Prepared by [Insertname of presenter] [Insert title] [Insert Branch name] February 2005

2. Program Goal Improve healthcare worker safety in the healthcare environment through appropriate and correct use of PPE

3. Aims and Objectives To ensure healthcare workers are aware of the appropriate PPE required, in order to provide protection in conjunction with standard and transmission-based precautions Ensure healthcare workers are aware of the correct sequence for donning PPE Ensure healthcare workers are aware of the correct sequence for removing PPE in a manner that prevents self-contamination and self-inoculation

4. 3 Personal Protective Equipment (PPE) PPE refers to whatever protective equipment may be used to insulate an individual from the hazards presented by the environment in which he or she is working In the healthcare environment it refers to specialised clothing or equipment worn by an employee or patient for protection against infectious materials and other contaminants The type of PPE used will vary based on the level of precautions required; such as, Standard, Contact, Droplet or Airborne Infection Isolation May put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staffMay put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staff

5. 4 Some important things to remember about PPE Don PPE before contact with patient, generally before entering the room Keep gloved hands away from the face and avoid touching or adjusting PPE Remove and discard PPE carefully. This should be done at the doorway (just prior to leaving patient�s room) or immediately outside patient room. Surgical or particulate masks should be removed outside room Immediately perform hand hygiene using soap and water or an alcohol-based gel or rub It is important to take into consideration the individual room configurations in healthcare facilities. Some facilities are equipped with ante rooms and Negative pressure ventilation, whilst other open directly onto corridor areas. It is important to factor in these individual configurations when planning and executing various levels of isolation and also to ensure contamination of common areas does not occur. Removing the respirator It is important to take into consideration the individual room configurations in healthcare facilities. Some facilities are equipped with ante rooms and Negative pressure ventilation, whilst other open directly onto corridor areas. It is important to factor in these individual configurations when planning and executing various levels of isolation and also to ensure contamination of common areas does not occur. Removing the respirator

6. 5 Sequence for Donning PPE Gown/apron Surgical or particulate mask Goggles or face shield Gloves May put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staffMay put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staff

7. 6 Step 1 Perform hand hygiene Perform hand hygiene before putting on Personal Protective Equipment (PPE) With soap and water, or Water-free skin cleanser

8. 7 Step 2 Gown/Apron Fully cover torso from neck to knee, arms to end of wrist, and wrap around the back. Fasten at back of neck and waist. * For obese staff where one gown fitted appropriately will not provide adequate protection, two gowns should be worn. The first worn with fastenings at the front and the second applied as per instructions in the slide.* For obese staff where one gown fitted appropriately will not provide adequate protection, two gowns should be worn. The first worn with fastenings at the front and the second applied as per instructions in the slide.

9. 8 Step 3 Surgical mask or particulate (P2 or N95) Secure ties or elastic bands at middle of head and neck Fit flexible band to nose bridge Fit snug to face and below chin Fit check particulate (P2 or N95) only For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�

10. 9 Step 3 continued,Fit Checking P2 or N95 Masks Gently inhale. When you breathe in the mask should draw in slightly toward the face and collapse Gently exhale. The mask should fill up with air. It is important at this stage that there is no air leakage around the edges of the mask For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�

11. 10 Step 3 continued,Fit Checking P2 or N95 Masks If you have not achieved a successful fit check as instructed it is important that you seek advice or have someone assist you with fitting and checking your mask. An incorrectly fitted mask will not provide you with the intended level of protection from airborne infectious diseases For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�For P2 or N95 Fit checking instructions see poster �Principles of donning and fit checking P2 or N95 masks�

12. 11 Step 4 Protective Eyewear Place goggles or face shield/visor over face and eyes and secure using the ear pieces or headband Adjust to fit comfortably

13. 12 Step 5 Gloves Don gloves last Select correct size and type Insert hands into gloves Extend to cover wrist of gown

14. 13 You are now ready and safe to enter the patient�s room Before you enter the room, it is a good idea to have a colleague check your PPE to ensure it is applied correctly or check yourself in a mirror.Before you enter the room, it is a good idea to have a colleague check your PPE to ensure it is applied correctly or check yourself in a mirror.

15. Safe use of PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Change gloves when torn or heavily contaminated Limit surfaces and items touched to prevent accidental contamination

16. 15 Sequence for Removing PPE Gloves Face shields or goggles Gown Mask or respirator May put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staffMay put an individual list of PPE available. A slide on each type of PPE in line with DOH IC policy may be useful for all disciplines of staff

17. 16 Sequence for Removing PPE It is important to remember that the sequence for removing PPE is intended to limit opportunities for self contamination and self inoculation Important to identify what sites or areas are considered �clean� and what are �contaminated� This is especially important when identifying the safest sequence for removal

18. 17 Where to remove PPE At the doorway, before leaving the patient�s room or in the anteroom if available It is important to remove mask/ respirator outside room, after the door to patient�s room has been closed Hand washing facilities ( soap and water-free skin cleanser) should be readily available after all PPE is removed

19. 18 Step 1 Gloves Outside of gloves is contaminated Grasp outside of glove with opposite gloved hand; peel off Hold removed glove in gloved hand Slide fingers of ungloved hand under remaining glove at wrist Peel glove off over first glove Discard gloves into waste container

20. 19 Step 2 Hand hygiene Perform hand hygiene following removal of gloves Using soap and water, or water-free skin cleanser

21. 20 Step 3 Protective Eyewear Outside of goggles or face shield is contaminated To remove, handle by head band or ear pieces Place reusable eyewear in designated receptacle for cleaning Or discard disposable eyewear into waste container for disposal * If visor is attached to mask then remove visor and mask last after leaving the patient�s room as both will be considered a �mask�* If visor is attached to mask then remove visor and mask last after leaving the patient�s room as both will be considered a �mask�

22. 21 Step 4 Gown/apron Gown front and sleeves are contaminated Unfasten ties at neck and waist Pull away from neck or shoulders, touching inside of gown only Turn gown inside out Fold or roll slowly into a bundle and discard into designated waste container

23. 22 Step 5 Surgical or particulate mask (P2 or N95) Front of mask is contaminated Remove by touching tapes or ties only Discard in designated waste container Remember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particlesRemember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particles

24. 23 Step 6 Hand Hygiene Perform hand hygiene following removal of all Personal Protective Equipment (PPE), Using soap and water, or water-free skin cleanser Remember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particlesRemember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particles

26. 25 Standard Precautions Assumes all blood and body fluids as potentially infectious Involves the use of protective barriers and safe work practices PPE choice designed to minimise contact with potentially infectious blood and body fluids Remember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particlesRemember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particles

27. 26 PPE for Standard Precautions (1) GLOVES - must be worn on both hands and must be used in situations where the health care worker is potentially exposed to blood and/or body substances GOWNS - A fluid-resistant gown/apron, made of impervious material must be worn during any procedure where there is a likelihood of splashes or contamination with blood or other body substances Remember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particlesRemember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particles

28. 27 PPE for Standard Precautions (2) MASK AND PROTECTIVE EYEWEAR OR A FACE SHIELD: must be worn while performing any procedure where there is a likelihood of splashing or splattering of blood or body substances. Remember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particlesRemember not to remove mask until outside patient�s room as this may expose the staff member to accidental contamination to infectious respiratory secretions/particles

29. 28 What type of PPE would you wear? Showering or bathing a patient? Suctioning oral or tracheal secretions? Transporting a patient in a wheelchair? Responding to a dislodged chest drain where visible blood is spurting out? During venepuncture? Cleaning a patient incontinent of diarrhoea? Irrigating a wound? Taking vital signs? Removing a patient�s meal tray? Discussion point ! Generally none Gloves and mask/face shield- depends on open or closed suction Generally none Gloves, fluid resistant gown, mask/eyewear or face shield Gloves Gloves and generally a gown or apron Gloves gown/apron, mask/eyewear or face shield Generally noneDiscussion point ! Generally none Gloves and mask/face shield- depends on open or closed suction Generally none Gloves, fluid resistant gown, mask/eyewear or face shield Gloves Gloves and generally a gown or apron Gloves gown/apron, mask/eyewear or face shield Generally none

30. 29 PPE for Additional (Transmission Based) Precautions Additional Precautions are designed for patients known or suspected to be infected with pathogens for which Additional Precautions, in addition to Standard Precautions, are needed to interrupt transmission of those pathogens in health care facilities Additional precautions include Airborne Precautions Droplet Precautions Contact Precautions Combination airborne/droplet/contact * * As specified by Infection Control Practitioner and may be warranted for novel viruses etc* As specified by Infection Control Practitioner and may be warranted for novel viruses etc

31. 30 PPE for Additional (Transmission Based) Precautions Airborne Precautions - Particulate (P2 or N95) mask Droplet Precautions - Surgical masks within 1 metre of patient and protective eyewear Contact Precautions � Gown/apron and gloves for contact with patient or environment e.g. equipment and surfaces in the patient�s environment * As specified by Infection Control Practitioner and may be warranted for novel viruses etc* As specified by Infection Control Practitioner and may be warranted for novel viruses etc

32. 31 Questions Please nominate the correct sequence for donning PPE Gloves, gown, mask, eye protection Gown, mask, goggles, gloves Mask, goggles, gown, gloves Eye protection, gown, gloves, mask 1. b1. b

33. 32 Questions 2. In the sequence for removing PPE it is advised that removal of masks should occur once outside the patient�s room. This is because: It is important to remain unidentifiable to the patient for as long as possible Because the garbage bin allocated for mask removal is located outside the room Removing the mask inside the room would put the HCW at unnecessary risk of exposure to respiratory/airborne infection None of the above 2. c2. c

34. 33 Questions 3. Gowns and masks should be removed by touching tapes or ties only. The reason for this is: The front of the mask or gown is considered contaminated Risk of tearing the mask or gown You no longer need the mask or gown So you cannot see what you are doing You will ruin your make-up if removal is performed from the front 3. a3. a

35. 34 Questions 4. Which of the following is not included under Standard Precautions ? Gloves Surgical mask Particulate (P2 or N95 mask) Eye protection Gown or apron 4. c4. c

36. 35 Questions 5. Which of the following statements are not true about Standard Precautions: All blood and body fluids are considered potentially infectious It involves safe work practices and protective barriers Provides protection from infections spread by airborne, droplet and contact transmission Provides protection from infections predominately transmitted through blood and body fluids None of the above 5. c5. c