Use%20of%20PPEs

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Use of PPEs

• Dr. Michael O. Oji
• Chair, Infection Control, Lagoon Hospitals
• Infection Control Ambassador for Society for
  Healthcare Epidemiology of America (SHEA)

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Outline

• Learning Objectives
• Introduction
• Definitions
• Infection Control Precautions
• Indications and Types

• Appropriate Use
• Challenges
• Conclusion
• Recommendations
• References

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Learning Objectives

• Understand what are PPEs.
• Understand basic principles of Infection Control
  Precautions.

• Understand Appropriate Use.
• Understand the Risks and how to manage them.

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Introduction
We must never accept that injury, illness or
death is the cost of doing business." President
Obama April 2014
"No one should have to sacrifice their life for
their livelihood, because a nation built on the
dignity of work must provide safe working
conditions for its people." Secretary of Labor
Thomas E. Perez.
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Definitions-PPEs

• specialized clothing or equipment worn by an
  employee for protection against hazardous/
  infectious materials.

• Specialized
• Personal
• Protective
• Equipment

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Infection Control Precautions

• Infection control precautions are a set of
  standard recommendations designed to reduce the
  risk of transmission of infectious agents from
  body fluids or environmental surfaces that
  contain infectious agents.

• Standard
• Contact
• Droplet
• Airborne
• Full Barrier

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Standard Precautions

• Previously called Universal Precautions
• Assumes blood and body fluid of ANY patient could
  be infectious
• Recommends PPE and other infection control
  practices to prevent transmission in any
  healthcare setting
• Decisions about PPE use determined by type of
  clinical interaction with patient

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PPE for Standard Precautions (1)

• Gloves Use when touching blood, body fluids,
  secretions, excretions, contaminated items for
  touching mucus membranes and non intact skin.
• Gowns Use during procedures and patient care
  activities when contact of clothing/ exposed skin
  with blood/body fluids, secretions, or excretions
  is anticipated

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PPE for Standard Precautions (2)

• Mask and goggles or a face shield Use during
  patient care activities likely to generate
  splashes or sprays of blood, body fluids,
  secretions, or excretions

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What Type of PPE Would You Wear?

• Giving a bed bath?
• Suctioning oral secretions?
• Transporting a patient in a wheel chair?
• Responding to an emergency where blood is
  spurting?

• Drawing blood from a vein?
• Cleaning an incontinent patient with diarrhea?
• Irrigating a wound?
• Taking vital signs

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What Type of PPE Would You Wear?

• Giving a bed bath?
• Generally none
• Suctioning oral secretions?
• Gloves and mask/goggles or a face shield
  sometimes gown
• Transporting a patient in a wheel chair?
• Depends on the pt-gloves,face-mask?
• Responding to an emergency where blood is
  spurting?
• Gloves, fluid-resistant gown, mask/goggles or a
  face shield

• Drawing blood from a vein?
• Gloves
• Cleaning an incontinent patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?
• Gloves, gown, mask/goggles or a face shield
• Taking vital signs?
• Generally none

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Use of PPE for Expanded Precautions

• Contact Precautions Gown and gloves for contact
  with patient or environment of care (e.g.,
  medical equipment, environmental surfaces)
• In some instances these are required for entering
  patients environment
• Droplet Precautions Surgical masks within 3
  feet of patient
• Airborne Infection Isolation Particulate r
• eNegative pressure isolation room also required
• spirator

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Contact Precautions

• Contact Precautions Gown and gloves for contact
  with patient or environment of care (e.g.,
  medical equipment, environmental surfaces)
• In some instances these are required for entering
  patients environment

• MRSA
• VRE
• EVD

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Droplet Precautions

• Droplet Precautions Surgical masks within 3
  feet of patient
• Common cold
• Influenza
• EVD

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Airborne Precaution

• Airborne Infection Isolation Particulate
  respirator
• gt3feet
• TB
• ?EVD

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Full Barrier Precaution

• Gloves and Gowns
• Head and Shoe covers
• Eye and face protection

Head Cover
Face Shield
Goggle
Respirator
Strapping
Apron
Hazmat Suit
Glove
Boot
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Hand Hygiene

• Required for Standard and Expanded Precautions
• Perform
• Immediately after removing PPE
• Between patient contacts
• Wash hands thoroughly with soap and water or use
  alcohol-based hand rub

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Components

• Gloves
• Gowns
• Shoes and Head Covers
• Masks and Respirators
• Face and Eye Protection

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Gloves

• Directly handling potentially infectious or
  contaminated surfaces.
• Change when visibly soiled, torn or punctured.
• Part of Standard or Contact Precaution
• Hand Hygiene on Removing gloves.

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How to Don Gloves

• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs

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Gowns

• Protect from potentially infectious material
• Cover torso, close body fitting, arms to wrists.
• Appropriate Disposable, Re-Useable,
  Fluid-Resistant, Non-Fluid resistant, Sterile
  ,Clean
• Standard and Contact P.

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Shoes and Head Covers

• Barrier for Environmental Protection.
• Use for Haemorrahgic diseases
• When sprays or airborne exposure
• Must be worn as part of FBP

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Masks (M)and Respirators(R)

• M. protects nose and mouth from splattered body
  fluids.
• R. filters air before inhalation
• Disposable R N95
• Powered Air Purifying R. (PAPR)
• Self Contained Breathing Apparatus R. (SCBA)

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Sequence for Donning PPE

• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves
• Combination of PPE will affect sequence be
  practical

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How to Don a Gown

• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
• Gown 1 ties in front
• Gown 2 ties in back

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How to Don a Mask

• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit

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How to Don a Particulate Respirator

• Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check
• Inhale respirator should collapse
• Exhale check for leakage around face

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Face and Eye Protection.

• Protect mucous membranes of eyes, nose, mouth
  and facial skin.
• Part of Standard Resp. Precaution.

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How to Don Eye and Face Protection

• Position goggles over eyes and secure to the head
  using the ear pieces or headband
• Position face shield over face and secure on brow
  with headband
• Adjust to fit comfortably

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Using your PPEs

• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn perform hand
  hygiene before donning new gloves
• Limit surfaces and items touched

Head Cover
Shield
Goggle
Respirator
strapping
Apron
Hazmat Suit
Gloves
Boots
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Principles Guiding the Use of PPEs

• Who or What?
• What is the Risk?
• What Precaution type?
• What Components?
• Manufacturers Specifications?

• Donning and Doffing?
• Unidirectional?
• Appropriate Disposal
• Documentation

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PPE matrix
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KYP?

• MRSA
• TB
• HiNI
• EVD/ Haemorrahgic Fevers

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Donning
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Doffing-Removing PPEs
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Doffing

• An Assistant?
• Pre-planned Sequential .
• Remove apron
• Shoe covers and Outer gloves and shoe cover.
• Step into Hazard Bag

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Contaminated and Clean Areas of PPE

• Contaminated outside front
• Areas of PPE that have or are likely to have been
  in contact with body sites, materials, or
  environmental surfaces where the infectious
  organism may reside
• Clean inside, outside back, ties on head and
  back
• Areas of PPE that are not likely to have been in
  contact with the infectious organism

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Sequence for Removing PPE

• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

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Where to Remove PPE?

• At doorway, before leaving patient room or in
  anteroom
• Remove respirator outside room, after door has
  been closed
• Ensure that hand hygiene facilities are
  available at the point needed, e.g., sink or
  alcohol-based hand rub

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Removing PPEs ? Ebola
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How to Remove Gloves (1)

• Grasp outside edge near wrist
• Peel away from hand, turning glove inside-out
• Hold in opposite gloved hand

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How to Remove 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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Remove Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands
• Lift away from face
• Place in designated receptacle for reprocessing
  or disposal

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Removing Isolation Gown

• Unfasten ties
• Peel gown away from neck and shoulder
• Turn contaminated outside toward the inside
• Fold or roll into a bundle
• Discard

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Removing a Mask

• Untie the bottom, then top, tie
• Remove from face
• Discard

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Removing a Particulate Respirator

• Lift the bottom elastic over your head first
• Then lift off the top elastic
• Discard

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Challenges

• Cost
• Availability
• Training
• Appropriate Use
• Appropriate Disposal

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Challenges

• Cost
• Availability
• Training
• Appropriate Use
• Appropriate Disposal

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Conclusion

• Correct PPE Use
• Protect yourself and others

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References

• 2007 Guideline for Isolation Precautions
  Preventing Transmission of Infectious Agents in
  Healthcare Settings . CDC.
• WHO. Standard Precautions in HealthCare. Oct
  2007. Infection Control