1. Personal Protective Equipment: Protecting Yourself and the Community from Infectious Disease Presented by: The Massachusetts Department of Public Health The Local Public Health Institute of Massachusetts Fall 2005 Next

2. The purpose of this training is… To promote a common-sense approach to infection control in a community setting To present basic, introductory information about the use of personal protective equipment for protection against and control of infectious diseases NOT to create new policy or regulations concerning the proper use of personal protective equipment Next HOME Back

3. Defining PPE Personal Protective Equipment (PPE) is specialized clothing or equipment worn for protection against dangerous or infectious materials PPE prevents contact with an infectious agent, or body fluid that may contain an infectious agent, by creating a barrier between the potentially infectious material and the public health responder NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

4. Defining Additional Terms “Community setting” is any setting outside a hospital or established health care clinic in which a public health responder carries out medical interventions A “public health responder” is a public health professional (either medical or non-medical) serving in a public health capacity NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

5. Defining Disease Transmission The spread of infectious disease requires a:  Source of infection  Route of transmission  Host susceptible to the infection NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

6. Defining Disease Transmission Infectious diseases are spread through one or more of the following routes of transmission:  Contact (skin, fecal-oral, blood) Hepatitis B  Droplet (coughing, sneezing, talking: droplets are large and only travel within 3 feet) Meningoccocal Meningitis  Airborne (coughing, sneezing: particles are small and travel more than 3 feet) Measles  Common vehicle (food, water, objects) Salmonella  Vector-borne (mosquitoes, ticks) Lyme Disease NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

7. Controlling Disease Transmission The spread of infectious disease can be controlled by:  Wearing PPE  Practicing Hand Hygiene  Promoting Respiratory Hygiene  Following Standard Precautions  Following Expanded Precautions, as necessary NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

8. Wearing PPE PPE acts as a barrier between you and:  Your client  Objects in your client’s environment  Infectious agents, substances, or materials Wear PPE to:  Stop the spread of illness/infection  Protect your health  Protect your client’s health  Protect your family’s health  Protect the community’s health NextBack HOME Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario PPE Basics

9. Available PPE A variety of PPE is available for your protection, including:  Gowns, Aprons, Cover-All Suits  Masks  Respirators  Goggles  Face shields  Gloves  Shoe covers (booties)  Hair covers NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

10. Donning PPE Don PPE in the following order: 1. Gown (or apron/cover-all suit) 2. Shoe and/or hair covers (when worn) 3. Mask/Respirator 4. Goggles (or face shield in lieu of mask and goggles) 5. Gloves NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

11. Donning Gowns The first piece of PPE you should put on is the gown. 1. Make sure the opening is in the back 2. Secure at the neck and waist 3. If the gown is too small, use two gowns:  Gown #1 ties in front  Gown #2 ties in back NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

12. About Masks There are several types of masks that can be worn to prevent the spread of infectious disease Masks are not respirators Masks vary by:  Shape (rectangular, round)  Method of securing (elastic, ties) Select a mask you are comfortable wearing and one that provides an adequate amount of protection Use common sense when donning and removing masks, as the procedure may vary based on the method of securing the mask to your face NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

13. About Masks, Continued This training demonstrates the use of one type of mask Other common types of masks include: NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE Elastic tieCloth ties

14. Donning Masks 1. Place mask over your mouth, nose and chin 2. Fit the flexible nose piece over nose bridge 3. Secure with ties or elastic 4. Adjust to fit NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

15. About Respirators There are several types of respirators that can be worn to control the spread of infectious disease Respirators vary by:  Size (small, medium, large)  Shape (oval, round)  Level of respiratory protection offered (N95 versus N100) Unlike masks, respirators must be fit-tested before use to ensure they fit your face properly NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

16. Fit-Testing Respirators Respirators must have a mask-to-face seal and must be checked annually to ensure adequate protection Fit-testing is the procedure used to ensure a mask- to-face seal and involves tests to make sure there is no air leakage between the mask and the face Contact your regional Health Educator for additional information about respirator fit-testing Remember: NEVER use a respirator that has not been fit-tested for your face NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

17. About Respirators, Continued This training demonstrates the use of one type of N95 respirator Other common types or variations of the N95 respirator include: NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE N95N100N95

18. Donning Respirators 1. Select a fit-tested respirator, such as an N- 95 respirator mask 2. Place the respirator over your nose, mouth and chin 3. Fit the flexible nose piece over your nose bridge 4. Secure on your head with elastic 5. Adjust to fit 6. Perform a fit check:  Inhale: Respirator should collapse  Exhale: Check for leakage around face NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

19. Donning Goggles 1. Position goggles over eyes and secure to the head using the ear pieces or headband 2. Adjust to fit comfortably *If wearing a face shield instead of a mask and goggles, position the face shield over face and secure on brow with headband Remember: Eyeglasses alone do NOT provide adequate protection NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

20. Donning Gloves 1. Put gloves on last 2. Select the correct type and size 3. Insert hands into gloves 4. If you are wearing a gown, tuck the gown cuffs securely under each glove NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

21. Removing PPE 1. Remove PPE in an area where you are not in danger of exposure to the infectious agent  Separate room  Porch or garage  Breezeway or other entryway 2. Identify “clean” and “contaminated” areas of PPE  Clean areas: Have NOT been in contact with infectious agent  Contaminated areas: HAVE been in contact with infectious agent NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

22. Removing PPE 3. To limit self-contamination, remove PPE in the following order: 1. Gloves 2. Goggles (or face shield in lieu of mask and goggles) 3. Gown (or apron/cover-all suit) 4. Shoe and/or hair covers (when worn) 5. Mask/respirator 4. Discard PPE immediately and properly so as not to contaminate the “clean” area 5. Perform hand hygiene immediately after removing PPE NextBack HOME PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

23. Removing Gloves 1. Remove your gloves first 2. Hold the outside edge near your wrist 3. Peel the glove away from your hand, turning the glove inside-out 4. Hold the glove in the opposite gloved hand 5. Slide your ungloved finger under the wrist of the remaining glove 6. Peel off from the inside, creating a bag for both gloves 7. Discard in a plastic bag NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

24. Removing Gowns 1. Unfasten the ties 2. Peel the gown away from your neck and shoulder 3. Turn the contaminated outside toward the inside 4. Fold or roll into a bundle 5. Discard in a plastic bag NextBack HOME Click on Movie to Play PPE Basics Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Using PPE

25. Welcome to STANDARD PRECAUTIONS This section includes:  An overview of Standard Precautions  PPE for Standard Precautions NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario

26. Overview Most of the time you respond in a public health role, you will not have a confirmed diagnosis for the person you might be dealing with Use Standard Precautions regardless of diagnosis NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Standard Precautions

27. PPE for Standard Precautions: Determining What to Wear Decisions about PPE use are determined by the type/level of contact you will have with the client To determine what PPE to wear, ask yourself:  Will I be touching the client or potentially contaminated objects in their environment?  Is there a likelihood of blood or body fluids spraying or splashing?  Is the client coughing, sneezing, or vomiting? Do they have diarrhea? When in doubt, applying the most conservative level of PPE is the best protection NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Standard Precautions

28. PPE for Standard Precautions Use:  Gloves: When you may touch a client in a way that might lead to exposure to blood or body fluids or touch objects in their environment that may be contaminated, and/or  Gowns: When there is a risk of your clothing or exposed skin coming in contact with anything wet or weeping, and/or  Mask and goggles or a face shield: When there is a risk of being splashed or sprayed with blood or body fluids Practice:  Hand hygiene and promote respiratory hygiene (if working with clients who have respiratory symptoms) as a regular part of Standard Precautions NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Standard Precautions

29. What PPE Would You Wear… When working with a client:  With a skin infection, or an open wound?  Who has incontinent diarrhea?  For whom you deliver food and mail without interaction? NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Standard Precautions

30. Welcome to EXPANDED PRECAUTIONS This section includes:  An overview of Expanded Precautions  A description of Contact and Droplet Precautions, and Airborne Infection Isolation  PPE for Expanded Precautions  Scenario demonstrating use of Expanded Precautions NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario

31. Overview Expanded Precautions are used in addition to Standard Precautions to prevent the spread of infection when you know or suspect:  A client’s diagnosis  What illness or infectious agent you may be exposed to  The client’s symptoms lead to a risk of contact with blood or body fluids NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

32. Overview Expanded Precautions is the use of PPE in addition to Standard Precautions Expanded Precautions include:  Contact Precautions  Droplet Precautions  Airborne Infection Isolation NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

33. PPE for Expanded Precautions: Determining What to Wear Decisions about PPE use are determined by the diagnosis or suspected diagnosis of the client, the client’s symptoms, or type of infectious agent or illness you will encounter To determine what PPE to wear, ask yourself:  What is the client’s diagnosis or suspected diagnosis?  Is the client infectious?  What is the infectious agent or illness I may encounter?  What is the mode of transmission of this agent or illness?  Does the client have symptoms which lead to increased likelihood of transmission? NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

34. PPE For Expanded Precautions In addition to Standard Precautions, and based on your assessment of the mode of transmission of the agent or illness you may encounter, it may be necessary to follow:  Contact Precautions Wear gown and gloves for all contact with client and/or objects in the client’s environment  Droplet Precautions Wear appropriate respiratory protection within 3 feet of client  Airborne Infection Isolation Wear appropriate respiratory protection (e.g., N-95 respirator) when entering client’s environment NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

35. What Type of Expanded Precautions Would You Follow When… Visiting with a client who has been diagnosed with:  Hepatitis A and is incontinent/diapered?  Influenza?  Pulmonary tuberculosis?  SARS? What PPE would you wear? NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

36. What Type of Expanded Precautions Would You Follow When… Visiting with a client who has been diagnosed with:  Hepatitis A and is incontinent/diapered Answer: Contact Precautions - Gown, gloves  Influenza Answer: Droplet Precautions - Appropriate respiratory protection (e.g., mask)  Pulmonary tuberculosis Answer: Airborne Infection Isolation - Appropriate respiratory protection (e.g., N-95 respirator)  SARS Answer: Contact Precautions, Droplet Precautions, Airborne Infection Isolation - Gown, gloves, goggles, appropriate respiratory protection (e.g., N-95 respirator) NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

37. Other Uses of PPE Sometimes, PPE may be used to protect public health responders from contact with a bioterrorism (BT) agent or hazardous material, such as one encountered during a bioterrorist event or other public health emergency PPE used for protection from exposure to biological agents may not protect against exposure to chemical agents NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Other Uses of PPE Final Quiz Comprehensive Scenario Expanded Precautions

38. Other Uses of PPE In these situations, you may hear terms such as:  Level A, B, C and D PPE Types of PPE used to protect against exposure to hazardous materials and bioterrorism (BT) agents Special training needed to use levels A, B, and C  Hot, Warm and Cold Zones Terms to identify level of danger of a particular site for control purposes during a chemical, biological, or radiological event  Hazmat Teams Teams that are highly trained and fully equipped to respond to a situation involving a hazardous material NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Final Quiz Comprehensive Scenario Expanded Precautions Other Uses of PPE

39. For more information about the PPE required for protection against hazardous materials and infectious agents, please visit: http://www.cdc.gov/niosh/topics/emres/ppe.html Future training opportunities may be available on this topic NextBack HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Final Quiz Comprehensive Scenario Other Uses of PPE

40. Thank You HOME PPE Basics Using PPE Hand Hygiene Respiratory Hygiene Standard Precautions Expanded Precautions Other Uses of PPE Final Quiz Comprehensive Scenario