PPE Donning and Doffing: Introduction, Requirements, Procedure and Application

PPE Donning and Doffing: Introduction, Requirements, Procedure and Application

Introduction of PPE Donning and Doffing

PPE stands for personal protective equipment. Definition according to OSHA( Occupational Safety and Health Administration)-“PPE  is specialized clothing or equipment, worn by an employee for protection against infectious materials.” It includes gloves, gowns, shoe covers, head covers, masks, respirators, eye protection, face shields, and goggles. PPE donning means putting on and PPE doffing means taking off or removing PPE.  PPE donning and doffing is very important method in health care set up for health care workers to save yourself and surrounding to save from infectious materials.

Requirements for PPE Donning and Doffing

Requirements for PPE donning and doffing  are totally depending on types of PPE used in healthcare settings. Common requirements are as follows-

  • PPE set that contains gloves, gowns, shoe covers, head covers, masks, respirators, eye protection, face shields, and goggles.
  • 70 % ethanol
  • Adhesive tapes
  • Waste bins
  • Scissor
  • Scrubs

Procedure of PPE Donning and Doffing

Sequence of Donning

  1. Perform hand hygiene:
  2. Put on shoe covers (if applicable)
  3. Put on gown: Purpose of use
    • Material
    – Natural or man-made
    – Reusable or disposable
    – Resistance to fluid penetration
    • Clean or sterile : 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
  4. Put on mask/respirator (if applicable): Masks – protect nose and mouth
    – Should fully cover nose and mouth and prevent fluid penetration  Purpose –protect from inhalation of infectious aerosols (e.g. Mycobacterium tuberculosis)
    • PPE types for respiratory protection
    – Particulate respirators
    – Half or full face elastomeric respirators
    – Powered air purifying respirators (PAPR): Using mask procedure– Place over nose, mouth and chin
    • Fit flexible nose piece over nose bridge
    • Secure on head with ties or elastic
    • Adjust to fit: 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
  5. Put on eye protection (if applicable): Goggles – protect eyes
    – Should fit snuggly over and around eyes
    – Personal glasses not a substitute for goggles
    – Antifog feature improves clarity Face shields – protect face, nose, mouth, and eyes
    – Should cover forehead, extend below chin and wrap around side of face: 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
  6. Put on gloves: Purpose – patient care, environmental
    services, other
    • Glove material – vinyl, latex, nitrile, other
    • Sterile or nonsterile
    • One or two pair
    • Single use or reusable:  How to use gloves
    • Don gloves last
    • Select correct type and size
    • Insert hands into gloves
    • Extend gloves over isolation gown cuffs

Sequence of Doffing

  1. Remove shoe covers (if applicable) without touching contaminated part.
  2. Remove gloves:
    • Grasp outside edge near wrist
    • Peel away from hand, turning glove inside-out
    • Hold in opposite gloved hand and slide ungloved finger under the wrist of the remaining glove
    • Peel off from inside, creating a bag for both gloves
    • Discard
  3. Remove gown: Unfasten ties
    • Peel gown away from neck and shoulder
    • Turn contaminated outside toward the inside
    • Fold or roll into a bundle
    • Discard
  4. Perform hand hygiene: Use an alcohol-based hand rub.
  5. Remove eye protection like goggles, face shield (if applicable):Grasp ear or head pieces with ungloved hands
    • Lift away from face
    • Place in designated receptacle for reprocessing or disposal
  6. Remove mask/respirator (if applicable): Removing a Mask
    • Untie the bottom, then top, tie
    • Remove from face
    • Discard  and Removing a Particulate Respirator:
    • Lift the bottom elastic over your head first
    • Then lift off the top elastic
    • Discard
  7. Perform hand hygiene:  Perform hand hygiene immediately after
    removing PPE.
    – If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE
    • Wash hands with soap and water or use an alcohol-based hand rub.
    PPE Use in Healthcare Settings: Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub.

Application of PPE

  • Improve personnel safety in the healthcare environment through appropriate use of PPE.
  • Gloves protect hands.
  • Gowns or aprons  protect skin and/or clothing.
  • Masks and respirators protect mouth/nose.
  • Respirators protect respiratory tract from airborne infectious agents.
  • Goggles protect eyes.
  • Face shields protect face, mouth, nose, and eyes.

References

  1. https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf
  2. https://www.aaha.org/aaha-guidelines/infection-control configuration/protocols/personal-protective-equipment/
  3. https://www.who.int/csr/resources/publications/Contact-Droplet-COVID-19-Precautions.pdf?ua=1
  4. https://www.health.state.mn.us/facilities/patientsafety/infectioncontrol/ppe/comp/index.html
  5. http://www.cdc.gov/niosh/npptl/respirators/
    respsars.html
  6. http://www.cdc.gov/niosh/99-143.html
  7. http://www.cdc.gov/niosh/topics/respirators
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