Best infection control practices, PPE, Donning, Doffing, and Hand hygiene during COVID -19 for health care professionals

1. Manju Mulamoottil Abraham

2. A coronavirus is a kind of common virus that causes an infection in your nose,
sinuses, or upper throat.
Coronaviruses were first identified in the 1960s
a new type, 2019 novel coronavirus (2019-nCoV)- Outbreak in China
Middle East Respiratory Syndrome (MERS) -2014
Severe Acute Respiratory Syndrome ( SARS ): 2003,
Manju Mulamoottil Abraham

3. Symptoms can show up anywhere from 2 to 14 days after exposure
* Common cold Symptoms ( running nose, sneezing, weakness and body pain)
* Fever
*Cough
* Sore throat
*Shortness of breath
Most coronaviruses spread the same way other cold-causing viruses do: through
infected people coughing and sneezing, by touching an infected person's hands
or face, or by touching public things such as doorknobs that infected people have
touched.
Manju Mulamoottil Abraham

4. *There is currently no vaccine to prevent coronavirus.
*Wash your hands thoroughly with soap and water or with an alcohol-based
hand sanitizer(with atleast 60% alcohol).
*Keep your hands and fingers away from your eyes, nose, and mouth.
*Avoid close contact with people who are infected.
You treat a coronavirus infection the same way you treat a cold:
*Take medical advice and screening.
*Get plenty of rest.
*Drink fluids.
*Take medical help if your cold and cough persisting for more than three days.
Manju Mulamoottil Abraham

5. THE DO’S ON CORONAVIRUS DISEASE (COVID-19)
Wash your hands frequently with soap and water or, use an alcohol-based hand rub.
Cover your mouth and nose with tissue when coughing and sneezing. Sanitize the
hands immediately after discarding the tissue
Maintain reasonable distance between yourself and someone who is coughing,
sneezing (at least 1 meter apart).
Avoid touching your eyes, nose and mouth. Hands touch many surfaces which can
be contaminated with the virus and you can transfer the virus from the surface to
yourself
If you have fever, cough and difficulty in breathing, seek medical care immediately.
If you are caring for individuals who have symptoms, such as cough and fever you
are encouraged to use a face mask to cover your nose and mouth for personal
protection.
Clean and disinfect frequently touched surfaces such as doorknobs/handles, car
doors, elevator buttons etc. daily with regular household disinfectant or soap and
water.
People with flu-like symptoms should use face masks to cover the nose and mouth
and stay home in a well-ventilated room.
Manju Mulamoottil Abraham

6. DON’TS ON CORONAVIRUS DISEASE (COVID-19)
Avoid hand shaking
Avoid close contact with people who are visibly sick with flu-like symptoms (fever,
cough, sneeze)
When sick with flu-like symptoms avoid going to public places, offices and public
gatherings. remain at home to avoid infecting others.
Don’t take self-medication such as antibiotics
Do NOT spit in public. Find a secluded place like toilets or pit latrines in which to spit
Delay travel to countries that currently have many patients with Coronavirus disease.
If you MUST travel, please follow the above protective measures.
Avoid travel if you have flu-like symptoms.
Avoid touching eyes, nose, mouth and ears.
Manju Mulamoottil Abraham

7. Perform hand hygiene
Hand hygiene can help prevent illness.
Wash your hands often with soap and water for
at least 20 seconds.
Do not rinse or wipe off the hand sanitizer
before it’s dry; it may not work as well against
germs.
Manju Mulamoottil Abraham

8. - to protect from exposure to COVID19
The necessary PPE required for the appropriate care of patients with or under
investigation for COVID-19
-Disposable isolation gown
-Fit tested N95 Respirator( mask)
-Face shield/eye protection
-Patient care gloves
Prior to Donning PPE
-Donning PPE must always take place in an area where it is safe to be without PPE.
-Gather all PPE items
-Don all PPE prior to entering the patient care area.
Donning PPE
1. Perform hand hygiene
2. Gown -protect skin and/or clothing
3. N95 Respirator - protect respiratory tract from airborne infectious agents
4. Face shield/eye protection- protect face, mouth, nose, and eyes
5. Gloves - protect hands
Manju Mulamoottil Abraham

9. Donning Step 1: Perform Hand Hygiene
• Apply one pump of hand sanitizer to the cupped palm of one hand
• Rub hands palm to palm
• Rub the right palm over the back of the left hand with interlaced fingers and
vice versa
• Rub both palms together with fingers interlaced
• With the left thumb clasped in the right palm, rub rotationally and switch
• Cup the hands and place the backs of fingers to opposing palms and rub side
to side with fingers interlocked
• Rotationally rubbing the clasped fingers of the right hand in a circular pattern on
the palm of the left hand and vice versa
• Continue to rub both hands together until the sanitizer is dry
Donning PPE
Manju Mulamoottil Abraham

10. Donning Step 2: Don Gown
• Double check gown for defect and untie any knots in the PPE
• Don the gown by inserting your arms into the sleeves with the opening to the
back
• Tie the neck and waist ties in bows that are easy to release as this will facilitate
easy removal by eliminating the need to struggle with untying knots
Donning Step 3: Don N95 Respirator
• Hold the respirator in the palm of your hand with straps facing the floor
• Place N95 respirator on your face covering your nose and mouth
• Pull the bottom strap over the top of your head and place at the nape of your
neck below the ear.
• Pull the upper strap over and place it behind your head towards the crown of
your head
• Mold the nose piece using pads of fingers over the cheeks and bridge of your
nose to obtain a tight seal. Be careful not to pinch the dose
• Perform a seal check by taking a few deep breaths and feeling around the
mask for escaping air to ensure there is good seal against the skin.
• Staff must resist the temptation to adjust the N95 respirator while in the patient
care area
Manju Mulamoottil Abraham

11. Donning Step 3: Don N95 Respirator
• Hold the respirator in the palm of your hand with straps facing the floor
• Place N95 respirator on your face covering your nose and mouth
• Pull the bottom strap over the top of your head and place at the nape of your
neck below the ear.
• Pull the upper strap over and place it behind your head towards the crown of
your head
• Mold the nose piece using pads of fingers over the cheeks and bridge of your
nose to obtain a tight seal. Be careful not to pinch the dose
• Perform a seal check by taking a few deep breaths and feeling around the mask
for escaping air to ensure there is good seal against the skin.
• Staff must resist the temptation to adjust the N95 respirator while in the patient
care area
Manju Mulamoottil Abraham

12. Donning Step 4: Don Face Shield and/or Goggles
• Don the face shield so that the foam headpiece rests on your forehead.
• If you are wearing goggles, ensure they are not interfering with the fit of the N95
respirator and are sitting comfortably and secure over your eyes.
• Eyeglasses are not a substitute for eye protection. If you are wearing glasses for
vision support, ensure they also are secure and comfortable.
• At no time should eye protection be readjusted in the patient care area.
• If face shield or goggles fog up it is likely because there is not a good seal of the N95
respirator to the healthcare worker's face.
Donning Step 5: Don Gloves
• Don patient care gloves to a size that is comfortable and conducive to providing
patient care
• Prior to donning gloves, the gown cuff may need to be pulled towards the knuckles to
prevent the gown sleeves from riding up.
• Ensure there is no skin exposed between the gown and glove cuffs.
• The white cuff of the gown should be completely covered by the glove.
Manju Mulamoottil Abraham

13. 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 PPE
Doff PPE in the following order
Doffing PPE begins in the patient room at the exit. Position yourself close to the exit
with a waste container and linen hamper within reach.
1. Perform hand hygiene
2. Gown
3. Gloves
4. Perform hand hygiene
5. Face shield/eye protection
6. Exit patient room (only PPE remaining is your
N95 respirator)
7. Perform hand hygiene
8. N95 Respirator
9. Perform hand hygiene
Manju Mulamoottil Abraham

14. Doffing Step 1: Perform Hand Hygiene
- Perform hand hygiene on the patient care gloves for a minimum of 20 seconds or
until the hand sanitizer is dry
Doffing Step 2: Doff Gown
- Carefully untie the gown at the waist and neck
-Doff the gown folding the outside of the gown tightly inward into a ball to contain the
contaminated side
- Once your gown is contained, separate the gown from the gloves and place gently
into the bin ( according to your HIC guideline)
Doffing Step 3: Gloves
- How to Remove Gloves (1st hand )
-Grasp outside edge near wrist
-Peel away from hand, turning glove inside-out
-Hold in opposite gloved hand PPE Use in Healthcare Settings
How to Remove Gloves (2nd hand)
-Slide ungloved finger under the wrist of the remaining glove
-Peel off from inside, creating a bag for both gloves
-Discard PPE Use in Healthcare Settings
Manju Mulamoottil Abraham

15. Doffing Step 4: Perform Hand Hygiene
- Perform hand hygiene for a minimum of 20 seconds or until the hand sanitizer is dry.
Doffing Step 5: Face Shield
-The last item of PPE to come off in the patient care area is the face shield.
- To remove it, bend slightly forward and grasp the elastic head band on both sides of
your head and pull it forward
and away from your face.
- Place the face shield gently into the waste face down
Doffing Step 6: Exit the Patient Care Area
- As you exit the only item of PPE remaining is your
N95 respirator.
-Exit the patient care room by opening the door, stepping out, and ensuring the door
immediately and completely closes behind you.
Doffing Step 7: Perform Hand Hygiene
- Perform hand hygiene for a minimum of 20 seconds or until the hand sanitizer is dry
Manju Mulamoottil Abraham

16. Doffing Step 8: N95 Respirator
-Lean near waste container and remove N95 one strap at a time
-First remove the bottom strap of the N95 with both hands and let dangle
-Then remove top strap of N95 with both hands and place gently into the trash
Doffing Step 9: Perform Hand Hygiene
- Perform hand hygiene for a minimum of 20 seconds or until the hand sanitizer
is dry
Manju Mulamoottil Abraham

17. 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
Manju Mulamoottil Abraham

18. Manju Mulamoottil Abraham