1. Personal Protective Equipment (PPE)
Donning & Doffing

2. Housekeeping Details

3. Welcome & Introduction
Welcome to PPE Donning & Doffing
Your name
Your title

4. What You Will Learn
The employer legislated responsibilities for personal protective equipment and education/training
Your legislated responsibilities and rights as a worker
The appropriate donning (putting on) and doffing (removing) of PPE

5. Legislation
Saskatchewan’s Occupational Health and Safety Regulations, 1996, 2(1)eee states:
“Train” means to give information and explanation to a worker with respect to a particular subject-matter and require a practical demonstration that the worker has acquired knowledge or skill related to the subject matter;

6. Legislation Regulation 12(c) states: General duties of employers
(12) The duties of an employer at a place of employment include:
(c) the provision of any information, instruction, training and supervision that is necessary to protect the health and safety of workers at work;

7. Legislation Regulation 13 states: A worker shall:
(a) use the safeguards, safety appliances and personal protective equipment provided in accordance with these regulations and any other regulations made pursuant to the Act; and
(b) follow the safe work practices and procedures required by or developed pursuant to these regulations and any other regulations made pursuant to the Act.

8. Legislation
1. Right to Know the hazards at their workplace, to be trained to recognize them, and to be trained to protect themselves.
2. Right to Participate in their own safety as well as the safety program in their workplace.
3. Right to Refuse an act or series of acts where the worker has reasonable grounds to believe that it is unusually dangerous. This is a refusal of an individual worker, not a group of workers.

9. Accountability What does accountability mean to you?
The general definition of “accountability” includes:
being bound to give an explanation of your conduct
being responsible; answerable.
How should we be held accountable?

10. Personal Protective Equipment
The purpose of PPE is to provide protection – not only to the worker, but also with eliminating or managing the risk of transferring a virus to a client or another individual.

11. Personal Protective Equipment
The purpose of PPE is to provide protection – for the worker, client or another individual.
N95 Respirator
Gown
Gloves
Boot/shoe covers
Goggles/safety glasses
Face shield
Surgical hood

12. Training, Practice, Competence, Observation
Training: this is considered your training session for donning and doffing PPE. Ask questions if you’re not sure about something.
Practice: we will practice donning and doffing each piece of equipment. Perfect practice makes perfect. This will take time, we’ll practice very slow and deliberate - this is a task that we will not rush through. After you leave this session, keep practicing and use another trained person to observe you.
Competence: this is your “know how”, your ability to use what you will be taught today. So “know how” to don and doff properly before you leave this session.
Observation: this is where I am going to watch and coach each of you don and doff every piece of PPE.

13. Principles of PPE Donning
PPE must be donned correctly in proper order before entry into patient care area.
 During Patient Care
PPE must remain in place and be worn correctly for the duration of exposure to potentially contaminated areas. PPE should not be adjusted during patient care. Don’t adjust your eyeglasses, hair, etc. Don’t touch any part of your face.
Having a “buddy” with you during patient care will help to check for a partial or total breach in PPE
Doffing
The removal of used PPE is a high-risk process that requires a structured procedure, a trained observer when using High Risk Ebola procedures, and a designated area for removal to ensure protection.
PPE must be removed slowly and deliberately in the correct sequence to reduce the possibility of self-contamination or other exposure viruses, such as Ebola.

14. Remember! Always move slowly – it is a step by step task
Do not rush when donning PPE
Avoid touching PPE once donned
Avoid touching face, exposed skin
Do not rush when doffing PPE
Use appropriate waste receptacle (preferably hands-free) and discard carefully

15. Donning & Doffing – Basic PPE
Use the following safe work practices to protect yourself and limit the spread of contamination:
Keep your hands away from your face and limit the surfaces you touch.
Change gloves when torn or heavily contaminated.
Regularly perform hand hygiene. An alcohol based hand rub (ABHR) is the preferred method to clean hands. If hands look or feel soiled, use soap and water to clean hands.

16. Donning Sequence – Basic PPE
Proper hand hygiene is first, then followed by:
1. Shoe covers or booties
2. Gown
3. Mask/respirator
4. Goggles/Face Shield
5. Gloves

17. Doffing Sequence – Basic PPE
1. Shoe covers or booties
2. Gloves
3. Gown
4. Goggles/face shield
5. Mask/respirator
Proper Hand Hygiene

18. Low Risk Ebola Virus Disease (EVD)
Encounter with patient suspected to have EVD who is mildly symptomatic: mild fever, fatigue, headache, sore throat, muscle pain.
Decision to upgrade to higher level of protection is based on your assessment of risk in each patient care situation. If risk is high, use the high risk protocol.
Trained observer and checklist is not required for a low risk encounter; however, HCWs are encouraged to request assistance, if needed.
Ensure you are signed into the log book prior to entering patient room.
Move slowly; do not rush when putting on PPE before entering the patient room.

19. Donning Sequence - Low Risk EVD
1. Hand hygiene 2. Surgical gown 3. Mask 4. Full face shield 5. Nitrile gloves

20. Doffing Sequence - Low Risk EVD
1. Disinfect gloves
2. Inspect PPE
3. Remove gloves
4. Remove gown
Hand hygiene
Remove face shield
Remove mask

21. Trained Observer - High Risk EVD
Dedicated; sole responsibility ensuring adherence to the entire process
knowledgeable in the facility’s protocol; correct donning and doffing procedures, including disposal of used PPE
reads aloud each step; visually confirm and document that step has been completed correctly
ensures the worker avoids touching their face/exposed skin during the donning and doffing procedure
provide guidance/technique recommendations
monitors and documents successful donning and doffing procedures, providing immediate corrective instruction steps not followed
inspects PPE for gaps and adjusts if necessary
range of motion activities - PPE stays intact and worker comfort
know exposure management plan - unintentional break in procedure

22. Trained Observer PPE- High Risk EVD
Single-use (disposable) fluid-resistant or impermeable gown that extends to at least mid-calf
Single-use (disposable) full face shield
Single-use (disposable) nitrile gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
Single-use (disposable) fluid-resistant or impermeable shoe covers. Shoe covers should allow for ease of movement and not present a slip hazard to the worker.

23. Trained Observer PPE- High Risk EVD
Donning Sequence:
Hand hygiene
Shoe/boot covers
Nitrile gloves
Surgical gown
Full face shield
Extended cuff nitrile gloves
Inspection

24. Trained Observer PPE- High Risk EVD
Doffing Sequence:
Remove outer gloves
Disinfect inner gloves
Remove surgical gown
Remove shoe/boot covers
Remove inner gloves
Hand hygiene
Don new gloves
Remove full face shield
Remove gloves

25. Trained Observer - High Risk EVD
Checklist for donning
Check off as completed
Date/time and signatures
Checklist for doffing

26. High Risk Ebola Virus Disease (EVD)
Patient is confirmed to have Ebola Virus Disease OR
Patient is suspected to have Ebola Virus Disease
AND
has high risk symptoms such as bleeding or uncontrolled diarrhea or uncontrolled vomiting; or
is unstable and requires a high risk procedure such as an aerosol generating medical procedure (includes intubation, open respiratory/airway suctioning, high-frequency oscillatory ventilation, nebulized therapy, non-invasive positive pressure ventilation), cardiopulmonary resuscitation, central line insertion, or any procedure that could potentially result in copious amounts of body fluid generation or exposure

27. PPE Storage and Donning Area High Risk EVD
An area outside of the patient room (e.g., nearby vacant patient room or a marked area in the hallway outside the patient room) where clean PPE is stored and where healthcare workers can don PPE under the guidance of a trained observer before entering the patient room
Post appropriate signage indicating room designation and purpose

28. Pre-Donning Activities High Risk EVD
Ensure all required PPE and supplies are available
Ensure you are signed into log book
Remove all personal items (e.g., jewelry, cell phones, etc.)
Ensure longer hair is tied back
Remove personal clothing and change into scrubs and dedicated washable shoes (fluid resistant footwear-closed toe and heels, plastic or rubber soles)
Hydrate (no drinking or eating is allowed in patient care area)
Ensure trained observer, in appropriate PPE, is available to document the steps of the donning checklist with you

29. Donning Sequence - High Risk EVD
Hand hygiene
Knee high boot covers
N95 respirator
Nitrile gloves
Surgical Gown
Apron (if used)
Surgical hood
Full face shield
Extended cuff nitrile gloves
Inspection (including range of motion)

30. PPE Doffing Area - High Risk EVD
Designate an area in close proximity to the patient room (or alternate area as per the Ministry of Health procedures)
Provide supplies for disinfection of PPE and for hand hygiene
Provide a space for sitting to remove boot covers
Provide leak-proof infectious waste containers for discarding used PPE
If a hallway is being used outside the patient room, construct physical barriers to close hallway to traffic (thereby creating an anteroom)
Post appropriate signage indicating room designation and purpose

31. Pre-Doffing Activities - High Risk EVD
Worker
Ensure trained observer is available to monitor, assist (where required), document the steps of PPE doffing checklist
Trained Observer
Don shoe covers, gown, face shield, and gloves to assist worker with removal of PPE
Prepare a doffing pad that is marked section 1 and section 2
Read aloud each step of the PPE doffing procedure; provide reminders to avoid reflexive actions such as touching their face
PPE Items shall be removed slowly and carefully and discarded one piece at a time in a hands-free waste receptacle

32. Doffing Sequence - High Risk EVD
Disinfect outer gloves
Clean door handle
Inspect
Remove outer gloves
Disinfect inner gloves
Remove gown
Remove knee high boot covers
Remove inner gloves
Perform hand hygiene
Put on new gloves
Remove face shield
Remove gloves
Perform hand hygiene
Put on new gloves
Remove surgical hood
Remove gloves
Remove N95 respirator
Clean shoes
Remove doffing pad

33. To Protect Yourself, You Can:
Ask for training on PPE
Use the appropriate PPE
Keep yourself current on PPE
Practice – perfect practice makes perfect
Know the current policy and procedures

34. Bringing it All Together
PPE will be provided by the employer
Staff will be trained on appropriate donning and doffing techniques
Follow guidelines in place; refer to documents available
Ask for help if you need it
“Buddy up”