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Personal Protective Equipment (PPE) Basics

Make sure you take a complete course and practice before using PPE in any real-life situation!

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Why Should I Care?

Because if you become sick or injured, you become part of the problem instead of being part of the solution.

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Why Should I Care?

We would never intentionally send you into a situation requiring extensive PPE. However, basic PPE would be prudent if dealing with the general public during a pandemic or other situation where exposure to harmful substances could occur.

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Why Should I Care?

You could find yourself in a situation where PPE would reduce your chances of being harmed. For example, think about the chemical fire in Marietta in May, 2014. Basic PPE could prevent inhalation of particulates, eye exposure.

But know what PPE can’t do!

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Why Should I Care?

Lives will be saved if bystanders can provide initial care to survivors of an incident: manage bleeding, blocked airways, burns, hypothermia, drowning.

All MRC members should strive to be able to help in this way. Some basic PPE could protect you.

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WHAT CAN PPE PROTECT AGAINST?

The type of PPE you are most likely to have available can NOT protect you against gas, chemical, or radiation exposure. It can protect you against body fluids and inhaled particles the size of bacteria and some viruses.

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How do influenza viruses spread among humans? This demonstrates a common way for diseases to be transmitted.

Seasonal human influenza viruses are most likely spread from person to person through droplets at close range when an infected person coughs, sneezes or talks. There is limited evidence that seasonal human influenza is transmitted close distances through the air and transmission may occur during aerosol-generating medical procedures. Seasonal human influenza can persist in the environment (for example, on surfaces) and so is thought to be spread through direct and indirect contact.

It is believed that most cases of avian influenza in humans is caused by close contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds. For example, activities such as plucking and preparing ill birds, handling fighting cocks and consumption of duck’s blood or possibly undercooked poultry have all been implicated in bird-to-human cases of avian influenza. Person-to-person spread of avian influenza viruses has been reported very rarely thus far. To date, all secondary cases have had close contact with primary cases and have not used any type of personal protection (such as gloves or face masks).

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Types of PPE

Gloves

Gowns/coveralls

Masks/respirators

Footwear Covers

Eye protection

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Masks and Respirators: Barriers and Filtration

Surgical masks

Cotton, paper
Protect against body fluids and large particles

Particulate respirators (N95)

Fit testing essential
Protect against small droplets and other airborne particles

Alternative materials (barrier)

Tissues, cloth

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Masks are another type of PPE. Wear masks that fully cover your nose and mouth to prevent fluid penetration. Masks should fit snugly, so ones with a flexible nose piece that can be secured to the head with string ties or elastic are preferable.

Respirators that filter the air before it is inhaled have been designed to protect the respiratory tract from airborne transmission of infectious agents. A commonly used respirator in healthcare settings is the N95 particulate respirator. The device has a sub-micron filter tested for exclusion of particles in the respirable size range, e.g., 0.3 microns. Prior to use, respirators should be fit tested for the appropriate size. And you should always check your respirator before use to make sure it has a proper seal.

Please note that there are many other masks and respirators on the market that have not been cleared by the FDA for medical use. These may include respirators certified by the National Institute for Occupational Safety and Health (NIOSH), and intended for use in other occupational settings, such as woodworking, metalworking, and masonry. The N95 surgical respirator is the one that has been NIOSH approved and cleared by the FDA for medical use. See http://www.fda.gov/cdrh/ppe/masksrespirators.html. Although the N95 respirator is recommended, there are other respirators that provide equal or better protection, including the 8 other types of particulate respirators (next slide), and powered air purifying respirators (PAPRs).

If surgical masks and respirators are not available, other materials such as tissues and cloth may be used to cover the nose and mouth. While the efficacy of these materials has not been scientifically evaluated, they are probably better than no mouth covering at all.

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PPE for Standard Precautions

Wear:

Gloves

Gown or coverall

Eye Protection and Mask

ALL

If:

Touching respiratory secretions, contaminated items or surfaces, blood, other body fluids

Handling soiled clothes, linens, other items with patient body fluids, secretions, or excretions

Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions

IF IN DOUBT.

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Under standard precautions,

Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated.
Wear a gown if soiling of clothes with a patient's body fluids, respiratory secretions, or excretions is anticipated.
Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
Change gloves and gowns after each patient encounter and perform hand hygiene.
Decontaminate hands before and after touching the patient and after touching the patient's environment or the patient's respiratory secretions, whether or not gloves are worn.
When hands are visibly soiled or contaminated, wash hands with soap (either plain or antimicrobial) and water.
If hands are not visibly soiled, you can use an alcohol-based hand rub.

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Sequence for Donning PPE

STOP! Assess the situation. Should I even be here???
Determine what level of PPE is needed.
Engage trained observer or buddy.
Carefully inspect all items. Look for rips, tears, any other sign of damage.
Don’t forget gravity!
Remove jewelry, trim nails if longer than ¼”

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Sequence for Donning PPE

Hand hygiene
Shoe covers if not part of coverall
Inner gloves (inside gown/coverall cuffs)
Gown/coverall and hood
N95 Particulate respirator
If needed, outer gloves (outside cuffs)
Goggles or face shield
Verify

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Gloves

Select correct type and size

Insert hands into gloves

Pull up so no wrinkles or sagging

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Finally, we will discuss gloves. Gloves will be the last PPE item that you don when preparing to work with a patient. Be sure to select the type of glove needed for the task in the size that best fits you. To review from earlier in the session, thick rubber gloves may be used for cleaning or housekeeping purposes in a patient’s room. Clean gloves might be used for general contact in the room or with the patient, while sterile gloves should be used when collecting specimens or conducting any type of medical procedure on the patient.

Insert each hand into the appropriate glove and adjust the gloves as needed for comfort and dexterity. If you are wearing an isolation gown, tuck the gown cuffs securely under each glove. This will provide a continuous barrier protection for your skin.

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N95 Particulate Respirator

Pay attention to size (S, M, L)
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic (inside hood)
Adjust to fit and check for fit:

Inhale – respirator should collapse

Exhale – check for leakage around face

Facial hair a problem? Use PAPR.

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The technique for donning a particulate respirator, such as an N95, N99 or N100, is similar to putting on a pre-formed mask with elastic head bands. First, note which size you have. Then place the respirator over the nose, mouth, and chin. Fit the flexible nose piece securely over the bridge of your nose, secure the mask onto your head with elastic, and adjust the elastic to fit.

With N95 and other particulate respirators, however, you must select a respirator for which you have been fit tested and you must fit-check the device before entering an area where there may be airborne infectious disease. To fit-check a respirator, inhale and the respirator should collapse. When you exhale, check for air leaking around the mask on your face.

Be sure to follow the manufacturer’s instructions for donning the device. In some instances, the manufacturer’s instructions may differ slightly from this presentation.

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Goggles

Position goggles over eyes and secure to the head using the ear pieces or headband

Adjust to fit comfortably

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Gloves

Don outer gloves last

Select correct type and size

Insert hands into gloves

Extend gloves over gown cuffs and tape

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Finally, we will discuss gloves. Gloves will be the last PPE item that you don when preparing to work with a patient. Be sure to select the type of glove needed for the task in the size that best fits you. To review from earlier in the session, thick rubber gloves may be used for cleaning or housekeeping purposes in a patient’s room. Clean gloves might be used for general contact in the room or with the patient, while sterile gloves should be used when collecting specimens or conducting any type of medical procedure on the patient.

Insert each hand into the appropriate glove and adjust the gloves as needed for comfort and dexterity. If you are wearing an isolation gown, tuck the gown cuffs securely under each glove. This will provide a continuous barrier protection for your skin.

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Key Infection Control Points

Minimize exposures

Plan before entering room

Avoid adjusting PPE after patient contact

Do not touch eyes, nose or mouth!

Avoid spreading infection

Limit surfaces and items touched

Change torn gloves

Wash hands before donning new gloves

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Duration of PPE Use

Gloves

Never reuse

Surgical Masks/N95

Respirators

Wear once and discard
Discard if moist
Can be reused for a

Limited time if absolutely necessary

Eye Protection

May wash, disinfect, reuse indefinitely

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Sequence for Removing PPE

Remove in anteroom when possible

Engage trained observer or buddy.
Disinfect outer gloves, remove, discard
Inspect and disinfect inner gloves
Remove goggles
Disinfect inner gloves
Remove coverall (hood first if separate)
Disinfect inner gloves (replace if attached to coverall

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The sequence for removing PPE is intended to limit opportunities for self-contamination; the exact order is not as important as limiting contamination, so you can change it if necessary.

Ideally, PPE should be removed in the anteroom. If there is no anteroom, make sure that the environment (and people) outside of the isolation room are not at risk of contamination. First, remove gloves, discard them, and then wash your hands. Next remove the gown, and apron, if you are wearing one. Then remove goggles, mask, and cap (if worn) and place those items in appropriate containers. Always use your health care facility’s protocol for any items that need to be discarded. The last item to remove will be any boots that you are wearing. Place those in an appropriate container. You will then wash your hands for a second time, this time up to the wrists, with soap and water, and dry them. The final step is to decontaminate your hands using a 70% alcohol hand rub before you leave the facility.

Non Hospital Settings: If shoe covers are worn they can be removed with gown. However shoe covers aren't generally recommended for most healthcare settings for infection control purposes. If head covering and boots are worn, they can be sequentially removed after the mask.

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Sequence for Removing PPE

Remove foot covering (if separate)
Change inner gloves
Remove N95 respirator
Disinfect new inner gloves
Disinfect shoes
Disinfect inner gloves
Remove and discard inner gloves
Perform hand hygiene
Review self for contaminants
Exit the doffing area.

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The sequence for removing PPE is intended to limit opportunities for self-contamination; the exact order is not as important as limiting contamination, so you can change it if necessary.

Ideally, PPE should be removed in the anteroom. If there is no anteroom, make sure that the environment (and people) outside of the isolation room are not at risk of contamination. First, remove gloves, discard them, and then wash your hands. Next remove the gown, and apron, if you are wearing one. Then remove goggles, mask, and cap (if worn) and place those items in appropriate containers. Always use your health care facility’s protocol for any items that need to be discarded. The last item to remove will be any boots that you are wearing. Place those in an appropriate container. You will then wash your hands for a second time, this time up to the wrists, with soap and water, and dry them. The final step is to decontaminate your hands using a 70% alcohol hand rub before you leave the facility.

Non Hospital Settings: If shoe covers are worn they can be removed with gown. However shoe covers aren't generally recommended for most healthcare settings for infection control purposes. If head covering and boots are worn, they can be sequentially removed after the mask.

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Removing Gloves (1)

Grasp outside edge near wrist

Peel away from hand, turning glove inside-out

Hold in opposite gloved hand

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Removing Gloves (2)

Slide ungloved finger under the wrist of the remaining glove

Peel off from inside, creating a bag for both gloves

Discard

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Removing Goggles

Grasp where elastic band joins to goggle
Pull gently away from face
Lift up over hood and back; don’t let elastic snap!
Discard properly

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Removing The N95 Respirator

Don’t touch front of mask!
Lift the bottom elastic over your head first
Gently lift the top elastic over your head, allowing the mask to fall forward
Discard

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Waste Disposal

Use Standard Precautions

Gloves and hand washing
Gown + Eye protection

Avoid aerosolization

Prevent spills and leaks

Double bag if outside of bag is contaminated

Incineration is usually the preferred method

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Standard precautions should be followed when handling waste from patients infected with avian influenza. This includes practicing hand hygiene and wearing gloves, a gown, and eye protection.

Although the possibility of transmission of avian influenza infection via human feces is unknown, waste should be handled with caution, and any potential aerosolization should be avoided. For example, aerosolization could occur as you remove feces from bedpans, commodes, clothing, or reusable incontinence pads by spraying the items with water.

All waste generated in the isolation room or patient care area should be removed in suitable containers or bags that do not allow for spillage or leakage of contents. One waste disposal bag should be adequate if waste can be placed in the bag without contaminating the outside of the bag. If the outside of the bag becomes contaminated, a second bag should be placed over the first bag (this is called double bagging). If additional bags are not available, clean and disinfect the outside of the bag before removing it from room. When transporting waste outside of the isolation room or patient care area, use gloves followed by hand hygiene.

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Summary

Contact with contaminants can be prevented using correct PPE
Viruses can be inactivated with infection control procedures
Hand washing is key
PPE must be donned and removed appropriately to prevent contamination of wearers and environments
Guidelines for using PPE and infection control measures should be practiced until they are routine

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For Emergencies…

you should keep on hand

A fresh (no more than six months old) bottle of household chlorine bleach
Several N95 particulate respirators
Several pairs of disposable gloves
At least one disposable coverall or one you can discard.

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Remember…

Your first obligation is to protect yourself!

If you have any doubt about your safety in any situation, avoid that situation!

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For more information

Standard Precautions

https://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html

Donning/Doffing PPE

https://www.medscape.com/viewarticle/833907

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