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Hand Hygiene and Personal Protective Equipment (PPE) Oct 2014 1.

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Presentation on theme: "Hand Hygiene and Personal Protective Equipment (PPE) Oct 2014 1."— Presentation transcript:

1 Hand Hygiene and Personal Protective Equipment (PPE) Oct

2 Purpose To provide guidance for: Proper hand hygiene Donning, doffing (removal), and disposal of Personal Protective Equipment (PPE) Oct

3 Background DFR provides prehospital medical care to the residents of and the visitors to the City of Dallas Provision of this care potentially exposes DFR personnel to infectious diseases Good hand hygiene, and the proper selection, use and disposal of PPE are critical to prevent the spread of disease Oct

4 Background The human body produces many body fluids, secretions and excretions that may contain pathogens Potentially infectious body fluids include: blood, vomit, feces, urine, sputum, saliva, and sweat, as well as amniotic, spinal, vaginal, pleural, pericardial, peritoneal, synovial fluids and semen To prevent exposure, ANY body fluid from any patient must be treated as potentially infectious Oct

5 Hand Hygiene: “5 Moments” Oct

6 Hand Hygiene: Soap & Water Use soap and warm, running water Keep fingers pointing down Rub hands vigorously for 20 seconds Wash all surfaces, including: Backs of hands Wrists Between fingers Tips of fingers Thumbs Under fingernails Dry vigorously with paper or clean cloth towel Turn off faucet with towel and open door with towel Oct

7 Hand Hygiene: Sanitizer If hands are visibly contaminated, soap and water must be used first If hands are not visibly contaminated, or if soap and water are not available, use alcohol-based hand rub (gel, foam or wipes) Apply a generous amount of hand rub gel/foam to the palm of one hand, or use an alcohol- based hand rub wipe Rub hands together, covering all surfaces of hands and fingers until hand rub is absorbed Oct

8 Isolation Precautions 4 Categories: Standard Precautions (ALL patients) Contact Precautions (“blood/body fluid”) Droplet Precautions (think “flu”) Airborne Precautions (think “TB”) These categories may be combined in certain cases Oct

9 PPE Components Disposable Gloves Disposable Gown (Impermeable or Fluid Resistant) Eye Protection Wraparound Goggles, Safety Glasses or Face Shield Respiratory Protection (must be worn with eye protection) Lowest: Standard surgical face mask Higher: N95 filter mask (respirator) Highest: Air-Purifying Respirator (“APR”) – powered or not; half-face, full-face or hood Components for high volume fluid or high-risk conditions: Disposable Boot Covers (or Shoe Covers) Disposable Bonnets Oct

10 PPE = Gloves and…. Oct

11 Standard Precautions 11 Oct 2014

12 Standard Precautions All patients, all the time, any setting Minimum PPE required: Disposable Gloves Hand Hygiene Additional PPE, as needed, to protect against blood, body fluids, secretions and excretions: Eye protection (goggles or face shield) Respiratory protection (surgical face mask) Impermeable or fluid-resistant gown Oct

13 Contact Precautions 13 Oct 2014

14 Contact Precautions Protection against viruses (such as Ebola), Influenza, HIV, Hepatitis; plague, MRSA, VRE, Strep; patients with diarrhea, vomiting, or generalized rash Minimum PPE Required Disposable Gloves (change if visibly soiled) Gown Hand Hygiene Disinfection of all equipment and surfaces Examples: monitor, glucometer, BP cuff, etc. Oct

15 Droplet Precautions 15 Oct 2014

16 Droplet Precautions Large particles created by coughing, sneezing, suctioning or intubation Disease examples: Influenza, meningitis, pertussis, plague, Ebola, mumps, rubella, and most viruses (including Enterovirus D68) Any patient with fever, respiratory symptoms, rash, and/or flu-like signs/symptoms, such as weakness, vomiting, diarrhea, severe headache, abdominal pain, or muscle and body aches Oct

17 Droplet Precautions Hand Hygiene Minimum PPE required: Gloves Gown Eye Protection Bonnet Leggings/Boot Covers (or Shoe Covers) Respiratory Protection…. Oct

18 Droplet Precautions What level of respiratory protection? Healthcare Providers (with eye protection): At least standard surgical face mask N95 mask for “Aerosol-Generating Procedures” or other high-risk procedures (e.g. CPR) See UTSW/BioTel TB PPE Patient (especially if coughing or sneezing): Standard surgical face mask or N95, if tolerated Add Nasal Cannula O 2, if supplemental oxygen needed Oct

19 Airborne Precautions 19 Oct 2014

20 Airborne Precautions Small particles created by coughing, sneezing, suctioning, intubation or even talking Disease examples: TB, measles, chickenpox, disseminated Herpes zoster, smallpox Any patient known or suspected to be infected with an organism spread through the air, or for a patient “found down” with unknown history Oct

21 Airborne Precautions Hand Hygiene Minimum PPE required: Gloves Gown Eye Protection Bonnet Leggings/Boot Covers (or Shoe Covers) Respiratory Protection…. Oct

22 Airborne Precautions What level of respiratory protection? Healthcare Providers (with eye protection): At least N95 filter mask Air-Purifying Respirator for “Aerosol- Generating Procedures” or other high-risk procedures (e.g. CPR) See UTSW/BioTel TB PPE Patient (especially if coughing or sneezing): N95 mask, if tolerated Add Nasal Cannula O 2, if supplemental oxygen needed Oct

23 Donning/Doffing Sequence 23 Oct 2014

24 Donning Sequence Hand Hygiene Leggings/Boot Covers (or Shoe Covers), if used Gown (tie at waist and neck) Gloves Double glove if gross contamination or large volume of body fluid Single or Inner Pair MUST completely cover gown cuff, so that there is no exposed skin Mask or Respirator (ensure proper fit) Eye and Face Protection (ensure proper fit) Bonnet  Remember: Do NOT touch your eyes, nose or mouth Oct

25 Doffing (Removal) = Critical Process Most Provider exposures occur during PPE Removal (doffing)! Oct

26 Doffing (Removal) = Critical Process PPE must be removed in the proper sequence & with extreme care/caution, to prevent inadvertent exposure Basic Principle: Touch ONLY “clean to clean” and “dirty to dirty” Perform hand hygiene and replace gloves if hands become contaminated during removal, AND immediately after PPE removal PPE must be removed immediately after patient care is transferred to hospital staff Oct

27 “Buddy System” A trained observer shall monitor the doffing procedure Can be used during donning, as well “Buddy” (in PPE) watches to prevent compromises or other procedural breaches Any compromise/breach must be reported to your EMS Field Supervisor immediately Oct

28 Doffing – Equipment Needed Clean disposable gloves Biohazard receptacle and bags (triple bag for high-risk) Hand hygiene supplies Lysol spray (bring can from Rescue, discard in E.D. after use) 1 set or package of hospital “Standard Precautions” PPE Disposable gloves (at least two pairs per team) Disposable gown Standard surgical mask (preferably with attached face shield or other eye protection, or equivalent) 28 Oct 2014

29 Doffing: Overall Sequence 2 Members in Full PPE (including double gloves) 1 st member serves as “Buddy” for 2 nd member during doffing 2 nd member then dons fresh Standard Precautions and serves as “Buddy” for 1 st member during doffing 1 st member then dons clean gloves and serves as “Buddy” for 2 nd member during doffing Both members shall use meticulous hand hygiene after all PPE is removed NOTE: Proceed slowly and carefully to avoid breaches! NOTE: Gloves shall be removed, hand hygiene performed and fresh gloves donned at any point in the procedure, if needed, because of inadvertent contamination Oct

30 Doffing Sequence Details Buddy sprays member with Lysol (especially legs and feet) Boot Covers: Touch ONLY outside, remove  Biohazard disposal, one at a time, as each is removed Do NOT contaminate by crossing legs Lean against wall or sit in chair, if needed Outer Gloves: Do not contaminate inner gloves, remove  Biohazard disposal Gown and Inner Gloves: Buddy unfastens from rear, then wearer rolls away from body, down to wrists, rolls into small bundle and removes without contaminating skin  Biohazard disposal HAND HYGIENE: Allow hand gel to be fully absorbed 30 Oct 2014

31 Doffing Sequence (cont’d.) Don TWO pairs of clean gloves Bonnet: With ONE hand, grasp as far to the rear as possible and pull away from head and face  Biohazard disposal Goggles: With OTHER hand, grasp as far to the rear as possible and pull away from face  Biohazard disposal Outer Gloves: Remove without contaminating inner gloves or skin  Biohazard disposal Respirator/Mask: Grasp from as far to the rear as possible and pull away from face while actively exhaling  Biohazard disposal Oct

32 Doffing Sequence (cont’d.) Inner Gloves: Without contaminating skin, remove  Biohazard disposal HAND HYGIENE: Allow hand gel to be fully absorbed Don Hospital Standard Precautions PPE Gown, Mask and TWO PAIRS of Disposable Gloves Wipe or Spray Lysol Can Outer Gloves: Without contaminating inner gloves, remove  Biohazard disposal Serve as the “Buddy” for the Repeat Doffing Procedure for the other DFR Member 32 Oct 2014

33 Doffing Sequence (cont’d.) After 2 nd Member has removed all PPE and performed Hand Hygiene, (s)he dons a final pair of clean gloves and serves as a “Buddy” one final time, to assist the 1 st Member with doffing of the Hospital Standard Precautions PPE Both Members wash hands and all at-risk skin surfaces with soap and water, then perform thorough Hand Hygiene 33 Oct 2014

34 Disposal of Contaminated PPE Once the contaminated PPE is placed in the Biohazard bag and the bag is triple-sealed: At a hospital, follow directions of facility staff If the Biohazard bag must be returned to a DFR station, deposit the bag in the contaminated material box for processing through Waste Management Oct

35 Procedure Breach or Contamination In the event of contact with patient blood, body fluids, secretions or excretions during patient care: Stop work as soon as possible Wash the affected area thoroughly with soap and water Report the exposure as soon as possible to your EMS Field Supervisor for follow-up In the event of inadvertent contamination during doffing: Stop the doffing sequence immediately Wash the affected area thoroughly with soap and water, or with alcohol-based gel or foam Report the exposure as soon as possible to your EMS Field Supervisor for follow-up 35 Oct 2014

36 Summary Hand hygiene is the single most important way to prevent infection spread Proper selection of appropriate PPE is vital Standard: ALL Patients Contact + Droplet: Sick Patients at risk for infectious diseases Airborne: Patients at risk for airborne-spread infection Doffing (removal) = greatest risk to Providers A “Buddy System” – especially during doffing – will reduce the risk of compromise/breach PPE must be disposed of properly after removal 36 Oct 2014

37 If you have any questions… 1.Contact your EMS Field Supervisor, or 2.Contact M. Allison Green, RN Office Cell Oct


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