standard precautions.pptx

standard precaution meaning components types

1. Standard Precautions

2. Introduction There are approximately 59 million healthcare workers worldwide Healthcare industry is one of the most hazardous environments to work in. Employees in this industry are constantly exposed to a complex variety of health and safety hazards in the course of their work. The need of the hour is to prioritize occupational health of health workers and ensure that the workforce is adequately trained and healthy

3. Objectives Discuss about standard precautions

4. Standard Precautions Previously called Universal Precautions Standard Precautions are the minimum infection prevention practices that apply to all patient care , regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect health care provider (HCP)and prevent HCP from spreading infections among patients Assumes blood and body fluid of ANY patient could be infectious https ://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html

5. Infection prevention actions that apply to all patient/client care and or interactions , regardless of suspected or confirmed infection status of the patient/client Are evidence-based practices designed to protect and prevent spread of infection If followed correctly, minimise the risk of contact with blood and other body substances. Standard Precautions are: Performing hand hygiene Appropriate and correct use of personal protective equipment (PPE) Use of aseptic technique Safe use and disposal of sharps Performing routine environmental cleaning Cleaning and reprocessing of shared patient equipment Respiratory hygiene and cough etiquette Safe handling and disposal of waste and used linen Clinical Excellence Commission 6 Infection Prevention and Control Practice Handbook Standard Precautions ( all day, everyday, every patient)

6. Key Components Of Standard Precautions https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html

7. Hand Hygiene Hand hygiene means cleaning your hands by using either handwashing (washing hands with soap and water), antiseptic hand wash, antiseptic hand rub (i.e., alcohol-based hand sanitizer including foam or gel), or surgical hand antisepsis. https://www.cdc.gov/handhygiene/providers/index.html

8. Germs Can Spread From Surfaces (https://www.cdc.gov/handhygiene/index.html)

9. Do We Really Have To Talk About Hand Hygiene ?Again ? YES Hand hygiene is the single most important measure for prevention of infection Evidence suggests that the hands of the HCWs are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment WHO Hand hygiene technical reference manual

10. Types Of Hand Hygiene Hand washing or hygienic hand scrub Surgical hand asepsis WHO Guidelines on Hand Hygiene in Health Care

11. Indications For Hand Hygiene Hand wash with soap and water ( antiseptic or non-antiseptic soap) When hands are visibly dirty or soiled with body fluids or spore forming organisms like clostridium difficile spread is suspected Alcohol-based hand rub If hands are not visibly soiled: use an alcohol-based hand rub for routinely decontaminating hands. Do not use soap and alcohol based solution concomitantly https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-%20final%281%29.pdf

12. My Five Moments Of Hand Hygiene

13. Antiseptic Agents For Hand Hygiene Plain water and soap : Antiseptic detergents : The following antiseptic detergents can be used: 4% chlorhexidine gluconate-detergent (CHG) Alcoholic hand rub products : Agents with 60-70% alcohol are most efficient. Alcohols used are either ethanol or propanol or isopropanol or combinations of these. Adding chlorhexidine (0.5-1%) to alcoholic hand rub increase their persistence activity against microbes. Some examples are: 0.5% chlorhexidine or povidone iodine in 70% isopropanol or ethanol. S ource : WHO Guidelines on Hand Hygiene in Health Care

14. Self-reported Factors For Poor Adherence With Hand Hygiene Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

15. Personal Protective Equipment Definition “Specialized clothing or equipment, worn by an employee for protection against infectious materials.” Occupational Safety and Health Administration, or OSHA Personal protective equipment (PPE) refers to physical barriers, which are used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents . https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HC

16. Types Of PPE In Health Care Gloves Gowns and Aprons Face masks Respirators Goggles Face shields Protective footwear https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-%20final%281%29.pdf

17. Factors Influencing PPE Selection Type of exposure anticipated – touch, splashes or sprays, or large volumes of blood or body fluids that might penetrate the clothing Durability and appropriateness of PPE for the task ( whether a gown or apron is selected, if a gown is selected, whether it needs to be fluid resistant/ proof, or neither). Fit (must fit the individual user)

18. Principles For PPE Use Don before contact with the patient – Generally before entering the room Remove and discard PPE carefully After doffing, immediately perform hand hygiene

19. PPE For Standard Precautions Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and non intact skin Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions

20. Gloving Gloves should be worn as an additional measure, not as a substitute for handwashing Wear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wash gloves Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment Perform hand hygiene immediately after removing gloves Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

21. Gloves Purpose – Patient care, environmental services, other Glove material – vinyl, latex, nitrile , other (latex products may cause allergy. Vinyl gloves may be used if there is limited patient contact) Gloves should fit the user’s hands comfortably – not be too loose or too tight. They also should not tear or damage easily.

22. Continued.. Sterile or non sterile : Sterile surgical gloves are worn by healthcare personnel who perform invasive patient procedures. One or two pair : During some surgical procedures, two pair of gloves may be worn .

23. Do’s and Don’ts of Glove Use Once contaminated, gloves can become a means for spreading infections. Work from “clean to dirty ”: touching clean body sites or surfaces before you touch dirty or heavily contaminated areas . Limit opportunities for “touch contamination ” - – Don’t adjust your glasses, rub nose or touch face with gloves that have been in contact with a patient – light switches, door and cabinet knobs can become contaminated if touched by soiled gloves.

24. Continued.. Change gloves as needed : During use if torn and when heavily soiled ( even during use on the same patient ) Always change gloves after use on each patient Discard in appropriate receptacle Patient care gloves should never be washed and used again.

25. Gowns Or Aprons International guidelines recommend that protective clothing (apron or gown) should be worn by all HCWs when: there is close contact with the patient, materials or equipment that may lead to contamination of skin, uniforms or other clothing with infectious agents; and there is a risk of contamination with blood, body substances, secretions or excretions (except sweat) Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

26. GOWNS or APRONS Purpose of use: Isolation gowns are generally preferred PPE but aprons are used If limited contamination is anticipated. If contamination of the arms is anticipated, a gown should be selected. Gowns should fully cover the torso and have long sleeves that fit snuggly at the wrist.

27. GOWN

28. Material – Natural or man-made : cotton / synthetic material that dictate whether they can be laundered and reused or must be disposed – Reusable or disposable – Resistance to fluid penetration If fluid penetration is likely, a fluid resistant gown should be used.

29. Face Protection Usual facial protection includes a medical/ surgical mask (triple-layer surgical mask) and eye protection (face shield or goggles) Respirators: These protect from inhalation of infectious aerosols (e.g. M.tuberculosis ). Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

30. Face Protection Masks – protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration S hould fit snuggly over the nose and mouth. M asks that have a flexible nose pie ce and can be secured to the head with string ties or elastic are preferable.

31. Simple Face Mask

32. Goggles Protect eyes – Should fit snuggly over and around eyes – Personal glasses not a substitute for goggles – Anti fog feature improves clarity of vision.

33. Face Protection Face shields P rotect face, nose, mouth, eyes Should cover forehead, extend below chin and wrap around side of face W hen irrigating a wound or suctioning copious secretions, a face shield can be used as a substitute to wearing a mask or goggles.

34. Respiratory Protection Purpose: protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis ) F ilter the air before it is inhaled. The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameter. EXAMPLES : N95, N99, or N100 particulate respirators.

35. N95 RESPIRATOR

36. N99 RESPIRATOR

37. N100 sub-micron filter capable of excluding particles that are less than 5 microns in diameter

38. FOOTWEAR A closed footwear, which can be easily cleaned and disinfected, must be used whenever work processes or environments could cause foot injuries or spillage of blood or body fluids. Personal footwear should be changed when entering clean areas such as OTs, labour rooms, ICU. HAIR COVERS Long hair must be secured with a rubber band and hair cover worn to protect the hair and to protect the patient from falling hair. Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

39. “ Contaminated” and “ Clean” Areas of PPE Contaminated the outside front and sleeves of the isolation gown outside front of the goggles, mask, respirator and face shield regardless of whether there is visible soil. Also, the outside of the gloves are contaminate d.

40. Clean : These are the parts that will be touched when removing PPE. I nside the gloves ; I nside and back of the gown, including the ties T he ties, elastic, or ear pieces of the mask, goggles and face shield.

41. Note: Combining transmission based precautions, like contact and droplet precautions is needed for some infectious diseases such as COVID-19. Where respiratory aerosol generating procedures (AGP) are performed on COVID-19 case, combined contact, droplet and airborne precautions are needed; refer to the CEC YouTube channel . Donning PPE for combined contact and droplet precautions in addition to standard precautions Clinical Excellence Commission 47

42. Sequence for donning PPE Clinical Excellence Commission 48 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

43. Remove items before hand hygiene Clinical Excellence Commission 49 Remove rings, watches, etc. that will interfere with effective hand hygiene, and roll up your sleeves NSW Health Infection Prevention and Control Policy Note: Nail polish, artificial and false nails must not be worn in clinical environments. Artificial or false nails continue to demonstrate increased opportunity for transmitting pathogenic microorganisms.

44. Perform hand hygiene Clinical Excellence Commission 50 Clean hands with: alcohol based hand rub (ABHR) in either liquid, foam or gel form; or antiseptic liquid hand wash and running water; or (plain) liquid soap and running water and dry with single use towels National Hand Hygiene Initiative Infection Prevention and Control Practice Handbook Note: manufacturers of ABHR solutions state the amount of solution delivered per pump dispenser action and how much solution is required per hand hygiene moment.

45. Sequence for donning PPE Clinical Excellence Commission 51 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

46. Put on Gown or Apron Clinical Excellence Commission 52 1. Open the gown without it touching any surfaces such as floor or wall 2. Ties secured at the waist at the back 3. Thumb hooks (some gowns) over the thumb 1. Bare below elbows 2. Open the apron without it touching any surfaces such as floor or wall 3. Ties secured at the waist at the back Gowns & aprons come in different shapes and colours. Local supply and availability may vary. Note: the tie for both styles is secured at the back

47. Sequence for donning PPE Clinical Excellence Commission 53 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

48. Surgical masks for droplet precautions Clinical Excellence Commission 54 Handle the mask by the straps only 2. Secure loops behind the ears 3. Mould the nose piece to fit your face

49. P2/N95 masks for airborne precautions Put on a P2 or N95 mask to cover your nose and mouth. Clinical Excellence Commission 55 Note: Do not be confused with fit testing and fit checking. Fit checking is a safety measure performed at the time of donning the P2/N95 mask prior to the airborne exposure risk. You should perform a fit check immediately after donning the mask. Breathe in and out to check that air is not escaping and the mask fits you well.

50. P2/N95 masks for airborne precautions Clinical Excellence Commission 56 Fit-checking-chart-2020.pdf

51. Sequence for donning PPE Clinical Excellence Commission 57 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

52. Eye protection Clinical Excellence Commission 58 Ensure eye protection is secure doesn’t need adjustment after applying Note: Eye protection is designed to protect the wearer from exposure to splash and fluid from blood and body substances. Prescription glasses are not designed for this purpose. Protecting your prescription glasses will protect your eyes from exposure risks.

53. Clinical Excellence Commission 59 Note: take a moment and observe for any isolation signage communicating infection control precautions. Use this opportunity to confirm the appropriate PPE is in place. Depending on your work location (e.g. in the client’s home) this slide may not be relevant. You are now ready to enter the patient’s room or zone

54. Sequence for donning PPE Clinical Excellence Commission 60 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

55. Perform hand hygiene Clinical Excellence Commission 61 National Hand Hygiene Initiative Infection Prevention and Control Practice Handbook Clean hands with: alcohol based hand rub (ABHR) in either liquid, foam or gel form; or antiseptic liquid hand wash and running water; or (plain) liquid soap and running water and dry with single use towels Note: Did you know all manufacturers of ABHR solutions state the amount of solution delivered per pump dispenser action and how much solution is required per hand hygiene moment?

56. Sequence for donning PPE Clinical Excellence Commission 62 Perform hand hygiene Put on gown/apron Put on mask Put on eye protection Perform hand hygiene Put on gloves

57. Clinical Excellence Commission 63 Note: When wearing a gown the gloves should cover the cuffs of the gown. Gloves don immediately before touching the patient

58. You have now completed the steps to don PPE Clinical Excellence Commission 64

59. Additional information Head covers are used only in theatre/procedural settings to protect the patient & environment from health workers’ skin and hair particles – NOT considered PPE Shoe covers are used in some theatre settings to reduce contamination of theatre floor & protect the shoes of staff – NOT considered PPE Powered-Air Purifying Respirator (PAPR) – a battery-powered blower that provides positive airflow through a filter, cartridge, or canister to a hood or face piece; may be used if a health worker has to stay in the patient’s room continuously for a long period (more than 1 hour) to perform multiple procedures,  or for additional comfort and visibility. Clinical Excellence Commission 65

60. Remember when the PPE is on: Avoid touching your face, including the mask Avoid touching or adjusting other PPE during care provision Change gloves when torn or heavily contaminated Limit surfaces and items touched to prevent accidental contamination of gloves Masks are not worn around the neck or under the chin. Clinical Excellence Commission 66 Note: remember, when changing gloves, hand hygiene still needs to be performed.

61. Doffing (Removing) PPE Clinical Excellence Commission 67 Note: Combining transmission based precautions, like contact and droplet precautions is needed for some infectious diseases such as COVID-19. Where respiratory aerosol generating procedures (AGP) are performed, combined contact, droplet and airborne precautions are needed; refer to the CEC YouTube channel . for combined contact and droplet precautions in addition to standard precautions

62. Remove and discard PPE: Away from the immediate patient environment Into general waste unless heavily contaminated by blood and or body substances If the patient/client is in a single room: remove gloves and gown – before leaving the patient’s room – hand hygiene eye protection and mask – is removed immediately outside patient’s room/zone, for airborne precautions, remove mask after the door to patient’s room has been closed (on exit) Hand hygiene facilities (soap and water, or alcohol based hand rub) should be readily available for use at the location of doffing PPE. Clinical Excellence Commission 68 Note: some environments may have designated areas for donning and doffing of PPE. Regardless, it is important that you move away from the immediate patient environment before removing PPE. Doffing (Removing) PPE

63. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 69 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

64. Remove gloves Clinical Excellence Commission 70 Care is taken to avoid contaminating the hands Dirty to dirty – pinch outside of glove Peel first glove off and hold it with your gloved hand Clean to clean – slip clean finger UNDER the remaining glove Peel glove off, rolling it over the top of the held glove Dispose of gloves in the correct waste bin

65. Clinical Excellence Commission 71 Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 71 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

66. Clinical Excellence Commission 72 Perform hand hygiene

67. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 73 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

68. Option 1 – Remove apron Clinical Excellence Commission 74 1. Break or undo ties 2. Break neck strap Hold apron away from yourself, touching the inside of apron only, fold apron in on itself and roll up

69. Clinical Excellence Commission 75 Discard the gown into the general waste bin Option 1 – Remove apron Untie the gown Pull the gown away from you Roll it inwards and downwards. Make sure you bend forward slightly to reduce self-contamination

70. Clinical Excellence Commission 76 Note: this is only an option for health workers that have been trained and are competent at removing their gown and gloves in one step. With gloved hands, grab and pull the gown from your chest to break the ties in a controlled manner. Continue to pull the gown and at the same time roll the gown inwards and down your arms, removing the gloves along with the sleeves of the gown. Continue to roll and dispose of the gown using the same steps as the previous slide. Option 2 – Remove gown and gloves In one sequence

71. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 77 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

72. Clinical Excellence Commission 78 Perform hand hygiene

73. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 79 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

74. Remove eye protection Clinical Excellence Commission 80 Remove goggles or face shield by handling the back strap or sides only Dispose of single use eye protection in waste Place reusable eye protection in designated receptacle for cleaning and disinfection and / or follow routine processes. Then perform hand hygiene Remove eye protection when outside patient’s room/zone

75. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 81 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

76. Removing surgical mask Clinical Excellence Commission 82 Untie mask, touching ties only, front of mask is contaminated Hold the mask away from yourself Dispose of in the correct waste bin Note: to remove the mask, the front of the mask is not touched. Remove mask when outside patient’s room

77. Remove the N95 / P2 by handling the straps only. 83 Removing N95/P2 mask Clinical Excellence Commission 83 Note: to remove the mask, the front of the mask is not touched. Remove mask when outside patient’s room Hold the 2 straps at the same time, and lift forward off your head. Hold the dirty mask away from yourself, and place it in the correct waste bin

78. Sequence for Removing PPE The sequence for removing PPE aims to limit opportunities for self contamination and further environmental contamination. When using reusable eye protection perform hand hygiene after cleaning. Remove gloves OR Remove gown and gloves in one step Perform hand hygiene Remove gown Perform hand hygiene Perform hand hygiene Remove eye protection Remove eye protection Remove mask Remove mask Perform hand hygiene Perform hand hygiene Clinical Excellence Commission 84 Hand hygiene must be performed if hands become contaminated at any step, and always after removing gloves Removing gown and gloves in one step is only performed if you have had training. CEC YouTube channel

79. Clinical Excellence Commission 85 Perform hand hygiene

80. Clinical Excellence Commission 86 You have now completed the steps to doff PPE

81. Respiratory Hygiene And Cough Etiquette

82. Prevention Of Injuries From Sharps Used needles must not be recapped by hand; if necessary, use the single hand “scoop” method Used needles should not be bent or broken after use. Used sharps should be disposed of immediately in designated puncture-proof containers If injured by sharps, contact the ward, clinic or unit supervisor immediately for further management. Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

83. Patient Care Equipment Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions carefully Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately. Ensure that single-use items are discarded properly. Disposable patient-care equipment should not be reused and must be discarded into an appropriate container Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

84. References CDCs Guideline for Hand Hygiene in Health-Care Settings file:///C:/Users/mhule/AppData/Local/Microsoft/Windows/INetCache/IE/E9B9P01K/rr5116.pdf https://www.cdc.gov/injectionsafety/ip07_standardprecaution.html https://main.icmr.nic.in/sites/default/files/guidelines/Hospital_Infection_control_guidelines.pdf Transmission-based precautions. In: Infection Prevention and Control [online course series]. Geneva: World Health Organization; 2021 ( https://openwho.org/channels/ipc ). National Guidelines for Infection Prevention and Control in Healthcare Facilities Infection control manual ,AIIMS

85. Question and discussion

86. What Type of PPE Would You Wear? Giving a bed bath? Suctioning oral secretions? Transporting a patient in a wheelchair? Responding to an emergency where blood is spurting? Drawing blood from a vein? Irrigating a wound? Taking vital signs?

87. Giving a bed bath? (generally none) Suctioning oral secretions? (gloves and mask/goggles or a face shield) Transporting a patient in a wheelchair? (generally none) Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, and mask/goggles or a face shield) Drawing blood from a vein? (gloves) Irrigating a wound ? (gloves, gown, and mask/goggles or a face shield) Taking vital signs? (generally none)

88. Select type of PPE to be used Nursing officer is checking pulse and measuring blood pressure of a preoperative patient

89. Select type of PPE to be used When resident doctor is irrigating a wound

90. Select type of PPE to be used A nurse who is assisting a physician during bronchoscopy procedure for a pulmonary tuberculosis patient.

91. Select type of PPE to be used Nursing officer is drawing blood from a vein