Infection Prevention and Control

(IPC)
considerations for Mpox

Case Management Pillar

Ministry of Health
 Introduction to Infection Control for MPox

In this session, participants should be able to:

1. Define the role of IPC in patient care

2. Understand modes of transmission for MPox

3. Apply Standard precautions to control MPox

transmission

4. Understand when to apply transmission-based

precautions
IPC refers to measures taken during service provision and
maintenance of health facilities to reduce chances of health
workers, clients and the community from getting infected.

Protect yourself &

family
Why IPC Protect your
community
Protect your
patients
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 Modes of transmission for Monkeypox

It is transmitted when the virus enters the body through broken skin, mucosal
surfaces (eyes, mouth, nose, genitals), or Inhalation via the respiratory tract.

Monkeypox (MPox) virus is mainly transmitted through:

A. Direct contact:
i) From infected animals to humans via; bites, scratches during
activities like hunting, skinning, trapping, or handling carcasses
ii)Humans to Humans transmission through:
Direct contact with infectious bodily fluids, skin lesions through face, skin,
mouth, sexual intercourse, Vertical transmission- MTCT

B. Indirect Contact:
Droplets- environmental, clothes, plates etc
Possible aerosol transmission
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 Risk Assessment
• A systematic examination of all aspects of work for the
purpose of evaluating risks to worker and patient safety and
health to decide on appropriate precautions
 Principles of IPC strategies associated with health care of
suspected and confirmed Mpox patients
1. Screening & triaging all patients

2. Application of standard precautions for all patients

3. Implementation of empiric additional precautions

4. Administrative controls

5. Environmental and engineering controls

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1. Screening, early recognition, and source control

• Establish a well-equipped screening station at the

entrance of the health facility.

• Encourage all HCWs to have a high level of clinical

suspicion and use updated case definitions.

• Reinforce adherence to standard precautions especially

respiratory hygiene and hand hygiene.

• Ensure social distancing of 1 meter in waiting areas

• Ensure that patients with symptoms of suspected Mpox

are not allowed to wait among other patients seeking
care.

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2. Apply standard precautions for all patients

• Hand hygiene
• Respiratory hygiene
• Appropriate Personal Protective Equipment (PPE)
according to risk assessment
• Injection safety practices/sharps safety
• Safe medical waste management
• Proper linens, environmental cleaning and sterilization of
patient-care equipment

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Application of Standard and Transmission Based Precautions

Standard based precautions Transmission Based Precautions

Are the basic level of infection control • Transmission based precautions Supplement

precautions standard precautions

Deployed to reduce the risk of • should be applied when caring for patients

transmission of pathogens from both with known infection OR

• Patients who are suspected of/under
recognized and unrecognized sources
investigation for infectious agents to avoid
in healthcare facilities.
spreading
They are used in the care of ALL
• Implementation of these precautions
patients at ALL times
depends on the mode of transmission of the
infection
Standard and Transmission based precautions

Standard Precautions Transmission based precautions

• Hand hygiene •Contact precaution
➢ Patient placement in single rooms or cohorts
• Respiratory hygiene & Cough etiquette
➢ Hand hygiene
• Appropriate use of Personal Protective ➢ Use appropriate PPEs (Gowns, gloves, Eye protection,
N95 masks)
equipment(PPE)
➢ Limit entry in and out of isolation
• Safe injection, sharps management and injury •Droplet precaution
prevention ➢ Use of appropriate PPEs: Face protection
➢ Hand hygiene
• Cleaning and disinfection of patient care
➢ Cleaning and disinfection
equipment.
➢ Dedicated patient care equipment
• Environmental cleaning. •Airborne precaution
➢ Consider appropriate PPEs for aerosol generating
• Safe handling and cleaning of linen procedure(AGPs) – N95 masks and where varicella zoster is
suspected
• Waste management
➢ Hand hygiene
• Aseptic technique ➢ Keep door to isolation closed
 Hand hygiene

Hand hygiene is the

most important
measure to prevent
infection

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Respiratory or cough etiquette

Cover mouth and nose when coughing

and sneezing

Wear a cloth mask when in public and

Maintain social distance (2m) from
others

Cover mouth/nose with tissue →

dispose of tissues in nearest waste bin
→ perform hand hygiene

Offer a face mask to patients with

suspected MPox infection while they
are in waiting/public areas
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 3. Implementation of empiric additional precautions:
applying droplet precautions
• Droplet precautions prevent large droplet transmission of
respiratory viruses.
• Use a mask while providing care for Mpox suspect or
confirmed patients
• For suspect cases, place patients in single rooms if available
or separate patients by 1 m spatial separation.
• When providing care in close contact with a patient with
respiratory symptoms (e.g., coughing or sneezing), use eye
protection (face shield or goggles) in addition to a mask.
• Limit patient movement within the facility and ensure that
patients wear masks when outside their rooms.
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 3. Implementation of empiric additional precautions:
applying contact precautions
Mpox can remain on surfaces for more than 15 days.
• Droplet and contact precautions prevent direct or indirect
transmission from contact with contaminated surfaces or
equipment.
• Use PPE (medical mask, eye protection, gloves and gown) when
entering room and appropriately remove PPE when leaving.
• If possible, use either disposable or dedicated equipment (e.g.,
stethoscopes, blood pressure cuffs and thermometers).
• If equipment needs to be shared among patients, clean and
disinfect between each patient use.
• Refrain from touching your eyes, nose, and mouth with
potentially contaminated gloved or ungloved hands. 14
 Implementation of empiric additional precautions:
applying airborne precautions
Use when performing Aerosol-Generating Procedures (AGP)
• Use Level 4 PPE, including gloves, long-sleeved gowns, eye
protection and fit-tested particulate respirators (N95 or
equivalent* or higher level of protection).
• Whenever possible, use adequately ventilated single rooms.
• Avoid the presence of unnecessary individuals in the room.
• Due to risk for AGPs during airway manipulation procedures,
maintain care for the patient in the same type of room where the
AGP was performed to lower the risk of aerosol spread to other
parts of the health facility.
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3. Implementing empiric additional precautions (cont.)

• Patients should be placed in adequately ventilated single

rooms
• When single rooms are not available, patients suspected of
being infected with Mpox should be grouped together
(“cohorting”)
• Suspect Mpox patients should be separated from the
confirmed cases
• All patients’ beds should be placed at least 1-2 m apart,
especially when Mpox status is unknown (i.e., area for
suspected patients)
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 3. Implementing empiric additional precautions (cont.)

• If transport is required:
• use pre-determined transport routes to minimize exposure for staff, other
patients and visitors
• offer a medical mask for the patient to wear during transport
• Routinely clean and disinfect surfaces with which the patient
has contact
• Maintain a record of all persons entering the patient’s room,
including staff and visitors
• Routinely clean and disinfect surfaces with which the patient
has had contact
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 3. Implementing empiric additional precautions—
Isolation Rooms
• Access to the isolation rooms should be restricted and open only to
authorized HCWs.
• Personnel entry and exit should be minimized
• Patient movement out of the room should also be minimized
• Once transported to a designated isolation room for confirmed cases, a
patient can remove her or his facemask.
• Outside the isolation room, patients should wear a facemask to contain
secretions and droplets
• Personnel entering the room should use appropriate PPE
• Patient rooms should undergo appropriate cleaning and surface
disinfection before it is returned to routine use

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 PPE covers the most important places
where germs can enter your body

EYES
NOSE

LIPS

HANDS
You must ALWAYS protect these areas of the body when
interacting with suspect and confirmed patients!
PPE for management of suspected or confirmed MPox

Face protection (goggles, face shield):

• During patient care, cleaning and other activities that may expose
your face to MPox virus
Medical mask:
• Protects nose and mouth from droplets and inhaling particles from
the environment
• Must be removed / changed if wet or dirty
N95 / FFP2 respirator:
• Use to protect against airborne particles and in case of AGPs/ where
varicella zoster is suspected
• Requires an appropriate adjustment for your face (Fit test)
PPE for management of suspected or confirmed Mpox
Body protection
• • Gumboots should be
• Health workers Aprons should be worn when
worn to protect the feet
should wear gowns likely to be exposed to body and disinfected every
while managing after use. Shoe covers
fluids.
suspect or confirmed are not necessary
patients
 4. Implementing administrative controls
• Establish sustainable IPC infrastructure and activities to prevent
hospital-acquired infections
• Educate patients and patients’ caregivers on IPC measures
• Ensure access to prompt laboratory testing for diagnosis of illness
• Provide dedicated waiting areas for symptomatic patients with
Mpox
• Appropriately isolate hospitalized patients with Mpox
• Ensure adequate supplies of PPE for Mpox
• Get SOPs on the early recognition of Mpox
• Provide appropriate isolation rooms for patients with Mpox or
refer to higher centers.
• Ensure an adequate staff-to-patient ratio
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 4. Implementing administrative controls—
Health Care Workers (HCWs)
• Ensure all HCWs have got adequate training in IPC, PPE donning
and doffing and clinical management of Mpox
• Ensure an adequate Staff-patient ratio
• Ensure linkage to surveillance focal points and keep alert contacts
in accessible are for health-workers.
• Monitor HCW compliance with standard precautions and provide
mechanisms for improvement as needed
• Health facilities should Conduct weekly CMEs on Mpox for their
health workers.

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 5. Using Environmental and Engineering Controls

• Spatial separation of at least 1-2m should be maintained

between all patients
• Ensure that cleaning and disinfection procedures are
followed consistently and correctly
• Clean environmental surfaces with water and detergent or
commonly used hospital disinfectants
• Manage laundry, food service utensils and medical waste in
accordance with safe routine procedures
• In-door spraying of disinfectants is not recommended

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Environmental Cleaning during MPox outbreak

• Wear appropriate PPE

• Avoid dry dusting, sweeping, or vacuuming. Wet cleaning methods are preferred

• Always proceed from the highest area to the lowest area, cleanest area to the dirtiest area and
from the furthest area to the nearest area.

• Buckets intended for specific uses must be labelled and/or of a specific color.

• Isolation cleaners must be stored and used only in isolation.

• Perform hand hygiene after

The isolation area must always be cleaned/disinfected last.

 Cleaning surfaces within the facility
Patient area Frequency
Screening/triage area At least twice daily. Focus on high touch surfaces then floors
Inpatient rooms / cohort – At least three times daily preferably for high touch surfaces, start
occupied with shared surfaces then each bed
Inpatient rooms – unoccupied Upon discharge/ transfer. Low touch, high touch, floors, bed
(terminal cleaning) cleaned/disinfected, waste removed
Outpatient / ambulatory care After each patient visit (in particular for high-touch surfaces) and
rooms at least once daily terminal clean
Hallways / corridors At least twice daily
Patient bathrooms/ toilets Private patient room toilet: at least twice daily Shared toilets: at
least three times daily. Staff should avoid sharing toilets with
patients
After cleaning surfaces, disinfect with Ethanol 70-90% or 0.5% Chlorine, or Hydrogen
Peroxide >0.5%

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 Cleaning and Disinfection of medical instruments

• Dedicated equipment for care of patients OR

• Use disposable equipment
• Wear appropriate PPE.
• Clean equipment with warm water (<45 °C) mixed with a
detergent
• wipewith alcohol (70%) or soak in chlorine for
contact time before rinsing and sterilization
• Clean used plates by washing with detergent manually in
hot water (>55°C) while wearing domestic gloves
• Re-usable PPEs like gumboots should be washed and
soaked in chlorine, rinsed and dried before re-use
• Perform hand hygiene

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 IPC Considerations during Linen Management
❑ Don appropriate PPEs: Wear gloves, apron or gown, a respirator (e.g.N95, FFP2) and eye protection

❑ Carefully lift and roll linens. Do not shake linen or laundry as this may disperse infectious particles.

❑ Carefully place into designated container or bag for transport to laundry services.

❑ Linens can be machine washed if available with hot water at > 60°C and detergent and air dried preferably
exposing them to heat.

❑ If machine washing is not possible and hot water is not available, linens can be soaked in a large drum with
soap and water using a stick to stir with care taken to avoid splashing.

❑ Then soak in chlorine 0.05% for 30min, rinse with clean water and allowed to air dry.

❑ Perform hand hygiene

Waste Management in the context of MPox

❑ Waste should be segregated (general waste, infectious waste and sharps) and placed in appropriate
bins at point collection.

❑ Management and disposal of waste (including PPE) should be done in accordance with
recommendations for management in Uganda

❑ Highly infectious waste from patients’ bandages and used materials should be double bagged,
disinfected and incinerated

❑ Health workers handling wastes should wear appropriate PPE (e.g. Gloves, gown, respirator
[e.g.N95, FFP2], eye protection) and must be trained.
IPC Considerations for dead body management
❑ Perform hand hygiene and wear appropriate PPE for contact and droplet precautions (gloves, gown, N95
respirators pref] and eye protection).

❑ Ensure that any leakage of body fluids is contained.

❑ Wrap the body in a cloth and transferred to the morgue as soon as possible. If body bags are available, place
the body in a bag

❑ The dignity of the dead, their cultural and religious traditions, and their families should be respected and
protected.

❑ Family and friends may view the body after it has been prepared for burial
❑ Ensure they don’t touch or kiss the body and should clean their hands with soap and water or alcohol-based
hand sanitizer after the viewing
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 Recommendations for Outpatient Care

• Screening and triage for early recognition

• Emphasis on hand hygiene and respiratory hygiene
• Prioritization of care of symptomatic patients
• When symptomatic patients are required to wait, ensure they
have a separate waiting area and have facemasks
• Educate patients and families about the early recognition of
symptoms, basic precautions to be used and to which health
care facility they should be referred

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Additional Recommendations

❑ Establish healthcare worker post exposure management guidelines for exposed

health workers at health facilities
❑ Initiate inpatient screening/surveillance

❑ Encourage mpox patients to abstain from sexual intercourse until all lesions are
crusted and scabs have fallen off, and a fresh layer of skin has formed
❑ If unable to abstain, provide condoms and encourage use

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 Summary
• Implement procedures for early detection and source control of monkeypox virus e.g. screening,
Isolation of suspect cases etc.

• Transmission based precautions supplement standard precautions- should be applied when mpox
is suspected or confirmed

• Encourage health workers to adhere to standard precautions

• Ensure proper hand hygiene practices and avoid unnecessary touching of surfaces and self

• Use appropriate PPEs guided by risk assessment

• Use medical masks for patients and keep the rash/ wounds covered/ dressed

• Educate patients on proper respiratory/cough etiquette to avoid droplet and fomite transmission of
MPox
 Reference Resources
• Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic
Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology
(DHCPP). Available at: http://www.cdc.gov/

• Monkeypox infection prevention and control guidance for primary and acute care settings.
Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-
infection-prevention-and-control-guidance.pdf

• Clinical management and infection prevention and control for monkeypox: Interim rapid
response guidance, 10 June 2022. Available at: https://www.who.int/publications

• Interim guidance on monkeypox for health workers. Available at:

https://www.health.gov.au/sites/default/files/2022-12/iceg-interim-guidance-on-monkeypox-
for-health-workers.docx

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Appreciation