1. Hand Hygiene and PPE Gail M. Maier, PhD., R.N. Associate Director
The Ohio State University Wexner Medical Center
Hello, my name is Gail Maier and I am a nurse educator working in the Department of Education, Development and Resources at the Medical Center.
One of the most important skills that you will be performing on a daily basis is hand hygiene and using standard precautions. Both work together to protect the patient and yourself from infection. You will also review the use of personal protective equipment and the precautions to take when handling needles and other sharps.

2. Objectives for this program
Describe the components of Standard Precautions to include:
Hand hygiene
Use of personal protective equipment
Respiratory hygiene and cough etiquette
Safe injection practices
Safe handling of potentially contaminated equipment in the patient environment.
Demonstrate
the proper steps of hand hygiene using an alcohol-based hand rub and soap and water.
At the completion of this program you should be able to
Define standard precautions
Identify the components of Standard Precautions which include hand hygiene, use of personal protective equipment, cough etiquette, safe injection practices and safe handling of potentially contaminated equipment.
There are 2 ways to perform hand hygiene – using soap and water or alcohol –based hand rub. In this course, you will demonstrate the proper procedure for the use of alcohol-based hand rub.

3. Standard Precautions
Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered.
Standard Precautions include:  1) hand hygiene, 2) use of personal protective equipment 3) respiratory hygiene and cough etiquette, 4) safe injection practices, and 5) safe handling of potentially contaminated equipment or surfaces in the patient environment.
The term “universal precautions” was initially developed in the 1980s when the Centers for Disease Control addressed the issue of blood borne pathogens such as HIV. In 1996, this term was changed to Standard Precautions to incorporate all body fluids . Standard Precautions must be observed with ALL patients at ALL times, regardless of their age, gender, diagnosis, or whether they are under isolation for a specific disease.
Since you will not know if any patient that you come into contact with is infected with a bacteria or virus, you must assume that all body fluids are infected and protect yourself accordingly.
Standard precautions include not only hand hygiene but also use of personal protective equipment, respiratory hygiene and cough etiquette, safe injection practices and safe handling of contaminated equipment.
Retrieved from

4. Importance of Hand Hygiene
HAND HYGIENE is IMPORTANT
Hand hygiene is one aspect of Standard Precautions
One of the most basic forms of standard precautions is proper hand hygiene. Thousands of patient are injured or die each year due to nosocomial infections – infections that are acquired in a healthcare setting. Proper hand hygiene is the most important action that you can take to avoid the spread of infection.
Please take a few minutes to watch a short video on the importance of hand hygiene.
Click on this link:

5. Soap and Water or Alcohol Hand rub
Hand washing can be accomplished using 2 methods:
Soap and water
Alcohol hand rub (should be 60% alcohol)
Use soap and water:
When hands are visibly soiled
After direct contact with blood and/or other body fluids
After caring for a patient with infectious diarrhea or norovirus
There are 2 accepted ways to properly sanitize your hands; that is, the use of soap and water or alcohol hand rub. The alcohol hand rub that should be used is a concentration of at least 60% alcohol.
Typically you will have a choice of methods; however, there are 3 cases in which you must use soap and water to sanitize your hands. First, if your hands are visibly soiled. Second, if you come into direct contact with blood and/or other body fluids with ungloved hands. Third, after caring for a patient with infectious diarrhea or a patient that has been diagnosed with a norovirus. It has been shown that the use of soap and water gives you better protection in these 3 cases.

6. Skill: Handwashing with Alcohol Hand rub
Dispense an ample amount of product into the palm of one hand.
Rub hands together, covering all surfaces of hands and fingers with antiseptic rub.
Rub hands together until the alcohol is dry. Allow hands to completely dry before applying gloves
NEJM video:
When sanitizing your hands with alcohol hand rub, there are some principles to keep in mind. Use an ample amount of product into the palm of your hand. Usually, 2 pumps at most dispensers is an ample amount.
Because friction and time are 2 of the most important factors in the effectiveness of hand sanitation, make sure that you rub your hands together, covering all surfaces of your hands and fingers.
Rub your hands together until the alcohol is dry. If your hands are still feel damp, you have not sanitized your hands effectively.
YouTube Video you can watch: Serious About Hand Hygiene in Hospitals

7. Personal Protective Equipment
Use of disposable gloves, gowns and masks are another important element of standard precautions.
Non-sterile gloves are available in all patient rooms.
Effective hand hygiene is the most important step you can take to protect your patients and yourself from the spread of infection. The second most important element in protection is the use of personal protective equipment, otherwise called PPE.
In the ambulatory setting, you will utilize non-sterile gloves frequently. The focus of this module will be the use of these non-sterile gloves. Other personal protective equipment includes gowns, masks, and protective eyewear. This type of PPE is worn less frequently in the ambulatory setting.
Non-sterile gloves are readily available in each patient’s room and in each exam room. Gloves are to be worn when it is likely that you will come into contact with blood or other body fluids.
The World Health Organization has developed a very thorough and helpful pamphlet on glove use. It is incorporated into the handouts of this module. You may find it very interesting.
**This pamphlet is also found in a PDF within the “Attachments Tab” located on the upper right hand corner of this player.

8. Use of Non-sterile gloves
Review page 3 of the WHO pamphlet.
Note the times when gloves are indicated.
Always remember to perform hand hygiene prior to donning and after removing gloves
See the “Attachments Tab” for the WHO Pamphlet (Glove Use leaflet)
Prior to and after removing gloves, always remember to perform hand hygiene.
The World Health Organization’s Glove Pyramid is an aid in decision-making on when to wear or not to wear gloves.
Non-sterile gloves are indicated in clinical situations where there is a potential for touching blood, body fluids, secretions, excretions and items visibly soiled by body fluids.
Exposure to body fluids can be both direct and indirect. Examples of direct situations are IV insertion or phlebotomy, discontinuing IVs, pelvic and vaginal examinations or suctioning a patient. Examples of indirect exposure include emptying emesis basins after a patient vomits or cleaning up spills of body fluids.

9. Donning and removing non-sterile gloves
Note that gloves are not a replacement for hand hygiene. Together they are the best protection for the patient and you!
Please review page 4 for the procedure on donning and removing non sterile gloves.
You will be able to practice these techniques in the skills portion of this course.
See the “Attachments Tab” for the Glove Use Leaflet
Donning and removing non-sterile gloves is an easy procedure but one that is important for you to master. The handout that accompanies this module includes visuals for your use.
After hand hygiene, remove one of the gloves from the box. Don the first glove. Take a second glove from the box. Gloves should be touched primarily at the wrist and once donned, should touch only the areas that should be touched by gloves.
When using gloves or other personal protective equipment, you should remain in the room with the patient. Personal protective equipment should not be worn outside of the patient’s room; you run the risk of contaminating any object or person that you come into contact with.
When the procedure has been completed, remove non-sterile gloves by pinching one glove at the palm. Peel away the glove from the hand allowing it to turn inside out. Hold the removed glove in the gloved hand. Slide your fingers between the wrist and the glove of the gloved hand. Remove that glove , rolling it over the first glove. Discard the gloves in the appropriate waste receptacle.
Complete the procedure by washing your hands.

10. Use of protective gowns
Any time when blood or body fluids may be splashed or splattered onto the body, a gown should be worn.
A gown must also be worn when working with a patient in contact isolation
A protective gown is to be worn when there is a likelihood that blood or body fluids will be splashed or splattered onto the body. Gowns must also be worn when caring for a patient that is in contact precautions. Understanding isolation or infection precautions is beyond the scope of this program. You will become familiar with these precautions when you begin clinical experience in the inpatient setting.

11. Protective gowns
All gowns are made of waterproof paper and are to be worn for only one use and one patient encounter.
Gowns must be removed after using.
If transporting a patient in contact precautions through hospital corridors, don a clean gown prior to leaving the room.
Contaminated PPE should never be worn outside of the patient room.
Gowns are usually made of waterproof paper and are to be used for only one patient and one encounter only. They are removed and discarded after use.
When working in the inpatient setting, you may need to transfer patients in isolation from one setting to another. Contaminated PPE should never be worn outside of the patient’ s room. Always don a clean gown prior to leaving the room.
In the ambulatory setting, always remove your gloves and wash your hands prior to leaving the exam room. Wearing contaminated PPE outside of the room puts all staff and patients at risk for an infection.

12. Donning and removing a protective gown
Donning a gown
The opening is in the back
Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back
Secure at neck and waist
If gown is too small, use two gowns: the first ties in front, the second ties in back
Removing a gown
Gown front and sleeves are ‘dirty’; handle by the inside/back of gown
Unfasten ties
Peel gown away from neck and shoulder
Turn contaminated outside surface toward the inside; fold or roll into a bundle
Discard
CNA Essential Skills YouTube Video:
The opening of a gown is at the back. Make sure that your entire torso is covered from the neck to the knees. The gown is secured at the neck and the waist by ties or by tape. If the gown is too small, wear 2 gowns – one that ties in the front; the second ties at the back.
It is important to remove a gown correctly, as there is a risk of contamination. The front of the gown and sleeves are considered “dirty” and should not be touched by your bare hands. Handle only the inside and the back of the gown. The contaminated outside of the gown should be turned inside out prior to being discarded.
To better understand how to don and remove a patient gown, watch this short video: Donning and Removing PPE (Gown & Gloves)

13. Protective masks and eyewear
Masks are to be worn when there is a likelihood of blood or other body fluids will be sprayed into the face and/or eyes.
Masks are to be worn for patients who are in respiratory (droplet) isolation.
If you are performing a procedure where there is a likelihood of blood or other body fluids may be splashed into your face or mouth, a mask and/or goggles or other types of eyewear will be required.
If the patient, in the inpatient setting, is in droplet or respiratory isolation, a mask must also be worn.
Masks can be 2 types – secured behind the ears, as seen in the picture, or by ties that are secured at the back of the head and the neck.

14. Masks and eyewear
In some cases, masks will be sufficient. But if blood and body fluids can be sprayed, eyewear should also be worn.
Dental procedures and some respiratory procedures are examples of when to use both mask and eyewear.
Eyewear can be separate from the mask as shown in the picture on the slide or can be attached to the mask.

15. Donning and removing a mask
Donning a mask
Secure on head with ear loops or ties
Place over nose, mouth, and chin
Fit flexible nose piece over bridge
Removing a mask
Adjust fit – snug to face and below chin
Front of mask is ‘dirty’; handle by ear-loops or ties
Remove from face, in a downward direction, using ear-loops
Discard
Donning and removing mask and goggles is an easy procedure but must be done properly to eliminate the risk of contamination.
When donning the mask, it is important that it fit snugly over the nose, mouth and chin. There is a flexible metal strip on most masks that will help you keep the mask snug. The mask must also fit below the chin.
When removing the mask, remember that the front of the mask is dirty. Handle the mask by the ties or the ear loops.

16. Airborne Precautions – N95 Respirator
When the patient is being treated for an airborne infection, e.g. active tuberculosis, the regular, surgical mask is not sufficient protection.
An N95 respirator or “duck-billed” mask is to be worn.
Staff must be properly fit-tested before using this type of PPE
If the patient is being treated for an active infection that is considered airborne, you will be required to wear a mask that prevents very small particles from passing through the mask. Active tuberculosis is a typical airborne infection. Procedure or surgical masks do not provide sufficient protection.
An N95 respirator, sometimes called a “duck-billed” mask, is used for patients in airborne precautions. This mask must be properly “fit-tested” prior to using. It is critical that the mask fit correctly to prevent airborne pathogens from entering your respiratory system.

17. Donning and removing eye shield/goggles
Donning shield/goggles
position eyewear over eyes and secure to head using ear pieces
Some facilities will utilize an eye shield that is directly attached to the mask
Removing shields/goggles
Outside of eyepiece is ‘dirty’; handle by earpieces
Grasp earpieces with ungloved hands
Pull away from face
Place in designated receptacle for reprocessing
Eye shields attached to a mask are discarded
Donning and removing eyewear and/or goggles is a relatively easy skill to master. When donning eyewear that is separate from the mask, position them over the eyes and assure that the earpieces are snug against the head.
The outside of the eyepiece is considered dirty. Grasp the earpieces by your ungloved hands when removing them.

18. Proper Use of PPE: A video
To review the proper procedures for donning and removing all PPE, click on the following link:

19. Needlestick Safety
Since blood is one of the highest risk body fluids, it is very important that you protect yourself and your patient from exposure to it.
Procedures that involve needles, such as injection and phlebotomy, puts you at risk for blood exposure.
Procedures that entail the use of needles and other sharps, such as scalpels, put you at risk for exposure to blood. Because blood is considered the highest risk fluid, it is important that you use proper procedures to protect yourself and the patient.

20. Needlestick Safety continued
Always use the “one-handed” scoop method to recap a needle.
You will have the opportunity to practice this during the skills portion of the class
Dispose of needles and other sharp objects into a designated sharps dispenser
When preparing injections, you will need to replace the cap onto the needle. Never recap the needle by holding the cap in one hand and the needle with the other. When replacing the cap, use the one-handed scoop method. You will have the opportunity to practice this during the skills portion of the course.
The needles that you will be using for venipuncture and injections have a protective sheath or a “button” mechanism to prevent needle exposure. Always utilize these protective mechanisms when handling needles.
Needles and other sharp objects must be discarded in sharps containers – hard plastic containers that are usually found in the exam or patient rooms. They are often red in color and have a biohazard label on them.

21. The biter should rinse their mouth following the directions above.
If an exposure occurs:
Flood the exposed area with water and thoroughly clean any wound with soap and water (use antimicrobial soap and water if available)
If mucus membranes or eyes are exposed, thoroughly flush with water; if eyes are exposed, use an eyewash station if readily available.
If there is a bite injury, the person bitten should wash the area following the directions above;
The biter should rinse their mouth following the directions above.
If you follow all procedures accurately, exposure to blood and body fluids is low. However, if an exposure occurs, it is important to follow these procedures:
The area should be washed thoroughly. If the eyes or mucous membranes are the site of exposure, thoroughly flush the area with water. Eyewash stations are normally available on all patient units and ambulatory clinics. Eyes should be flushed with water for 15=20 minutes.
If the exposure is a bite, wash the area thoroughly with soap and water. The biter should be encouraged to also flush their mouth with water.
The medical center’s policy on exposure is attached to this program. After first aid to the exposure site, it is important that you report all exposures. Managing exposure events is the responsibility of Student Health Services. Follow their directions closely.

22. Respiratory Hygiene/Cough Etiquette
The following measures to contain respiratory secretions are recommended for all individuals:
Cover your mouth and nose with a tissue when coughing or sneezing.
If you do not have a tissue, use your sleeve rather than your hand.
Use the nearest waste receptacle to dispose of the tissue after use.
Perform hand hygiene after having contact with respiratory secretions and contaminated objects/materials.
Many infections are spread via sputum and oral secretions during the act of coughing. It is important for health care providers as well as the public to understand and practice effective cough etiquette. As a health care provider, you may be required to teach a patient correct cough etiquette.
To avoid the spread of infection via the respiratory tract, remember these important actions:
Cover your mouth and nose with a tissue when coughing or sneezing. If you do not have a tissue, use your sleeve rather than your hand to cover your mouth and nose.
Dispose of tissues in appropriate waste receptacles
Perform hand hygiene after coughing and/or sneezing.

23. Summary
This program has introduced you to the importance and use of hand hygiene and standard precautions.
Proper hand hygiene is a critical factor in the reduction of nosocomial infections in the healthcare setting.
Standard precautions is the minimum level of precautions that all healthcare workers are required to use when caring for patients.
Preventing the spread of infection in the health care setting is critical to the delivery of safe, quality medical care. This module has introduced you to the importance of hand hygiene, use of non-sterile gloves and cough etiquette. These are the minimum measures you will need to protect the patient and yourself.

24. Thank you for completing this module
If you have any questions, I am available for help.

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