Use of PPEs

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

2. Outline • Appropriate Use • Challenges • Conclusion • Recommendations • References • Learning Objectives • Introduction • Definitions • Infection Control Precautions • Indications and Types

3. Learning Objectives • Understand Appropriate Use. • Understand the Risks and how to manage them. • Understand what are PPEs. • Understand basic principles of Infection Control Precautions.

4. 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.

5. Definitions-PPEs • Specialized • Personal • Protective • Equipment • specialized clothing or equipment worn by an employee for protection against hazardous/ infectious materials.

6. Infection Control Precautions • Standard • Contact • Droplet • Airborne • Full Barrier • 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.

7. 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

8. 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

9. 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

10. What Type of PPE Would You Wear? • Drawing blood from a vein? • Cleaning an incontinent patient with diarrhea? • Irrigating a wound? • Taking vital signs • Giving a bed bath? • Suctioning oral secretions? • Transporting a patient in a wheel chair? • Responding to an emergency where blood is spurting?

11. What Type of PPE Would You Wear? • 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 • 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

12. 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 patient’s environment • Droplet Precautions – Surgical masks within 3 feet of patient • Airborne Infection Isolation – Particulate r • eNegative pressure isolation room also required • spirator

13. Contact Precautions • MRSA • VRE • EVD • 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 patient’s environment

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

15. Airborne Precaution • Airborne Infection Isolation – Particulate respirator • >3feet • TB • ?EVD

16. 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

17. 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

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

19. 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.

20. How to Don Gloves • Don gloves last • Select correct type and size • Insert hands into gloves • Extend gloves over isolation gown cuffs

21. 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.

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

23. 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)

24. Sequence* for Donning PPE • Gown first • Mask or respirator • Goggles or face shield • Gloves • Combination of PPE will affect sequence – be practical

25. 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

26. 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

27. 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

28. Face and Eye Protection. • Protect mucous membranes of eyes, nose, mouth and facial skin. • Part of Standard & Resp. Precaution.

29. 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

30. 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

31. Principles Guiding the Use of PPEs • Donning and Doffing? • Unidirectional? • Appropriate Disposal • Documentation • Who or What? • What is the Risk? • What Precaution type? • What Components? • Manufacturers Specifications?

32. PPE matrix

33. KYP? • MRSA • TB • HiNI • EVD/ Haemorrahgic Fevers

34. Donning

35. Doffing-Removing PPEs

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

37. “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

38. Sequence for Removing PPE • Gloves • Face shield or goggles • Gown • Mask or respirator

39. 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

40. Removing PPEs ? Ebola

41. How to Remove Gloves (1) • Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand

42. 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

43. 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

44. 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

45. Removing a Mask • Untie the bottom, then top, tie • Remove from face • Discard

46. Removing a Particulate Respirator • Lift the bottom elastic over your head first • Then lift off the top elastic • Discard

47. Challenges • Cost • Availability • Training • Appropriate Use • Appropriate Disposal

48. Challenges • Cost • Availability • Training • Appropriate Use • Appropriate Disposal

49. Conclusion • Correct PPE Use • Protect yourself and others

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