use of ppes

Dr. Michael O. OjiChair, Infection Control, Lagoon

HospitalsInfection Control Ambassador for

Society for Healthcare Epidemiology of America (SHEA)

Learning Objectives

Introduction Definitions Infection Control

Precautions Indications and

Types

Appropriate Use Challenges Conclusion Recommendations References

Understand what are PPEs.

Understand basic principles of Infection Control Precautions.

Understand Appropriate Use.

Understand the Risks and how to manage them.

“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.

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

• Specialized

• Personal

• Protective

• Equipment

• 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

• 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

• 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

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

• 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

• 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

• 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

• 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

MRSA VRE EVD

Droplet Precautions – Surgical masks within 3 feet of patient

Common cold Influenza EVD

Airborne Infection Isolation – Particulate respirator

>3feet TB ?EVD

Gloves and Gowns Head and Shoe

covers Eye and face

protection Apron

Face Shield

Respirator

Strapping

Hazmat Suit

Boot

Glove

Goggle

Head Cover

• 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

Gloves Gowns Shoes and Head

Covers Masks and

Respirators Face and Eye

Protection

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.

• Don gloves last• Select correct type and size• Insert hands into gloves

• Extend gloves over isolation gown cuffs

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.

Barrier for Environmental Protection.

Use for Haemorrahgic diseases

When sprays or airborne exposure

Must be worn as part of FBP

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)

• Gown first• Mask or respirator• Goggles or face shield• GlovesCombination of PPE will affect

sequence – be practical

• 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

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit

• 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

Protect mucous membranes of eyes, nose, mouth and facial skin.

Part of Standard & Resp. Precaution.

• 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

• 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

GoggleShield

Respirator

strapping Apron

Hazmat Suit

Gloves

Boots

Who or What?

What is the Risk?

What Precaution type?

What Components?

Manufacturers Specifications?

Donning and Doffing?

Unidirectional?

Appropriate Disposal

Documentation

MRSA

TB

HiNI

EVD/ Haemorrahgic Fevers

An Assistant?

Pre-planned & Sequential .

Remove apron Shoe covers and

Outer gloves and shoe cover.

Step into Hazard Bag

• 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

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

• 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

• Grasp outside edge near wrist• Peel away from hand, turning glove inside-

out• Hold in opposite gloved hand

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• Discard

• Grasp ear or head pieces with ungloved hands

• Lift away from face• Place in designated receptacle for

reprocessing or disposal

• Unfasten ties• Peel gown away from neck and shoulder• Turn contaminated outside toward the

inside• Fold or roll into a bundle• Discard

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

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

Cost Availability Training Appropriate Use Appropriate Disposal

Cost Availability Training Appropriate Use Appropriate

Disposal

Correct PPE Use

Protect yourself and others

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings . CDC.

WHO. Standard Precautions in HealthCare. Oct 2007. Infection Control