DONNING AND DOFFING

Personal Protective
Equipment (PPE)
University of Perpetual Help DALTAMddPinas City 1
DR.SHARI.S.R
IST YR MDS
DEPT.OF PROSTHODONTICS
GOVT.DENTAL COLLEGE
TVM

Personal Protective Equipment (PPE)
Definition
•Refers to protective clothing,
helmets, gloves, face shields,
goggles, facemasks and/or
respirators or other equipment
designed to protect the wearer from
injury or the spread of infection or
illness.
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/default.htm 2

Personal Protective Equipment (PPE)
•Effective use of PPE includes properly removing
and disposing of contaminated PPE to prevent
exposing both the wearer and other people to
infection.
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/default.htm 3

Types of PPE Used in Healthcare Settings
• GLOVES – protect hands
• GOWNS/ 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
http://www.cdc.gov/HAI/prevent/ppe.html 4

Factors Influencing PPE Selection
•Type of exposure anticipated
- Splash/spray versus touch
- Category of isolation precautions
•Durability and appropriateness for the
task
•Fit
http://www.cdc.gov/HAI/prevent/ppe.html 5

Key Definitions
• Hand Hygiene
A general term that applies to any one of the following:
1. Handwashing with plain (nonantimicrobial) soap and water).
2.Antiseptic handwash (soap containing antiseptic agents and
water).
3.Antiseptic handrub (waterless antiseptic product, most often
alcohol-based, rubbed on all surfaces of hands).
4.Surgical hand antisepsis (antiseptic handwash or antiseptic
handrub performed preoperatively by surgical personnel to
eliminate transient hand flora and reduce resident hand flora).
CDC. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(16)(RR-16):1-44 6

Key Definitions
• Mask
A term that applies collectively to items used to
cover the nose and mouth and includes both
procedure masks and surgical masks.
1. Procedure Mask
A covering for the nose and mouth that is
intended for use in general patient care situations.
These masks generally attach to the face with ear
loops rather than ties or elastic.
www.fda.gov/cdrh/ode/guidance/094.html#4 7

Key Definitions
2. Surgical Mask
A device worn over the mouth and
nose by operating room personnel
during surgical procedures to protect
both surgical patients and operating
room personnel from transfer of
microorganisms and body fluids.
www.fda.gov/cdrh/ode/guidance/094.html#4 8

WHAT IS
THE
TRUTH
BEHIND
THIS? 9

How do I know that the mask is oncorrectly?
•The metal nose piece is at the top.
•The white, or smoothest side, is on the
inside against the wearer’s skin; the color
always faces out.
•The pleats fall downwards and away from
the nose (called a “waterfall” pleat).
http://www.primed.ca/clinicalresources/maskstandardsandfaq.aspx 10

Key Definitions
•
•
3. Respirator
A personal protective device worn by healthcare personnel to
protect them from inhalation exposure to airborne infectious
agents that are < 5 μm in size.
• N95 disposable particulate, air purifying, respirator is the
type used most commonly by healthcare personnel.
• N-99
N-100 particulate respirators
Powered air-purifying respirators (PAPRS) with high efficiency
filters
• Non-powered full-facepiece elastomeric negative pressure
respirators. www.fda.gov/cdrh/ode/guidance/094.html#4 11

12
•Goggles
• These are tight-fitting eye
protection that completely cover
the eyes, eye sockets and the
facial area immediately
surrounding the eyes
• Provide protection from impact,
dust and splashes.
https://www.osha.gov/Publications/osha3151.pdf

13
Face Shields
• These transparent sheets of plastic
extend from the eyebrows to below
the chin and across the entire width
of the employee’s head.
• Face shields protect against
nuisance dusts and potential
splashes or sprays of hazardous
liquids but will not provide adequate
protection against impact hazards.

Facts about Eye Protection
•Eye protection can be in the form of goggles,
safety glasses, or face shields.
• Personal eyeglasses and contact lenses
provide some but not complete protection
and are not considered adequate eye
protection.
•Reusable eye protection should be cleaned
according to the manufacturer’s instructions.
14
https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf

16
• Natural (Latex) Rubber Gloves
• They feature outstanding tensile
strength, elasticity and temperature
resistance.
• Latex gloves have caused allergic reactions in
some individuals and may not be appropriate
for all employees.
• Hypoallergenic gloves, glove liners and
powderless gloves are possible alternatives
for workers who are allergic to latex gloves.

17
• Nitrile Gloves
• Are made of a copolymer and provide
protection from chlorinated solvents such
as trichloroethylene and
perchloroethylene.
• They offer protection when working with
oils, greases, acids, caustics and alcohols
• But are generally not recommended for
use with strong oxidizing agents, aromatic
solvents, ketones and acetates.

Vinyl gloves
• Loose fit
• Used in less risk situations
• Less expensive

Facts about Gloves
19
•Although gloves do not prevent needlestick or
sharps injuries, studies have demonstrated that
the transmission of blood-borne pathogens may
be significantly reduced due to the ‘cleaning’
effect the material of the glove has on the
instrument as it passes through the glove. Gloves
may also reduce the injured person’s contact time
with the source’s blood.

Facts about Gloves
20
•Prolonged and indiscriminate use of gloves
should be avoided as they may cause adverse
reactions and skin sensitivity.
•In countries with limited resources and an
inadequate supply of gloves, used sterile
gloves may be washed, sterilized and reused
for hygiene purposes only – not for invasive
procedures.

Key Definitions
21
•Gown
“Fluid-resistant Gown” apply to protective
clothing tested against water as the liquid
challenge.
“Impermeable Gown” materials that have
demonstrated blockage of microorganisms
using a recognized standard test method.
http://www.cdc.gov/niosh/npptl/topics/protectiveclothing

GOWN vs. COVERALL
22
•Surgical gowns rated for high levels of barrier
protection may include the high-performance
barrier materials in only certain portions of
the gown (sleeves and front panel). This is
especially important when contact from
hazardous/contaminated fluids can come
from multiple directions.

GOWN vs. COVERALL
23
•Although Coveralls typically provide 360-degree
protection because they are designed to cover the
whole body, including back and lower legs and
sometimes head and feet as well, the design of
surgical/isolation gowns do not provide
continuous whole-body protection (e.g., possible
openings in the back, coverage to the mid-calf
only).

Facts about Gowns or Aprons
• Clinical or laboratory coats or jackets worn over personal clothing
for comfort and/or purposes of identity are not considered to be
PPE.
• Aprons and gowns should be removed in a manner that prevents
contamination of the wearer’s clothing or skin. The outer
‘contaminated’ side of the gown should be turned inward and
rolled into a bundle and then discarded into a designated
container for waste linen to contain contamination.
• In countries with limited resources where impermeable aprons
or gowns are unavailable, a large plastic bag can be cut open and
worn under a cotton apron or gown to protect clothing.
https://smah.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow137337.pdf 22

General Considerations (Donning of PPE)
•Keep hands away from face.
•Limit surfaces touched.
•Change when torn or heavily
contaminated.
•Work from clean to dirty.
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf 26

1. Hand Hygiene
27
http://singaporemotherhood.com/articles/wp-
content/uploads/2012/10/8-step-handwashing-technique.jpg

Sequence* for Donning PPE
•Gown first
•Mask or respirator
•Goggles or face shield
•Gloves

2. How to don a GOWN?
• Fully cover from
neck to knees, arms
to end of wrists,
and wrap around
the back.
•Fasten in back of neck
and waist.
http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf 30

• If gown is too small, use two
gowns
1. Gown #1 ties in front
2. Gown #2 ties in back

3. MASK or RESPIRATOR
32
•Secure ties or elastic bands
at middle of head and neck.
•Fit flexible band to nose
bridge.
•Fit snug to face and below
chin.
•Fit-check respirator.
http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf

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

4. GOGGLES or FACE SHIELD
34
•Place over face and eyes
and adjust to fit.
•Anti-fog feature improves
clarity.

5. GLOVES
35
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend to cover wrist of isolation gown.

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

General Considerations (Doffing PPE)
•Remove all PPE before exiting the patient
room except a respirator, if worn.
•Perform Hand Hygiene between steps if
hands become contaminated and
immediately after removing all PPE.
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf 39

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

1. GLOVES
• Outside of gloves are contaminated!
• If your hands get contaminated during glove removal, immediately
wash your hands or use an alcohol-based hand sanitizer.
• Using a gloved hand, grasp the palm area of the other gloved hand and
peel off first glove.
• Hold removed glove in gloved hand.
• Slide fingers of ungloved hand under remaining glove at wrist and peel
off second glove over first glove.
• Discard gloves in a waste container.

2. GOGGLES or FACE SHIELD
• Outside of goggles or face shield are contaminated!
• If your hands get contaminated during goggle or face shield removal,
immediately wash your hands or use an alcohol-based hand sanitizer.
• Remove goggles or face shield from the back by lifting head band or
ear pieces.
• If the item is reusable, place in designated receptacle for reprocessing.
Otherwise, discard in a waste container.

3. GOWN
43
• Gown front and sleeves are contaminated!
• If your hands get contaminated during gown removal, immediately
wash your hands or use an alcohol-based hand sanitizer.
• Unfasten gown ties, taking care that sleeves don’t contact your
body when reaching for ties.
• Pull gown away from neck and shoulders, touching inside of gown
only.
• Turn gown inside out.
• Fold or roll into a bundle and discard in a waste container.

4. MASK or RESPIRATOR
44
• Front of mask/respirator is contaminated — DO NOT
TOUCH!
• If your hands get contaminated during mask/respirator
removal, immediately wash your hands or use an
alcohol-based hand sanitizer.
• Grasp bottom ties or elastics of the mask/respirator, then
the ones at the top, and remove without touching the
front.
• Discard in a waste container.

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

5. HAND HYGIENE
38
http://singaporemotherhood.com/articles/wp-
content/uploads/2012/10/8-step-handwashing-technique.jpg

PPE Use in Healthcare Settings: When to Use PPE

Standard and Expanded Isolation Precautions

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

PPE for Standard Precautions
• Gloves – Use when touching blood, body fluids, secretions,
excretions, contaminated items; for touching mucus membranes and
nonintact skin
• Gowns – Use during procedures and patient care activities when
contact of clothing/ exposed skin with blood/body fluids, secretions,
or excretions is anticipated

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

What Type of PPE Would You Wear
• 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?
Generally none required
• 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

PPE for Expanded Precautions
Expanded Precautions include
• Contact Precautions
• Droplet Precautions
• Airborne Infection Isolation

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 respirator*
• Negative pressure isolation room also required

CONCLUSION
• PPE is available to protect you from exposure to infectious agents in
the healthcare workplace
• Know what type of PPE is necessary for the duties you perform and
use it correctly

THANK YOU FOR YOUR KIND
ATTENTION…
40
Infection Prevention and
Control Unit (IPCU)

DONNING AND DOFFING

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