1. Training structure EFFO Safety and good quality work
Module 1: Ebola Virus Disease
Module 2:
Epidemic control on different levels
Module 3:
Standard precautions & disinfection
Module 4:
Screening & isolation
Module 5:
Personal protective equipment
Module 6:
Waste management & cleaning
Support from the community
Support from the hospital administration
Support from the population

2. Personal Protective Equipment (PPE) Module 5
- Concept adapted from Doctors Without Borders -

3. Learning objectives module 5
General objectives
To know how to put on and take off PPE
Be prepared to work in PPE
Specific objectives
To know the principles of PPE
To know the conditions for working in PPE
Know how to use every element of PPE
To be able to put on PPE
To be able to take off PPE 3

4. Principle of PPE Completely cover skin and mucosa
→ protection against contact with infectious agent
Thereby:
Protecting yourself
Protecting hospital staff
Protecting other patients
Protecting the community

5. Which PPE is the most suitable?
Examples:
Additional information:
These are examples, and the skin is not protected here which is why they are not suited for the context of Ebola.
PPE may need to be adapted depending on the situation and the equipment available. It is important to know the weaknesses of PPE and to consider them.
Attention: Only when knowing the PPE and training regularly using it, you can be protected by it. This applies for every type of PPE.
Source: RKI 5

6. PPE requires training
There are different types of each component of PPE, and several methods for doffing and donning.
→ EFFO: adapted concept of doctors without borders
Repeated practice in using PPE is essential, because in critical scenarios, an error might be dangerous!
Advantage of training: to learn by errors
→ Errors are important!
Always work in pairs (buddies)!
Additional information
While donning PPE and while working in the red area, you work as buddies.
One person takes on a job with which he / she can be possibly contaminated („dirty person“). The other person tries not to be contaminated („clean person“) et carries disinfection solution (e.g. in a spray bottle).
Both persons in PPE are subsequently decontaminated and follow the different procedures of doffing. 6

7. - concept adapted from Doctors Without Borders -
Donning –
How to dress PPE
- concept adapted from Doctors Without Borders -

8. Working with checklists
Working with checklists enhances your safety!
→ This applies also for experienced personnel.
Before start donning, everything that is needed must be prepared! 8

9. Elements of PPE
Note
The single components of PPE that is used in the EFFO project: suit, gloves single-use (inner / outer pair), goggles, apron, hood, FFP-3 mask, boots

10. Checklist: components of PPE
PPE for one person:
1 liquid-proof suit (type 3)
2 pairs of appropriate gloves, long sleeves
1 mask (FFP-3)
1 pair of goggles
1 liquid-proof apron
1 hood
1 pair of boots
Surgical cap (if necessary) 10

11. Further equipment Adhesive tape 1 pen 1 waste bag 1 pair of scissors
1 large poster: Donning PPE
1 mirror
List at entrance of the red area : name of persons in PPE, when PPE has been put on, when the red area has been left
Additional information
Monitoring the time people spend in PPE is important because work in PPE is exhausting (Attention: working safety and risk of accidents!) Wearing time: minutes, this time must not be exceeded!

12. Step 1 MSF MSF Additional information
Cut the legs with scissors and remove the elastic band (take off the suit for this!)  
→ this will facilitate the doffing of the suit later on and ensures a proper lengths of the suit
First put on the suit then the boots (in order not to soil the inner part of the suit with the boots)
Have a chair in order to sit down (to save energy).
MSF
MSF

13. Step 2 MSF Additional information
Put the suit over the inner pair of gloves
Close the zipper and the adhesive tape wrinkle-free
Carefully enrolling the suit‘s hood
By using the MSF-hood, the hood of the suit is not needed!
Inner pair of gloves: covered by suit
If there are thumb loops → Put them above the gloved thumbs (other fingers possible)
This prevents both the slipping up of the suit and the loss of the gloves.
If there are no thumb loops → insert a hole per sleeve (in the part of the sleeve) with a pen at the height of both thumbs
MSF 13

14. Step 3 MSF MSF Additional information
Before the mask is put on, put on a hairnet (especially for long hair!)
Hold the mask in one hand, put straps up
Start by putting the mask on the face on the chin → Pull the bands over the head
Adjust the nose clip with both forefingers
The bands of the mask must not be twisted, too long or too short!
MSF
MSF 14

15. Step 4 MSF Additional information
Ensure correct placement, especially around the eye area (hood should be at about the height of the eyebrows - not higher!)
First tie straps at front above the belly
Then let tie the straps at the back of the head by your buddy
Tie the hood as much as possible so that the front part (surgical mask) rests as close as possible to the FFP-3 mask (reduction of the dead space volume).
All nodes should be tight, but later be easy to loosen!
MSF 15

16. Step 5 MSF MSF Additional information
Chest part should be covered → tie up apron
Pull an end of a band through the neck band
→ Tie loop with other string end on the back (firm, but easy to loosen!)
MSF
MSF 16

17. Step 6 Use anti-fog spray against fogging of glasses MSF
Additional information
Careful check if there are uncovered areas (check with pen, for example)
Correct the position of the glasses by careful movements
Use anti-fog spray against fogging of glasses
MSF 17

18. Step 7 MSF Additional information Put on the outer pair of gloves 18

19. Step 8 RKI RKI Additional information
Use the mirror to check the fit of the entire PPE
Use movements (such as light squats) to check whether you can move within PPE without problems
Final check of the entire PPE by buddy (Caution: no free skin, no damage of PPE, all nodes in the proper position)
Already think of how to doff the PPE during the donning process! With this you avoid difficulties during doffing.
RKI 19

20. Overview: Donning of PPE
adapted from doctors without borders 20

21. - concept adapted from Doctors Without Borders -
Doffing –
How to undress PPE
- concept adapted from Doctors Without Borders -

22. Checklist: Doffing of PPE
Basin with 0.5% chlorine solution between red and yellow area
Vessel with tap and chlorine solution 0.5% in the yellow area
1 large waste bin with waste bag
Basin with 0.5% chlorine solution for reusable equipment
1 large mirror
Sprayer with 0.5% chlorine solution
Vessel with tap and chlorine solution 0.05% in the green area
1 large poster „Doffing - How to undress PPE?“
1 PPE „light“ (for instructor)
List of people in PPE
Cellulose / Paper towels
Waste bags
→ Is there enough chlorine solution?
Additional information
Instead of chlorine solution, another suitable disinfectant can be used. 22

23. Before doffing
MSF 23

24. Step 1 MSF Additional information
Stretch out arms to the right and left
Careful spraying from the front, from the neck towards down horizontally
MSF 24

25. Step 2 MSF Additional information
Walk slowly and carefully so as not to slip on the wet surface
Spray horizontally downwards from the neck
MSF 25

26. Step 3 Additional information
The correct removal of the gloves is important! 26

27. Step 4 Additional information
First, open the loop of the apron on the back
→ Bands must be completely detached from each other
Take the neckband with both hands, right and left
Bend over → Carefully pull the apron over your head
Do not touch glasses and hood when taking off the apron! 27

28. Schritt 5 MSF Additional information
While looking in the mirror carefully grab the glasses with both hands on the left and the right
Bend over, close eyes, carefully move glasses forward, then pull off over the head.
MSF 28

29. Step 6 MSF Additional information
In bent over position: careful loosening the three loops on the back of the head (Attention: bands should be carefully put aside so that they do not touch the face later!)
Loosen the loop on the front, if possible without touching the suit (otherwise: hand disinfection)
→ Hold these bands and pull the hood over your head with the bands
MSF 29

30. Step 7 MSF Additional information
If possible, do not touch the suit from the outside → if so: additional hand disinfection!
Open the adhesive tape and the zipper one after another while looking in the mirror, "Flaps" help
If possible, keep the chin parallel to the floor so that the suit is not accidentally touched by bare skin. The mirror helps!
MSF 30

31. Step 8 MSF Additional information
Take the suit with clean hands from the inside (without touching your own clothes) and pull it off over the shoulders
Carefully move the upper body to shake off the suit
MSF 31

32. Step 9 MSF Additional information
Continue to take off the suit; Avoid touching the boots or your own cloths
With careful foot movements finally take off the suit with the boots (not with the hands!)
This step is much easier when the suit’s legs and the elastic band have been cut off
MSF 32

33. Step 10 Additional information
Subsequently, make sure to grab the suit only on the inner side in order to put it in the waste 33

34. Step 11 MSF Additional information
While looking in the mirror, grasp the FFP3 mask on the right and left of the valve with both hands
Bend over, close eyes, pull mask forward and then over head
MSF 34

35. Step 12 MSF Additional information
The correct removal of the gloves is important!
MSF 35

36. Step 13
MSF 36

37. Step 14 MSF Additional information
Move carefully to avoid falling on the slippery floor!
MSF 37

38. Step 15 38

39. Overview: Doffing – how to undress PPE

40. Instructor
The instructor uses the PPE poster to give clear instructions on how to undress PPE.
Attention: Not all concepts of PPE include the role of an instructor.
Source: RKI

41. Storage of PPE Store PPE in its original packaging
Store it above ground
Store it in a dry place
The recommended temperature range is -10 °C to + 40°C.
Follow instructions on package
Additional information
The recommended temperature range for PPE depends on the producer 41

42. Maximum working time in PPE
Work minutes max in PPE because…
… The respiratory mask leads to exhaustion because it causes resistance during breathing.
… wearing PPE provokes sweating a lot and you risk dehydration..
… concentration decreases which is often accompanied by an elevated risk for errors.

43. Thank you for your attention!
Copyright Images
© Fiedels - Fotolia.com 43