Project Overview

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Sequence for donning and removing personal
protective equipment (PPE)
Prepared by Insertname of presenterInsert
titleInsert Branch name February 2005
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Program Goal

• Improve healthcare worker safety in the
  healthcare environment through appropriate and
  correct use of PPE

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Aims and Objectives

• To ensure healthcare workers are aware of the
  appropriate PPE required, in order to provide
  protection in conjunction with standard and
  transmission-based precautions
• Ensure healthcare workers are aware of the
  correct sequence for donning PPE
• Ensure healthcare workers are aware of the
  correct sequence for removing PPE in a manner
  that prevents self-contamination and
  self-inoculation

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Personal Protective Equipment (PPE)

• PPE refers to whatever protective equipment may
  be used to insulate an individual from the
  hazards presented by the environment in which he
  or she is working
• In the healthcare environment it refers to
  specialised clothing or equipment worn by an
  employee or patient for protection against
  infectious materials and other contaminants
• The type of PPE used will vary based on the level
  of precautions required such as, Standard,
  Contact, Droplet or Airborne Infection Isolation

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Some important things to remember about PPE

• Don PPE before contact with patient, generally
  before entering the room
• Keep gloved hands away from the face and avoid
  touching or adjusting PPE
• Remove and discard PPE carefully. This should be
  done at the doorway (just prior to leaving
  patients room) or immediately outside patient
  room. Surgical or particulate masks should be
  removed outside room
• Immediately perform hand hygiene using soap and
  water or an alcohol-based gel or rub

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Sequence for Donning PPE

• Gown/apron
• Surgical or particulate mask
• Goggles or face shield
• Gloves

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Step 1 Perform hand hygiene

• Perform hand hygiene before
• putting on Personal Protective
• Equipment (PPE)
• With soap and water, or
• Water-free skin cleanser

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Step 2 Gown/Apron

• Fully cover torso from
• neck to knee, arms to end
• of wrist, and wrap around
• the back.
• Fasten at back of neck
• and waist.

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Step 3 Surgical mask or particulate (P2 or N95)

• 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 particulate (P2 or N95) only

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Step 3 continued,Fit Checking P2 or N95 Masks

• Gently inhale. When you breathe
• in the mask should draw in slightly
• toward the face and collapse
• Gently exhale. The mask
• should fill up with air.
• It is important at this stage that
• there is no air leakage around the
• edges of the mask

Observe for air leakage around edges of mask
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Step 3 continued,Fit Checking P2 or N95 Masks

• If you have not achieved a successful fit check
  as instructed it is important that you seek
  advice or have someone assist you with fitting
  and checking your mask.
• An incorrectly fitted mask will not provide you
  with the intended level of protection from
  airborne infectious diseases

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Step 4 Protective Eyewear

• Place goggles or face shield/visor
• over face and eyes and secure
• using the ear pieces or headband
• Adjust to fit comfortably

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Step 5 Gloves

• Don gloves last
• Select correct size and type
• Insert hands into gloves
• Extend to cover wrist of gown

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• You are now ready and safe to enter the
  patients room

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Safe use of PPE

• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Change gloves when torn or heavily contaminated
• Limit surfaces and items touched to prevent
  accidental contamination

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Sequence for Removing PPE

• Gloves
• Face shields or goggles
• Gown
• Mask or respirator

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Sequence for Removing PPE

• It is important to remember that the sequence
  for removing PPE is intended to limit
  opportunities for self contamination and self
  inoculation
• Important to identify what sites or areas are
  considered clean and what are contaminated
• This is especially important when identifying the
  safest sequence for removal

contaminated
contaminated
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Where to remove PPE

• At the doorway, before leaving the patients room
  or in the anteroom if available
• It is important to remove mask/ respirator
  outside room, after the door to patients room
  has been closed
• Hand washing facilities ( soap and water-free
  skin cleanser) should be readily available after
  all PPE is removed

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Step 1 Gloves

• Outside of gloves is contaminated
• Grasp outside of glove with opposite
• gloved hand peel off
• Hold removed glove in gloved hand
• Slide fingers of ungloved hand under
• remaining glove at wrist
• Peel glove off over first glove
• Discard gloves into waste container

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Step 2 Hand hygiene

• Perform hand hygiene following removal of gloves
• Using soap and water, or
• water-free skin cleanser

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Step 3 Protective Eyewear

• Outside of goggles or face shield is
• contaminated
• To remove, handle by head band
• or ear pieces
• Place reusable eyewear in
• designated receptacle for cleaning
• Or
• discard disposable eyewear into waste
• container for disposal

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Step 4 Gown/apron

• Gown front and sleeves are contaminated
• Unfasten ties at neck and waist
• Pull away from neck or
• shoulders, touching inside
• of gown only
• Turn gown inside out
• Fold or roll slowly into a bundle and
• discard into designated waste container

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Step 5 Surgical or particulate mask (P2 or N95)

• Front of mask is contaminated
• Remove by touching tapes or ties only
• Discard in designated waste container

Remove mask when outside patients room
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Step 6 Hand Hygiene

• Perform hand hygiene following
• removal of all Personal Protective
• Equipment (PPE),
• Using soap and water, or
• water-free skin cleanser

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Recommendations for use of personal protective
equipment (PPE)
Prepared by Insertname of presenterInsert
titleInsert Branch name February 2005
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Standard Precautions

• Assumes all blood and body fluids as
• potentially infectious
• Involves the use of protective barriers
• and safe work practices
• PPE choice designed to
• minimise contact with potentially
• infectious blood and body fluids

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PPE for Standard Precautions (1)

• GLOVES - must be worn on both hands and must be
  used in situations where the health care worker
  is potentially exposed to blood and/or body
  substances
• GOWNS - A fluid-resistant gown/apron, made of
  impervious material must be worn during any
  procedure where there is a likelihood of splashes
  or contamination with blood or other body
  substances

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PPE for Standard Precautions (2)

• MASK AND PROTECTIVE EYEWEAR OR A FACE SHIELD
  must be worn while performing any procedure where
  there is a likelihood of splashing or splattering
  of blood or body substances.

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What type of PPE would you wear?

• Showering or bathing a patient?
• Suctioning oral or tracheal secretions?
• Transporting a patient in a wheelchair?
• Responding to a dislodged chest drain where
  visible blood is spurting out?
• During venepuncture?
• Cleaning a patient incontinent of diarrhoea?
• Irrigating a wound?
• Taking vital signs?
• Removing a patients meal tray?

?
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PPE for Additional (Transmission Based)
Precautions

• Additional Precautions are designed for patients
  known or suspected to be infected with pathogens
  for which Additional Precautions, in addition to
  Standard Precautions, are needed to interrupt
  transmission of those pathogens in health care
  facilities
• Additional precautions include
• Airborne Precautions
• Droplet Precautions
• Contact Precautions
• Combination airborne/droplet/contact

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PPE for Additional (Transmission Based)
Precautions

• Airborne Precautions - Particulate (P2 or N95)
  mask
• Droplet Precautions - Surgical masks within 1
  metre of patient and protective eyewear
• Contact Precautions Gown/apron and gloves for
  contact with patient or environment e.g.
  equipment and surfaces in the patients
  environment

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Questions

• Please nominate the correct sequence for donning
  PPE
• Gloves, gown, mask, eye protection
• Gown, mask, goggles, gloves
• Mask, goggles, gown, gloves
• Eye protection, gown, gloves, mask

?
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Questions

• 2. In the sequence for removing PPE it is
  advised that removal of masks should occur once
  outside the patients room. This is because
• It is important to remain unidentifiable to the
  patient for as long as possible
• Because the garbage bin allocated for mask
  removal is located outside the room
• Removing the mask inside the room would put the
  HCW at unnecessary risk of exposure to
  respiratory/airborne infection
• None of the above

?
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Questions

• 3. Gowns and masks should be removed by touching
  tapes or ties only. The reason for this is
• The front of the mask or gown is considered
  contaminated
• Risk of tearing the mask or gown
• You no longer need the mask or gown
• So you cannot see what you are doing
• You will ruin your make-up if removal is
  performed
• from the front

?
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Questions

• 4. Which of the following is not included under
  Standard Precautions ?
• Gloves
• Surgical mask
• Particulate (P2 or N95 mask)
• Eye protection
• Gown or apron

?
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Questions

• 5. Which of the following statements are not true
  about Standard Precautions
• All blood and body fluids are considered
  potentially infectious
• It involves safe work practices and protective
  barriers
• Provides protection from infections spread by
  airborne, droplet and contact transmission
• Provides protection from infections predominately
  transmitted through blood and body fluids
• None of the above

?