Unit 1 PPE PDF

UNIT 1. APPLICATION OF PERSONAL PROTECTIVE settings. Rationale: Short, natural nails are less likely to EQUIPMENT harbor microorganisms, scratch a client, or puncture...

UNIT 1. APPLICATION OF PERSONAL PROTECTIVE settings. Rationale: Short, natural nails are less likely to EQUIPMENT harbor microorganisms, scratch a client, or puncture gloves. Learning Outcomes Removal of all jewelry is recommended. Rationale: After completing this topic students will be able to: Although the research is controversial, microorganisms 1. Verbalize the steps used in: can lodge in the setting of jewelry and under rings. Removal facilitates proper cleaning of the hands and i. Performing hand hygiene arms. ii. Applying and removing a gown, face mask, and clean Check hands for breaks in the skin, such as hangnails or gloves iii. Applying and removing sterile gloves by the cuts. Rationale: A nurse who has open sores may open method. require a work assignment with decreased risk for iv. Applying a sterile gown and gloves by the closed transmission of infectious organisms due to the chance method of acquiring or passing on an infection. 1. PERFORMING HAND HYGIENE ∙ Hand washing is an essential skill for all health care providers to F. Performance perform before and after client care. 1. If washing hands where the client can observe, A. Purpose introduce yourself and explain to the client what you're going to do and why it is necessary. To reduce the number of microorganisms on the hands 2. Turn on the water and adjust the flow. To reduce the risk of transmission of microorganisms to There are five common types of faucet client controls: To reduce the risk of cross contamination among clients a. Hand-operated handles. To reduce the risk of transmission of infectious b. Knee levers. organisms to oneself c. Foot pedals d. Elbow controls. Move these with B. Assessment the elbows instead of the hands. e. Infrared controls. Motion in front Determine the client's : of the sensor causes water to start and stop flowing automatically. Presence of factors increasing susceptibility to infection Adjust the flow so that the water is warm. and possibility of undiagnosed infection (e.g., HIV) Rationale: Warm water removes less of the Use of immunosuppressive medications protective oil of the skin than hot water. Recent diagnostic procedures or treatments that 3. Wet the hands thoroughly by holding them under the penetrated the skin or a body cavity running water and apply soap to the hands. Current nutritional status Hold the hands lower than the elbows so that Signs and symptoms indicating the presence of an the water flows from the arms to the infection: fingertips. Rationale: The water should flow - Localized signs : swelling, redness, pain or from the least contaminated to the most tenderness with palpation or movement, contaminated area; the hands are generally palpable heat at site, loss of function of considered more contaminated than the affected body part, presence of exudate lower arms. Note that this is a different - Systemic indications : fever, increased pulse technique than is used when performing and respiratory rates, lack of energy, surgical hand washing. Nurses will learn to anorexia, enlarged lymph nodes perform that level of hand washing if they are working in the operation room. C. Planning If the soap is liquid, apply 4 to 5 mL (1 tsp). If it is bar soap, granules, or sheets, rub them Determine the location of running water and soap or firmly between hands. soap substitutes 4. Thoroughly wash and rinse the hands. Use firm, rubbing, and circular movements to D. Equipment wash the palm, back, and wrist of each hand. Be sure to include the heel of hand. Interlace Soap the fingers and thumbs, and move the hands Warm running water back and forth. The WHO (2009) Paper towels recommends these steps: E. Preparation a. Right palm over left dorsum with interlaced fingers and vice versa. Assess the hands : b. Palm to palm with fingers interlaced. Nails should be kept short. Most agencies do not permit c. Backs of fingers to opposing palms health care workers in direct contact with clients to with fingers interlocked. have any form of artificial nails. The CDC guidelines d. Rotational rubbing of left thumb prohibit artificial nails in caring for high-risk clients, and clasped in right palm and vice the WHO guidelines prohibit artificial nails in all versa.  Continue this motion for about 30 To reduce the chance that the nurse's hands will seconds. Rationale: The circular action creates friction that helps transmit microorganisms from one client or an object to remove microorganisms mechanically. Interlacing the fingers and another client. thumbs cleans the interdigital spaces. Indication to wear gown - to prevent the nurse's uniform becoming soiled as an example Rub the fingertips against the palm of the changes the dressings of a client with extensive wounds. opposite hand. Rationale: The nails and fingertips are commonly missed during the hand hygiene. Indication to wear mask Rinse the hands. - to reduce the risk for transmission of organisms by the droplet 5. Thoroughly pat dry the hands and arms. contact and airborne routes and by splatters of body substances. Dry hands and arms thoroughly with a paper towel without scrubbing. Rationale: Moist B. Assessment skin becomes chapped readily as does dry skin that is rubbed vigorously; chapping - consider which activities will be required while the nurse is in the produces lesions. client's room at that time. Discard the paper towel in the appropriate container. C. Planning 6. Turn off the water. Use a new paper towel to grasp a hand- - Application and removal of PPE can be time consuming. operated control. Rationale: This prevents Prioritize care and arrange for personal care for your the nurse from picking up microorganisms other clients if indicated. from the faucet handles. Apply hand lotion if Determine which supplies are present within the client's desired. Use only agency-approved hand room and which must be brought to the room. lotions and dispensers. Other lotions may Consider if special handling is indicated for removal of make hand hygiene less effective, cause the any specimens or other materials from the room. breakdown of latex gloves, and become contaminated with bacteria if dispensers are D. Equipment refilled. Rationale: Hand lotions are important to prevent skin dryness and Gown irritation. Mask Eyewear Variation: Hand Washing Before Performing Sterile Clean gloves Skills. Apply the soap wash as described in step 4, i. Type of gloves but hold the hands higher than the elbows Sterile during this hand wash. Wet the hands and Non sterile forearms under the running water, letting it Nitrile glove run from the fingertips to the elbows so that Latex glove the hands become cleaner than the elbows. Vinyl glove Rationale: In this way, the water runs from Chloroprene glove the area that now has the fewest ii. Type of mask microorganisms to areas with a relatively Sterile (3 ply) greater number of pathogens. N95 After washing and rinsing, use a towel to dry one hand thoroughly in a rotating motion iii. Type of gown from the fingers to the elbow. Use a new Surgical gown towel to dry the other hand and arm. Isolation gown Rationale: A clean towel prevents the Surgical isolation gown transfer of microorganisms from one elbow Non surgical gown (least clean area) to the other hand (cleanest Procedural gown area). Operating room gown Apply sterile gloves before touching any unsterile items. E. Preparation 2. APPLYING AND REMOVING PERSONAL PROTECTIVE - Remove or secure all loose items such as name tags or jewelry. EQUIPMENT (PPE) (GLOVES, GOWN, MASK) F. Performance A. Purpose Gloves are worn for 3 reasons: 1. Prior to performing the procedure, introduce yourself To protect the hands when the nurse is likely to handle and verify the client's identity using agency protocol. any body substances, for example, blood, urine, feces, Explain to the client what you are going to do, why it is sputum, and nonintact skin. necessary, and how he or she can participate. To reduce the likelihood of nurses transmitting their 2. Perform hand hygiene. own endogenous microorganisms to individuals 3. Apply a clean gown. receiving care. Pick up a clean gown, and allow it to unfold in front of you without allowing it to touch  any area soiled with body substances. second soiled glove with the bare hand is Slide the arms and the hands through the avoided. sleeves. Pull the second glove off to the fingers by Fasten the ties at the neck to keep the gown turning it inside out. This pulls the first glove in place. inside the second glove. Rationale: The Overlap the gown at the back as much as soiled part of the glove is folded to the inside possible, and fasten the waist ties or belt. to reduce the chance of transferring any Rationale: Overlapping securely covers the microorganisms by direct contact. uniform at the back. Waist ties keep the Using the bare hand, continue to remove the gown from falling from the body, which can gloves, which are now inside out, and cause inadvertent soiling of the uniform. dispose of them in the refuse container. 4. Apply the face mask. 8. Perform hand hygiene. Rationale: Contact with Locate the top edge of the mask. The mask microorganisms may occur while removing PPE. usually has a narrow metal strip along the 9. Remove protective eyewear and dispose of properly or edge. place in the appropriate receptacle of cleaning. Hold the mask by the top two strings or 10. Remove the gown when preparing to leave the room. loops. Avoid touching soiled parts on the outside of Place the upper edge of the mask over the the gown, if possible. Rationale: The top part bridge of the nose, and tie the upper ties at of the gown may be soiled, for example, if the back of the head or secure the loops you have been holding an infant with a around the ears. If glasses are worn, fit the respiratory infection. upper edge of the mask under the glasses. Grasp the gown along the inside of the neck Rationale: With the edge of the mask under and pull down over the shoulders. Do not the glasses, clouding of the glasses is less shake the gown. likely to occur. Roll up the gown with the soiled part inside, Secure the lower edge of the mask under the and discard it in the appropriate container. chin, and tie the lower ties at the nape of the 11. Remove the mask. neck. Rationale: To be effective, a mask must Remove the mask at the doorway to the cover both the nose and the mouth because client's room. If using a respirator mask, air moves in and out of both. remove it after leaving the room and closing If the mask has a metal strip, adjust this the door. firmly over the bridge of the nose. Rationale: If using a mask with strings, first untie the A secure fit prevents both the escape and the lower strings of the mask. Rationale: The inhalation of microorganisms around the front of the mask through which the nurse edge of the mask and the fogging of has been breathing is contaminated. eyeglasses. Discard a disposable mask in the waste Wear the mask only once, and do not wear container. any mask longer than the manufacturer Perform proper hand hygiene again. recommends or once it becomes wet. Rationale: A mask should be used only once because it comes ineffective when moist. Do not leave a used face mask hanging around the neck. The Practice Guidelines provide further instructions on applying a face mask. 5. Apply protective eyewear if it is not combined with the face mask. 6. Apply clean gloves. No special technique is required. If wearing a gown, pull the gloves up to cover the wrists. 7. To remove soiled PPE, remove the gloves first since they are the most soiled. If wearing a gown that is tied at the waist in front, undo the ties before removing gloves. Remove the first glove by grasping it on its palmar surface, taking care to touch only glove to glove. Rationale: This keeps the soiled parts of the used gloves from touching the skin of the wrist or hand. Pull the first glove completely off by inverting or rolling the glove inside out. Continue to hold the inverted removed glove by the fingers of the remaining gloved hand. Place the first two fingers of the bare hand inside the cuff of the second glove. Rationale: Touching the outside of the