risk of splashes onto the health care worker’s body - add
gown
o If there is a risk of splashes onto the body and face – add eye wear
such as goggle and face shield
 Limit opportunities for touch contamination. Always use a job aid to
put on and remove PPE, and never be in a hurry to take off PPE
12 The next IPC measure is Respiratory Hygiene commonly called Cough  Highlight
Etiquette ‘Respiratory
 It is a measure put in place to reduce the risk of transmission/spread of Hygiene’
respiratory illness. This can be achieved by following these principles;
o Cover your nose and mouth when sneezing and/or coughing with a
tissue or a surgical mask. Do not use a handkerchief because you
most likely will not dispose it.
o Immediately and appropriately dispose of any of these items used.
o You can also cough/sneeze into your sleeve/inside of your elbow if
no tissue is available
o Perform hand hygiene with alcohol based hand rub or water and
soap if hands are visibly soiled
o Wear a medical mask if you/suspect have respiratory symptoms
o Stay away from others when sick
o Do not exchange introductory kissing or shaking hands when ill
o Avoid close contact with people who exhibit symptoms, maintain at
least 1 metres from suspect
 Discourage suspect/ill person from touching the face, nose, eyes and
ears.
 The fate of droplets released can be determined by observing good
respiratory hygiene
13&14 When caring for patient(s) with Severe Acute Respiratory Infections, such 
as; seasonal or pandemic human influenza virus, MERS CoV, zoonotic
influenza virus, emerging respiratory virus of potential concern (COVID-
19) to mention but a few, its crucial to apply additional precautions
 First is Droplet Precautions: this prevent droplet transmission of
respiratory viruses.
o For Health care workers, it’s imperative to wear a medical/surgical
mask when within 1 metre of patient with ARI, and also wear eye
protection (goggles or face shield) if there is a risk of splashes to the
face.
o While for the suspect/patient, place him/her in single room (when
available) or cohorted and ensure the suspect is separated from
others by at least 1 metre.
  Also limit/restrict the person’s movement out of the hospital room
and ensure the patient puts on a medical-surgical mask if he/she has
to move outside.
15  Another additional precaution is Contact Precautions. This prevent  Ellipses
direct or indirect transmission from contact with contaminated surfaces. signify
 Contact precaution is not necessary when caring for patients with transition
seasonal influenza or common bacterial respiratory infections as the use while the last
of PPE based on risk assessment should suffice. sentence is
still being
spoken
16&17  For Health care worker, it is important to; 
o Wear appropriate PPE (gloves, masks, eye protection, and long
sleeved-gown) upon entering room with a suspect or < 1 metre in
distance.
o Remove PPE immediately after leaving the room, and perform hand
hygiene
o Hand hygiene should be performed according to the “5 Moments” as
discussed earlier.
o Use disposable or dedicated patient equipment when possible, and
o Clean and disinfect equipment between use if sharing between
patients.
o Refrain from touching your eyes, nose or mouth with contaminated
gloved or ungloved hands.
o Avoid contaminating surfaces not involved with direct patient care:
i.e. door knobs, light switches, mobile phones; and also
o Ensure appropriate and frequent (at the least daily) environmental
and equipment cleaning, disinfection, and sterilization (when
indicated).
o Health care workers must also prioritize frequently-touched surfaces
(e.g., bed rails, over-bed table, lavatory surfaces in patient
bathrooms, doorknobs etc.) and equipment in the immediate vicinity
of the patient.
 While the patient;
o Should be placed in single room or cohorted with other patients with
same etiologic diagnosis but keep in mind 1 metres between
patients; and
o Avoid movement or transport of patients out of hospital room.
 Next is the 3rd additional precautions
18&19  This is known as Airborne Precautions, this prevents transmission of 
very small droplets of all respiratory pathogens.
 This precaution must be taken for all patients with SARI that are
undergoing aerosol-generating procedures such as;
o aspiration or open suctioning of respiratory tract secretions,
intubation, during cardiopulmonary resuscitation, bronchoscopy,
o aerosolized nebulizer*, non-invasive ventilation* and high-flow
oxygen*. Although there is limited data where it concerns
aerosolized nebulizer, non-invasive ventilation and high-flow
oxygen, as these interventions may produce aerosols and thus
airborne precautions recommended.
 Airborne precautions must be employed at all times, in patients
 suspected to have an emerging respiratory virus of potential concern and
Tuberculosis.
20&21  Health care worker(s) handling patients in this category, must use a 
particulate (N-95) respirator, gown, eye protection, gloves. Simply put,
complete PPE must be worn.
 The Patient on the other hand, must be in a single airborne room and
unnecessary individuals must be avoided from entering into the room
 Airborne precaution room means
o a naturally well ventilated room with at least 160 L/s/patient air flow
o negative pressure rooms with at least 12 air changes per hour; and
o Controlled direction of air flow.
21  Before entering an airborne precaution room, 
o Place the respirator over your nose, to cover the nose, mouth and
chin, ensuring the edge with the metal strip is facing upwards.
o Secure the strings or elastic bands at the middle of the head by
wearing the top strings first, then the bottom string after, around the
neck
o Adjust to fit the face and below chin
o Perform a user “fit test” by molding the flexible nose piece (metal
strip) over the nose bridge to the shape of your nose and a “seal
check”;
 Exhale sharply onto the respirator, a positive pressure inside the
respirator is equivalent to no leakage, however, if there is leakage,
readjust the respirator and retest the seal. Repeat until properly
sealed.
 Proceed to perform a negative seal check by inhaling deeply, if no
leakage, the respirator will cling to your face, however, leakage will
result in loss of negative pressure in the respirator due to air entry
through the gaps in the seal.
22  Always remember that if a patient has symptoms suggestive of an 
emerging or re-emerging ARI with epidemic or pandemic potential and
transmission not yet established, it is safer to implement airborne,
droplet and contact precautions in addition to the standard IPC
measures.
 Now we have come to the end of Unit 1. Let’s take a break while you
attempt the mid-section quiz. See you in Unit 2
23  Welcome back! Good job attempting the mid-section quiz. It’s time to 
take a quick look through how administrative and engineering
controls facilitate the implementation of IPC
24  There are 3 basic building blocks that uphold infection prevention and  Ellipses
control; signify
o The first is administrative control. transition
o Followed by engineering control; and while the last
o The final one is personal protective equipment. sentence is
 These 3 priorities work harmoniously, to prevent, detect and control still being
infections, hence the importance of communicating and collaborating spoken
with your IPC team cannot be over-emphasized.
 A quick look at Infrastructure, policies and procedures will help drive
home this importance.
25  As you can see on the slide, these can be further broken down into: 
 i. Managing ill patients seeking care
ii. Implementing occupational health policies and procedures
iii. Implementing source control measures, and
iv. Organizing health care service delivery e.g. postpone elective
procedures, restrict visitors
 Now let’s discuss “managing ill patient seeking care”
26  The management of ill patient seeking care involves;  Highlight
o Timely and effective triage Cleaning and
o Patients’ admission to dedicated area in the facility Disinfection
o Specific case and clinical management protocols; as well as
o Safe transport and discharge home
 For the purpose of this module, we will focus on the 1st two.
27-28  Triaging means sorting and prioritizing of patients based on degree of
urgency. During this period, it is important to;
o Prevent overcrowding the patient,
o Place ARI patients in dedicated waiting areas with adequate
ventilation.
o Implement droplet precautions in addition to standard IPC measures
as discussed earlier, and
o Conduct rapid, prompt and effective triage.
 Once through with triage, the next phase is Patient Admission
o However, avoid admitting low-risk patients with uncomplicated
seasonal influenza virus infection.
o Patients with the same diagnosis can be cohorted in one area but
ensure you maintain the distance apart amongst them.
o Do not place suspect patients in same area as those who are already
confirmed.
o Ensure patients with ARI of potential concern are placed in single,
well ventilated room, when possible; and
o Assign health care worker with experience with IPC and outbreaks
to these rooms.
 Now let’s go over the second Infrastructure, policies and procedures
29-30 Occupational Health Policies.  Highlight
 All the staff must be well educated about: Workspace
o Acute Respiratory infections (ARIs), at the POE!
o Appropriate and adequate protective measures, as well as the risk
factors for severe disease(s).
 While for staff who fall within the ‘at-risk category such as pregnant,
immune-compromised etc.’, offer them alternative work assignments.
 Vaccinate staff if vaccine is available for the respiratory illness, and
 Ensure regular screening of all staff for symptoms of ARI. Upon
screening, if any staff develop symptoms, instruct him/her to;
o Notify infection-control team/hospital authorities immediately.
o Stop working with patients immediately.
o Limit contact with other staff and family members.
o Exclude themselves from public areas, and always
o Apply standard and droplet precautions.
31-32  The third Infrastructure, policies and procedures is Source Control 
 This include provision and availability of adequate equipment,
 education, training, policies, and protocols for:
o hand hygiene
o PPE use
o cleaning and disinfection of materials and environment
o One-time use patient care items such as oxygen delivery devices,
ventilator circuits, closed suction system.
 Also in place and available for use, there must be basic infrastructure
such as:
o At least 1 metre physical separation between patients in cohorted
rooms
o physical structures as barriers to serve the purpose of partition in the
triage areas
o well ventilated corridors; as well as
o well ventilated patient care areas
33-34 Finally, the last building block of IPC, which is Personal Protective  Highlight the
Equipment (PPE) image as
 This is the last line of defence against hazards that cannot otherwise be teacher
eliminated or controlled. These must be used appropriately as it is only speaks to it
effective if;
o used throughout potential exposure periods and adherence is 100%
 Also it must be properly used and maintained, however, PPE use does
not eliminate need for proper and frequent hand hygiene
 For example, take a look at the images on this slide;
o In the 1st image (top left), the medical mask and the head cover are
inappropriately worn, which can put the health care worker at risk of
infection.
o Similarly in the 2nd image (top right), the health worker is seen
rubbing her nose with a gloved hand.
o Lastly, in the lower image, the gentleman attending to a patient has
no medical mask on, seen touching his mouth with his bare hands
and he is also touching possibly contaminated surface with his bare
hands.
In Summary,
35  When caring for all patients, always use standard precautions.
 Then apply droplet precautions, when caring for patients suspected to
have SARI and respiratory virus infection.
 When COVID-2019, zoonotic influenza, MERS-CoV, or emerging
respiratory virus is suspected, also use contact precautions.
 Always use airborne precautions, when carrying out high-risk, aerosol-
generating procedures such as intubation or open suctioning in patient
with SARI; and finally,
 Use all precautions (airborne, droplet, contact in addition to standard
precautions) when caring for patients with emerging infection of
concern (and transmission pattern unknown).
 Promoting IPC reduces the risk of infection transmission;
Remember, Infection prevention and control is Everyone’s Responsibility!
36&37 We have come to the end of this module and hope that you can now
implement and ensure IPC measures when caring for patients with Severe
Acute Respiratory Infections!
You may now proceed to the post-tests
Thank you!