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Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings 1.

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Presentation on theme: "Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings 1."— Presentation transcript:

1 Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings 1

2 Learning Objectives Understand concepts in the selection and use of PPE in healthcare settings Understand how to safely don and remove PPE 2

3 Outline Types and selection of PPE How to safely done, use, and remove PPE When to use PPE 3

4 Personal Protective Equipment: Definition 4 “Specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA)

5 Hierarchy of Safety and Health Controls Training and administrative controls Engineering controls Work practice controls Personal protective equipment (PPE) 5

6 Types of PPE Used in Healthcare Settings 6 Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose  Respirators – protect respiratory tract from airborne infectious agents Eye protection Face shields – protect face: mouth; nose; and eyes

7 Review Question 1 Name 3 different pieces of PPE used in healthcare settings. Possible answers: GlovesRespirators GownsEye protection (goggles) ApronsFace shields Masks 7

8 Factors Influencing PPE Selection 8 Type of exposure anticipated  Splash/spray versus touch  Category of isolation precautions Durability and appropriateness for the task Fit

9 Gloves 9 Purpose – patient care, environmental services, other Glove material – vinyl, latex, or nitrile Glove fit Sterile or nonsterile One or two pair Single use or reusable

10 Dos and Don’ts of Glove Use 10 Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment  Don’t touch your face or adjust PPE with contaminated gloves  Don’t touch environmental surfaces except as necessary during patient care

11 Dos and Don’ts of Glove Use (cont’d) Change gloves  During use if torn and when heavily soiled (even during use on the same patient)  After use on each patient Discard in appropriate receptacle  Never wash or reuse disposable gloves 11

12 Gowns or Aprons 12 Purpose of use Material –  Natural or man-made  Reusable or disposable  Resistance to fluid penetration Clean or sterile

13 Face Protection 13 Masks – protect nose and mouth  Should fully cover nose and mouth and prevent fluid penetration Eye visor – protect eyes  Should fit snuggly over and around eyes  Personal glasses not a substitute for goggles  Antifog feature improves clarity

14 Face Protection Face shields – protect face, nose, mouth, and eyes  Should cover forehead, extend below chin and wrap around sides of face 14

15 Respiratory Protection 15 Purpose – protect from inhalation of infectious aerosols (example: Mycobacterium tuberculosis) PPE types for respiratory protection  Particulate respirators  Half- or full-face elastomeric respirators  Powered air purifying respirators (PAPR)

16 Elements of a Respiratory Protection Program 16 Medical evaluation Fit testing  Required by NIOSH in the United States  Local regulations apply in international settings Training Fit checking before use

17 Examples of N95 Particulate Respirators 17 Duckbill Cup style Fan fold Flat fold

18 Powered air purifying respirator (PAPR) 18 Powered air-purifying respirator. Uses a battery-powered blower to provide HEPA- filtered breathing air

19 Half- or Full-face Elastomeric Respirators Use replaceable filters Must be cleaned, disinfected, and fitted with new filters for reuse Typically have exhalation valves, so should not be used by infected persons 19

20 Review Question 2 Why does one wear a respirator? What types of PPE are there for respiratory protection? Answer: To protect the healthcare worker from inhaling infectious aerosols. Respiratory PPE includes: Particulate respirators, elastomeric respirators, and powered air purifying respirators (PAPR) 20

21 PPE Use in Healthcare Settings: How to Safely Don, Use, and Remove PPE 21

22 Key Points About PPE 22 Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene

23 Sequence* for Donning PPE 23 Gown first Mask or respirator Eye protection or face shield Gloves *Combination of PPE will affect sequence – be practical

24 How to Don a Gown 24 Select appropriate type and size Opening should be in the back Secure at neck and waist If gown is too small, use two gowns  Gown #1 ties in front  Gown #2 ties in back

25 How to Don a Mask 25 Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

26 How to Don a Particulate Respirator 26 Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check –  Inhale – respirator should collapse  Exhale – check for leakage around face

27 How to Don Eye and Face Protection 27 Position eye protection over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably

28 How to Don Gloves 28 Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs

29 Review Question 3 What is the correct sequence for donning the following PPE? a.Gloves b.Mask (or respirator) c.Gown d.Eye protection Answer: c, b, d, a 29

30 How to Safely Use PPE 30 Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched

31 PPE Use in Healthcare Settings: How to Safely Remove PPE 31

32 “Contaminated” and “Clean” Areas of PPE 32 Contaminated – outside front  Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back  Areas of PPE that are not likely to have been in contact with the infectious organism

33 Sequence for Removing PPE 33 Remove the most contaminated items first 1. Remove gloves and gown 2. Perform hand hygiene 3. Remove eye protection 4. Remove respirator 5. Perform hand hygiene

34 Where to Remove PPE 34 At doorway, before leaving patient room or in anteroom (at least 1 m from the patient)* Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

35 How to Remove Gloves (Option 1) 35 Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand

36 How to Remove Gloves (Option 2) 36 Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard PPE Use in Healthcare Settings

37 Remove Goggles or Face Shield 37 Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal

38 Removing Isolation Gown 38 Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard

39 Removing a Mask 39 Untie the bottom tie, then the top tie Remove from face Discard

40 Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard 40

41 Hand Hygiene 41 Perform hand hygiene immediately after removing PPE  If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rub *Make sure that hand hygiene facilities are available at the point needed

42 PPE Use in Healthcare Settings: When to Use PPE 42

43 PPE for Standard Precautions (Part 1) 43 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 and/or exposed skin with blood/body fluids, secretions, or excretions is anticipated

44 PPE for Standard Precautions (Part 2) 44 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

45 Review Question 4 In which of the following describes when a gown should be worn? a.When touching blood, body fluids, secretions, excretions, or contaminated items b.During procedures and patient care activities when contact of clothing and/or exposed skin with blood, body fluids, secretions, or excretions is anticipated c.During patient care activities that are likely to generate splashes and sprays of blood, body fluids, secretions, or excretions d.None of the above Answer: b 45

46 Use of PPE for Transmission-based Precautions 46 Contact Precautions – Gown and gloves for contact with patient or environment of care  In some instances these are required for entering patient’s environment Droplet Precautions – Surgical masks within 3 feet of patient Airborne Infection Isolation – Particulate respirator* *Airborne infection isolation room may also be used

47 Hand Hygiene 47 Required for Standard and Expanded Precautions Perform…  Immediately after removing PPE  Between patient contacts Wash hands thoroughly with soap and water or use alcohol-based hand rub

48 Avoid Inappropriate Use of Infection Control Practices Inappropriate or random use of Infection Control practices will result in:  Confusion and Uncertainty  Fear  Waste  Risk of occupational injury  Risk of infection transmission to patients and others 48

49 Inappropriate use of Personal Protective Equipment Wearing in public areas Failure to discard after use Wearing too many Failure to remove gloves after each task 49 CDC Public Health Image Library

50 Review Question 5 What are some of the inappropriate infection control practices that should be avoided? a.Wearing protective equipment in public areas b.Failure to discard protective equipment after use c.Wearing too many protective garments d.Failure to remove gloves after each task e.All of the above Answer: E 50

51 Final Thoughts PPE is available to protect you from exposure to infectious agents in the healthcare workplace Know what type of PPE is necessary for the duties you perform and use it correctly 51

52 Glossary Personal Protective Equipment (PPE) Touch contamination Powered Air Purifying Respirator (PAPR) 52

53 References and Resources Additional information on respirators:  respsars.html  cehc.html   53

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