Proper Donning and Doffing of PPE

by Mr. Juan Paulo V. Chavez

1. 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 PinasCity
1

2. 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.htm2

3. 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.htm3

4. 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

5. Factors Influencing PPE Selection
•Type of exposure anticipated
-Splash/spray versus touch
-Category of isolation precautions
•Durability and appropriateness for the
task
•Fit
http://www.cdc.gov/HAI/prevent/ppe.html
5

6. Key Definitions
•Hand Hygiene
A general term that applies to any one of the following:
1. Handwashingwith 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 handwashor antiseptic
handrubperformed 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

7. 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

8. 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

9. WHAT IS
THE
TRUTH
BEHIND
THIS?
9

10. 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 color
always faces out.
•The pleats fall downwards and away from
the nose (called a “waterfall” pleat).
http://www.primed.ca/clinicalresources/maskstandardsandfaq.aspx 10

11. 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 μmin 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-facepieceelastomeric negative pressure
respirators.
www.fda.gov/cdrh/ode/guidance/094.html#4 11

12. 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

13. 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

14. 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

15. 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 powderlessgloves are possible
alternatives for workers who are allergic to latex
gloves.
https://www.osha.gov/Publications/osha3151.pdf 15

16. 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

17. Facts about Gloves
•Although gloves do not prevent needlestickor
sharps injuries, studies have demonstrated that
the transmission of blood-borne pathogens may
be significantly reduceddue 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

18. 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

19. 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

20. GOWN vs. COVERALL
•Surgical gownsrated 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

21. GOWN vs. COVERALL
•Although Coverallstypically 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

22. 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

23. Personal Protective Equipment (PPE) Cart
23

24. PPE Checklist and Posters
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25. Proper DONNING of PPE
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26. 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

27. 1. Hand Hygiene
27
http://singaporemotherhood.com/articles/wp-
content/uploads/2012/10/8-step-handwashing-technique.jpg

28. 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

29. 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

30. 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

31. 5. GLOVES
•Extend to cover wrist
of isolation gown.
http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 31

32. Proper DOFFING of PPE
32

33. 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

34. 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 unglovedhand 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

35. 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

36. 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

37. 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

38. 5. HAND HYGIENE
38
http://singaporemotherhood.com/articles/wp-
content/uploads/2012/10/8-step-handwashing-technique.jpg

40. THANK YOU FOR YOUR KIND
ATTENTION…
40
Infection Prevention and
Control Unit (IPCU)