proper donning and doffing of ppe

Proper Donning and Doffing of Personal

Protective Equipment (PPE)Juan Paulo V. Chavez, RN

Board Member, Philippine Hospital Infection Control Nurses Association (PHICNA), Inc.

Senior Infection Prevention & Control Nurse Specialist,

University of Perpetual Help DALTA Medical Center – Las Pinas City 1

Personal Protective Equipment (PPE)

•Refers to protective clothing, helmets, gloves, face shields, goggles, facemasks and/or respirators or other equipment designed to protect the wearer from injury or the spread of infection or illness.

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/default.htm 2

Personal Protective Equipment (PPE)

•Effective use of PPE includes properly removing and disposing of contaminated PPE to prevent exposing both the wearer and other people to infection.

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/default.htm 3

Types of PPE Used in Healthcare Settings

• GLOVES – protect hands

• GOWNS/ APRONS – protect skin and/or clothing

• MASKS and RESPIRATORS – protect mouth/nose

RESPIRATORS – protect respiratory tract from airborne infectious agents.

• GOGGLES – protect eyes

• FACE SHIELDS – protect face, mouth, nose, and eyes

http://www.cdc.gov/HAI/prevent/ppe.html 4

Factors Influencing PPE Selection

•Type of exposure anticipated

- Splash/spray versus touch

- Category of isolation precautions

•Durability and appropriateness for the task

•Fithttp://www.cdc.gov/HAI/prevent/ppe.html

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Key Definitions

• Hand Hygiene

A general term that applies to any one of the following:

1. Handwashing with plain (nonantimicrobial) soap and water).

2. Antiseptic handwash (soap containing antiseptic agents and water).

3. Antiseptic handrub (waterless antiseptic product, most often alcohol-based, rubbed on all surfaces of hands).

4. Surgical hand antisepsis (antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient hand flora and reduce resident hand flora).

CDC. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(16)(RR-16):1-44 6

Key Definitions

• Mask

A term that applies collectively to items used to cover the nose and mouth and includes both procedure masks and surgical masks.

1. Procedure Mask

A covering for the nose and mouth that is intended for use in general patient care situations. These masks generally attach to the face with ear loops rather than ties or elastic.

www.fda.gov/cdrh/ode/guidance/094.html#4 7

Key Definitions

2. Surgical Mask

A device worn over the mouth and nose by operating room personnel during surgical procedures to protect both surgical patients and operating room personnel from transfer of microorganisms and body fluids.

www.fda.gov/cdrh/ode/guidance/094.html#4 8

WHAT IS THE

TRUTH BEHIND THIS?

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How do I know that the mask is on correctly?

•The metal nose piece is at the top.

•The white, or smoothest side, is on the inside against the wearer’s skin; the coloralways faces out.

•The pleats fall downwards and away from the nose (called a “waterfall” pleat).

http://www.primed.ca/clinicalresources/maskstandardsandfaq.aspx 10

Key Definitions

3. Respirator

A personal protective device worn by healthcare personnel to protect them from inhalation exposure to airborne infectious agents that are < 5 μm in size.

• N95 disposable particulate, air purifying, respirator is the type used most commonly by healthcare personnel.

• N-99

• N-100 particulate respirators

• Powered air-purifying respirators (PAPRS) with high efficiency filters

• Non-powered full-facepiece elastomeric negative pressure respirators.

www.fda.gov/cdrh/ode/guidance/094.html#4 11

Key Definitions

•Goggles

These are tight-fitting eye protection that completely cover the eyes, eye sockets and the facial area immediately surrounding the eyes and provide protection from impact, dust and splashes.

https://www.osha.gov/Publications/osha3151.pdf 12

Key Definitions

• Face Shields

These transparent sheets of plastic extend from the eyebrows to below the chin and across the entire width of the employee’s head. Face shields protect against nuisance dusts and potential splashes or sprays of hazardous liquids but will not provide adequate protection against impact hazards.

https://www.osha.gov/Publications/osha3151.pdf 13

Facts about Eye Protection

•Eye protection can be in the form of goggles, safety glasses, or face shields. Personal eyeglasses and contact lenses provide some but not complete protection and are not considered adequate eye protection.

•Reusable eye protection should be cleaned according to the manufacturer’s instructions.

14https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf

Key Definitions

• Natural (Latex) Rubber Gloves

They feature outstanding tensile strength, elasticity and temperature resistance.

Latex gloves have caused allergic reactions in some individuals and may not be appropriate for all employees. Hypoallergenic gloves, glove liners and powderless gloves are possible alternatives for workers who are allergic to latex gloves.

https://www.osha.gov/Publications/osha3151.pdf 15

Key Definitions

• Nitrile Gloves

Are made of a copolymer and provide protection from chlorinated solvents such as trichloroethylene and perchloroethylene.

They offer protection when working with oils, greases, acids, caustics and alcohols but are generally not recommended for use with strong oxidizing agents, aromatic solvents, ketones and acetates.

https://www.osha.gov/Publications/osha3151.pdf 16

Facts about Gloves

•Although gloves do not prevent needlestick or sharps injuries, studies have demonstrated that the transmission of blood-borne pathogens may be significantly reduced due to the ‘cleaning’ effect the material of the glove has on the instrument as it passes through the glove. Gloves may also reduce the injured person’s contact time with the source’s blood.

17https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf

Facts about Gloves

•Prolonged and indiscriminate use of gloves should be avoided as they may cause adverse reactions and skin sensitivity.

• In countries with limited resources and an inadequate supply of gloves, used sterile gloves may be washed, sterilized and reused for hygiene purposes only – not for invasive procedures.

18https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf

Key Definitions

•Gown

“Fluid-resistant Gown” apply to protective clothing tested against water as the liquid challenge.

“Impermeable Gown” materials that have demonstrated blockage of microorganisms using a recognized standard test method.

http://www.cdc.gov/niosh/npptl/topics/protectiveclothing 19

GOWN vs. COVERALL

•Surgical gowns rated for high levels of barrier protection may include the high-performance barrier materials in only certain portions of the gown (sleeves and front panel). This is especially important when contact from hazardous/contaminated fluids can come from multiple directions.

http://www.cdc.gov/niosh/npptl/topics/protectiveclothing 20

GOWN vs. COVERALL

•Although Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including back and lower legs and sometimes head and feet as well, the design of surgical/isolation gowns do not provide continuous whole-body protection (e.g., possible openings in the back, coverage to the mid-calf only).

http://www.cdc.gov/niosh/npptl/topics/protectiveclothing 21

Facts about Gowns or Aprons

• Clinical or laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered to be PPE.

• Aprons and gowns should be removed in a manner that prevents contamination of the wearer’s clothing or skin. The outer ‘contaminated’ side of the gown should be turned inward and rolled into a bundle and then discarded into a designated container for waste linen to contain contamination.

• In countries with limited resources where impermeable aprons or gowns are unavailable, a large plastic bag can be cut open and worn under a cotton apron or gown to protect clothing.

https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf 22

Personal Protective Equipment (PPE) Cart

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PPE Checklist and Posters

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Proper DONNING of PPE

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General Considerations (Donning of PPE)

•Keep hands away from face.

•Limit surfaces touched.

•Change when torn or heavily contaminated.

•Work from clean to dirty.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf 26

1. Hand Hygiene

27http://singaporemotherhood.com/articles/wp-

content/uploads/2012/10/8-step-handwashing-technique.jpg

2. GOWN

•Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back.

•Fasten in back of neck and wrist.

http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 28

3. MASK or RESPIRATOR

•Secure ties or elastic bands at middle of head and neck.

•Fit flexible band to nose bridge.

•Fit snug to face and below chin.

•Fit-check respirator.http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 29

4. GOGGLES or FACE SHIELD

•Place over face and eyes and adjust to fit.

•Anti-fog feature improves clarity.

http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 30

5. GLOVES

•Extend to cover wrist of isolation gown.

http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 31

Proper DOFFING of PPE

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General Considerations (Doffing PPE)

•Remove all PPE before exiting the patient room except a respirator, if worn.

•Perform Hand Hygiene between steps if hands become contaminated and immediately after removing all PPE.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf 33

1. GLOVES

• Outside of gloves are contaminated!

• If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer.

• Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove.

• Hold removed glove in gloved hand.

• Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove.

• Discard gloves in a waste container.

http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 34

2. GOGGLES or FACE SHIELD

•Outside of goggles or face shield are contaminated!

• If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer.

•Remove goggles or face shield from the back by lifting head band or ear pieces.

• If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container. http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 35

3. GOWN

• Gown front and sleeves are contaminated!

• If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer.

• Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties.

• Pull gown away from neck and shoulders, touching inside of gown only.

• Turn gown inside out.

• Fold or roll into a bundle and discard in a waste container.http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 36

4. MASK or RESPIRATOR

• Front of mask/respirator is contaminated — DO NOT TOUCH!

• If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer.

• Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front.

• Discard in a waste container.http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 37

5. HAND HYGIENE

38http://singaporemotherhood.com/articles/wp-

content/uploads/2012/10/8-step-handwashing-technique.jpg

THANK YOU FOR YOUR KIND ATTENTION…

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Infection Prevention and Control Unit (IPCU)