Activity 3 - PPE Donning and Doffing PDF

Name: ______________________________ Score: ______________ Date: _______________________________ Group No. __________ Activity No. 3 Person...

Name: ______________________________ Score: ______________ Date: _______________________________ Group No. __________ Activity No. 3 Personal Protective Equipment: Donning and Doffing Introduction: Personal protective equipment is a shield that protects both healthcare workers and patients and should be applied and removed in the correct sequence to avoid cross-contamination. Donning involves putting on the required apparel before patient contact and must be performed in the following order; hand hygiene, gown, mask, eye or face protection, and gloves. When doffing, hand hygiene must be performed after taking off each item; starting with gloves, eye or face protection, gown and mask. If the proper procedure is not followed, blood, body substances, and other potentially infectious material could be transferred to both healthcare workers and patients. (munglobal.com.au) Objectives: At the end of the laboratory period, the student should be able to 1. Differentiate correctly between donning and doffing 2. Enumerate the different components of PPE 3. Perform confidently the sequence of donning the doffing PPE used in a molecular lab 4. Appreciate the importance of this procedure to the safety of lab personnel Materials Gowns Goggles Masks Shoe covers Gloves Head covers Concept in focus Standard Precautions Standard precautions are the basic level of infection control that should be used in the care of all patients all of the time. - Use standard precautions in the care of all patients to reduce the risk of transmission of microorganisms from both recognized and non-recognized sources of infection. - Applies to blood, all body fluids, secretions and excretions (except sweat) whether or not they contain visible blood; non-intact skin; and mucous membranes. Contact Precautions In addition to Standard Precautions, use Contact Precautions in the care of patients known or suspected to have a serious illness easily transmitted by direct patient contact or by indirect contact with items in the patient’s environment. Illnesses requiring contact precautions may include, but are not limited to: presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, presence of generalized rash, or presence of ostomy tubes and/or bags draining body fluids. Full Barrier Precautions Full Barrier Precautions are the combination of airborne and contact precautions, plus eye protection, in addition to standard precautions. Diseases requiring full barrier precautions include, but are not limited to: Severe Acute Respiratory Syndrome (SARS) and all known and suspect avian and pandemic influenza patients. Droplet Precautions Droplets can be generated from the source person during coughing, sneezing, talking and during the performance of certain procedures such as suctioning or bronchoscopy. Droplets may contain microorganisms and generally travel no more than 3 feet from the patient. These droplets can be deposited on the host’s nasal mucosa, conjunctivae or mouth. Diseases requiring droplet precautions include, but are not limited to: Pertussis, Influenza, Diphtheria and invasive Neisseria meningitidis Airborne Precautions Airborne precautions are required to protect against airborne transmission of infectious agents. Diseases requiring airborne precautions include, but are not limited to: Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis. Airborne precautions apply to patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei. Preventing airborne transmission requires personal respiratory protection and special ventilation and air handling. Components of Personal Protective Equipment (PPE) (Lifted from: www.health.state.mn.us) 1. Gloves - Gloves help protect when directly handling potentially infectious materials or contaminated surfaces.  Wear gloves when directly handling potentially infectious materials or in contact with contaminated surfaces.  Vinyl, latex or nitrile gloves may be worn.  Change gloves when visibly soiled, torn or punctured.  Wash hands upon removing gloves. Gloves do not replace the need for excellent handwashing.  Gloves should be worn as part of Standard Precautions or Contact Precautions. 2. Gowns - help protect you from the contamination of clothing with potentially infectious materials.  Wear a gown when contamination of clothing with potentially infectious material is possible.  Your gown should fully cover the torso, fit close to the body and cover the arms to the wrists.  Choose a gown appropriate to the situation:  Disposable vs re-useable (requires laundering).  Fluid-resistant vs non-fluid-resistant.   Sterile vs clean.  Gowns should be worn as part of Standard Precautions or Contact Precautions. 3. Shoe and Head Covers - shoe and head covers provide a barrier against possible exposure within a contaminated environment.  Shoe covers  Wear shoe covers to provide a barrier against possible exposure to airborne organisms or contact with a contaminated environment.  Use shoe covers for patients with hemorrhagic disease.  Shoe covers should be worn as part of Full Barrier Precautions.  Head covers (bonnets)  Wear head covers to protect the hair and scalp from possible contamination when sprays or airborne exposure is anticipated.  Head covers can be worn as part of Full Barrier Precautions. 4. Masks and Respirators - Surgical masks help protect your nose and mouth from splattered body fluids, respirators filter the air before you inhale it.  Surgical masks/Procedure masks  Surgical masks help protect your nose and mouth from splattered body fluids (such as blood, respiratory secretions, vomit, urine or feces).  Surgical masks should be worn as part of Standard Precautions or Droplet Precautions.  Respirators  Respirators filter the air to help protect the molecular lab technician from microorganisms including bacteria and many viruses.  Types of respirators include: A. Disposable Respirators (includes N95)  Surgical N95 respirators  Surgical N95 respirators give you the protection of both an N95 respirator and a surgical or procedure mask.  Industrial or non-medical respirators  Most N95 respirators are available in local hardware stores or pharmacies, however, they do not have the additional protection of a surgical mask. N95 respirators and surgical masks are examples of personal protective equipment that are used to protect the wearer from particles or from liquid contaminating the face. The Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) also regulates N95 respirators. The Department of Labor’s Occupational Safety and Health Administration (OSHA) regulates entities for compliance with worker safety rules and OSHA standards, including, for example, the proper use of respirators in different work environments. It is important to recognize that the optimal way to prevent transmission of microorganisms, such as viruses, is to use a combination of interventions from across the hierarchy of controls, not just PPE alone. Use of N95 Respirators - Molecular lab technicians must be instructed on how to put on, position, adjust and remove respirators o Fit testing – fit testing must be done prior to use, whenever a different respirator is worn, and at least annually thereafter.   This is performed to determine if a lab technician can maintain an acceptable respiratory fit and seal  Fit testing is administered using an OSHA-accepted qualitative fit test or quantitative fit test protocol  When should one perform a fit test? _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________  Enumerate the factors that affect the respirator seal _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ o Qualitative fit test  No eating, drinking (water is allowed), gum or smoking for 15 minutes prior to test  Sensitivity test procedure  Subject is place in hood without respirator  Subject should open mouth and extend tongue  Subject should breathe though mouth  Apply 10 bulb squeezes of testing solution into the hood  DO NOT spray testing solution into the subject’s face  If subject does not taste fit test solution in 10 squeezes, apply another 10 squeezes  If subject can’t taste solution by 30 squeezes, use another fit testing solution  What are the testing solutions? ____________________________________________ ____________________________________________ o Changing of N95 Respirators  N95 respirators are disposable and cannot be cleaned.  If an N95 is used in the care of a patient on Contact Precautions, in addition to Standard Precautions (e.g., SARS, smallpox), it must be disposed of after each use.  N95s can be reused if used in the care of a tuberculosis patient.  Check before putting on each time and replace if facepiece or head straps show any signs of damage or deterioration.  Replace if facepiece is visibly dirty, splashed on, or becomes difficult to breathe through.  Replace in accordance with your laboratory's infection control protocols.  B. Powered Air Purifying Respirator (PAPR) - A PAPR (or tight-fitting goggles and an N-95 respirator) should be worn for high-risk aerosol- generating procedures. These respirators also meet CDC guidelines for protection against TB exposure  The equipment is battery operated, consists of a half or full facepiece, breathing tube, battery-operated blower, and particulate filters (HEPA only).  A PAPR uses a blower to pass contaminated air through a HEPA filter, which removes the contaminant and supplies purified air to a facepiece.  A PAPR is not a true positive-pressure device because it can be over-breathed when inhaling.  A face shield may also be used in conjunction with a half-mask PAPR respirator for protection against body fluids. C. Self-Contained Breathing Apparatus (SCBA) Respirators - The U.S. Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) has a program to approve self- contained breathing apparatus (SCBA) for use by fire fighters and other first responders to terrorist attacks. NIOSH approval under the program signifies that an SCBA is expected to provide needed protection to first responders in situations where an act of terror has released harmful chemicals, pathogens, or radioactive materials into the air. Approvals are based on positive results from rigorous test on sample units submitted to NIOSH by manufacturers, and from stringent evaluation of manufacturers’ quality control practices, technical specifications, and other documentation  Respirators should be worn as part of Airborne Precautions or Full Barrier Precautions. 5. Face and Eye Protection  Face shields - Face shields protect the mucous membranes of the eyes, nose and mouth from splashes of body fluids (during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and/or excretions).  Wear a face shield when facial skin protection is needed in addition to eye, nose and mouth protection.  A face shield may be worn with an N95 respirator in place of goggles to provide eye and face protection.  The face shield should cover the forehead, extend below the chin and wrap around the side of the face.  Face shields should be worn as part of Standard Precautions.  Goggles – a barrier style of protection for the eyes  Goggles should fit snuggly over and around the eyes or prescriptive lenses.  Note: prescriptive lenses do not provide adequate eye protection.   Goggles should be worn as part of Standard Precautions. Procedure: Sequence for putting on PPE (Lifted from www.aaha.org and www.cdc.org) 1. Remove unnecessary accessories (jewelry and watches) 2. Perform hand hygiene 3. Wear shoe covers (if necessary) 4. Gown  Fully cover torso from neck to knees, arms, to end of wrists, and wrap around the back  Fasten in back of neck and waist 5. 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 6. Head cover  Make sure that every hair placed inside the cover 7. Gloves  Extend to cover wrist of isolation gown Safe work practices to protect yourself and limit the spread of contamination o Keep hands away from face o Limit surfaces touched o Change gloves when torn or heavily contaminated o Perform hand hygiene Sequence of removing PPE Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door. Remove PPE in the following sequence: 1. Gloves  The outside of the gloves is contaminated  It 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 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 you 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  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 waste container (if disposable) 4. Mask or respirator  Front of mask/respirator is contaminated – do not touch.  If your hands get contaminated during mask/respiratory 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 5. Wash hands or use an alcohol-based hand sanitizer immediately after removing all PPE *One may perform hand hygiene in between steps if hands are contaminated and immediately after removal of all PPE *Students should be able to perform this skill accurately and precisely. Questions for Research 1. Enumerate and describe the different types of gowns used in the laboratory 2. Name other procedures to be done when dealing with airborne precautions and droplet precautions.