How to put on and remove personal protective equipment

Put personal protective equipment

An alleged “protocol breach” caused a Texas nurse with full personal protective equipment (PPE) to contract the Ebola virus. Unfortunately very few healthcare workers have been trained in the proper measures to avoid transmission of such a contagious disease. One such measure is to adequately put on and remove PPE. The most basic sequence for putting on PPE is as follows (though the protocol should be customized to suit the specific type of PP, which varies depending on the level of protection required).

  1. Gown.

-        Completely cover torso from neck to knees, arms to end of wrists, and wrap around the back.

-        Fasten in the back of the neck and waist.

  1. Mask or respirator.

-        Fix ties or elastic bands at the middle of the head and neck.

-        Secure flexible band to the bridge of the nose.

-        Fit tightly to face and below the chin.

-        Fit-check respirator.

  1. Goggles/face shield.

-        Put on over the face and eyes and adjust to fit.

  1. Gloves.

-        Extend to cover the wrist of the isolation gown.

Safety habits that can decrease the spread of contamination while wearing PPE include:

-        Keeping hands away from the face.

-        Touching as few surfaces as possible.

-        Changing gloves as soon as they rupture or become heavily contaminated.

-        Performing hand hygiene.

How to remove personal protective equipment safely

Method 1

Method 2

Gloves

·         With a gloved hand, grab the palm area of the other gloved hand and peel off the first glove.

·         Hold removed glove in gloved hand.

·         Slide fingers of ungloved hand under the wrist of remaining glove and peel off the second glove over the first.

·         Dispose of gloves in an infectious waste container.

Gowns and gloves

·         Grab the front of the gown and pull away from the body breaking the ties. Touch only the outside of the gown with gloved hands.

·         Fold or roll the gown inside out.

·         Peel off gloves at the same time as you remove the gown. Touch only the inside of the gloves and gown with bare hands.

·         Place in an infectious waste container.

Goggles/face shield

·         Remove from the back by lifting head band or ear pieces.

·         Place in a designated receptacle if reusable. If disposable, discard in an infectious waste container.

Goggles/face shield

·         Remove from the back by lifting the head band. Don’t touch the front of the goggles or face shield.

·         Place in a designated receptacle if reusable. If disposable, discard in an infectious waste container.

Gown

·         Unfasten ties, making sure that sleeves don’t touch your body when reaching for the ties.

·         Pull away from neck and shoulders, touching only the inside of the gown.

·         Turn inside out.

·         Fold or roll and discard in an infectious waste container.

Mask/respirator

·         Grab bottom ties or elastics and then the top ones and remove. Don’t touch the front.

·         Discard in an infectious waste container.

Mask/respirator

·         Grab bottom ties or elastics and then the top ones and remove without touching the front.

·         Discard in an infectious waste container.

 

 

In both methods, health workers should wash their hands or use an alcohol-based sanitizer as soon as they remove all personal protective equipment. They should also perform hand hygiene in between steps if their hands become contaminated. The outside of all PPE items is contaminated and must not be touched. Potentially Ebola-contaminated PPE should be discarded in an infectious waste container. 

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