University of Calgary Medical Students Year 2 2017 Jun 30 · University of Calgary Medical Students...

UniversityofCalgaryMedicalStudentsYear2 2017Jun30

References:AHSExternalwebsiteforInfectionPreventionandControl:PersonalProtectiveEquipment

DonningChecklist

1.Preparationo Removeextraitemsonperson(rings,watch,etc.)o Securelonghairoffoffaceandneck

2.HandHygieneo Performhandhygieneusingalcoholbasedhandrub.Ifhandslookorfeeldirty,use

soapandwater.3.Gown

o Insertarmsthroughsleeveso Ensuregowncoversfromnecktokneestowristo Tieatthebackofnecko Tieatthebackofwaist

4.Procedure/SurgicalMasko Securetiesorelasticbandsaroundhead(orears)sothatthemaskstaysinplaceo Moldthenosebridgebandtoyournose.Fitshouldbesnugtofaceandcontinueto

wrapunderthechin.5.EyeProtectionorfaceshield(ifnotintegratedintotheproceduremask)

o Placeeyeprotectionovertheeyes.Ifusingafaceshield,placebandaroundtheheadwithfoamperpendiculartotheforehead.

o Adjusttofit6.Gloves

o PullcuffsofglovesoverthecuffsofthegownRationale:

1. JewelryandextraitemscangetcaughtinyourPPE,especiallyonremoval,resultinginself-contamination,puttingyouatrisk.SuchitemscanbecomecontaminatedasaresultofbreachesinPPEorunconscioustouching/practiceandaredifficulttoclean.RingsorsharpedgescancausetearsandbreachesinyourPPE.Haircanbecomecontaminatedthroughsplashing,touching,orbeingtangledinPPE.

2. WhendonningPPE,itisimportanttostartoffwithcleanPPE.PerforminghandhygieneremovesgermsthatmaycontaminateyourcleanPPE.

3. CarefulandmethodicaldonningofyourPPEisimportanttoensurepropercoverageandmovementforyourbody.Donningbeginswithyourgowntoensurepropercoveragearoundyourneckandtorso(includingyourback).Securingthetiespreventsthegownfromdraggingacrosscontaminatedobjectsintheenvironmentandpreventsunconsciouspracticesofreachingunderyourgowntoretrieveitemsonyourperson(e.g.,pens,pagers,phones,resources)

4. Carefuldonning/securingofthemaskensuresthatyourmouthandnoseareproperlycovered.Ifyourmaskisnotsecure,itmayslipandresultinyouconsciouslyorunconsciouslytouchingittoadjust,therebyriskingcontaminationofyourmaskandmucousmembranes.Apoorlyfittedmaskcanresultingapsaroundyourmouthandnose,whichdefeatthepurposeofwearingamaskinthefirstplace.

5. Ifyouarethinkingyoushouldprotectyourrespiratorytract,youshouldalsobethinkingaboutprotectingyoureyesastheyareamucousmembrane.Microbescanlandonyoureyes,andtheeyescanbecomeaportalofentryintoyourbody.Eyeglassesdonotprovidesufficientprotectionfromdroplets.

6. Glovesshouldcoverthecuffsofyourgown,asthiswillsignificantlyreducetheriskofcontaminationofyourhands,wrists,andarmsduringyourdoffing(removalofyourPPE).

UniversityofCalgaryMedicalStudentsYear2 2017Jun30

References:AHSExternalwebsiteforInfectionPreventionandControl:PersonalProtectiveEquipment

UniversityofCalgaryMedicalStudentsYear2 2017Jun30

References:AHSExternalwebsiteforInfectionPreventionandControl:PersonalProtectiveEquipment

DoffingChecklist

INSIDEROOM1.Gloves

o Graspoutsideedgeofglovenearthewristandpeelawayfromthehand,turningthegloveinside-out.Holdremovedgloveinopposite(stillgloved)hand.

o Slideanunglovedfingerorthumbunderthewristoftheremainingglove.o Peelthegloveoffandoverthefirst(removed)glove,makingabagforbothgloves.o Putglovesinthegarbage.

2.HandHygieneo Performhandhygieneusingalcoholbasedhandrub.Ifhandslookorfeeldirty,use

soapandwater.3.Gown

o Carefullyunfastenties.(Necktiefirst.)o Grasptheoutsideofthegownatthebackoftheshoulders,andpullthegowndown

overthearms.o Gentlyturnthegowninside-outduringremoval.o Placeinthehamperinthepatientroomor,ifdisposable,putinthegarbage.

4.HandHygieneo Performhandhygieneusingalcoholbasedhandrub.Ifhandslookoffeeldirty,use

soapandwater.o Exitroom.(Ifdoorisclosedwhenleavingpatientroom,ensuretoperformhand

hygieneagainpriortoremovalofeyeprotection.)OUTSIDEROOM5.EyeProtectionorFaceShield

o Handleonlybyheadbandorearpieces.o Carefullypullawayfromface.o Placereusableitemsinappropriateareaforcleaning.Putdisposableitemsintothe

garbage.6.Procedure/SurgicalMask

o Bendforwardslightly,andcarefullyremovethemaskfromyourfacebytouchingonlythetiesorelasticbands.(Startwithbottomtieandthenremovethetoptie.)

o Putmaskintothegarbage.7.HandHygiene

o Performhandhygieneusingalcoholbasedhandrub.Ifhandslookoffeeldirty,usesoapandwater.

UniversityofCalgaryMedicalStudentsYear2 2017Jun30

References:AHSExternalwebsiteforInfectionPreventionandControl:PersonalProtectiveEquipment

Rationale:Eachstepoftheremovalprocessshouldbedonecarefully,deliberatelyandgentlytoavoidcontamination.

1. AlwaysremovePPEworkingfromdirtiest(mostlikelycontaminated)tothecleanest.Glovesarethedirtiest.Thetechniquedescribedistheleastlikelymethodtocontaminateyourhandsandwrists.Donotpeelofftheglovesandgowntogether,asintheoperatingroom,asyouarenotdoubleglovedandthereforewouldhavenoprotectionforyourhandsoncetheouterlayerispeeledoff.

2. Alwaysperformhandhygieneafteryouhaveremovedyourgloves.Glovemanufacturersareallowedtohaveupto5%defectsandsotheremaybemicro-tearsintheglovesthatgrowlarger,thelongertheglovesareworn.Microbescanpassthroughthesemicro-tearsandcontaminatehands.Also,glovesprovideanicewarmenvironmentformicrobestogrow,soanyresidualmicrobesonyourhandsortheinteriorsurfaceofthegloveswillhaveincreasedinnumberwithwear.

3. Toremoveyourgown,workfromthecleanestparttothedirtiest.Therefore,alwaysstartwiththenecktieandthenmovetoyourwaisttie.Pullingyourhandsinsidethegownpreventsyoufromdraggingthegownsleevesoveryourarmsandcontaminatingthem.NB:thisiswhycoveringyourcuffswithyourglovesisimportantasitreducesthecontaminationofyourgowncuffswhenyoupullyourarmsinside.Leaningovertodrawyourgownofffromyourshouldersallowsgravitytohelpyouremovethegown.Gentlyrollingthegowninsideouthelpspreventself-contaminationandmaintainscontaminantswithinthegarment.

4. Handhygieneshouldbeperformedagaintomitigateriskofcontaminatingyourhandsinthegownremovalprocess.Thisisimportantasyouarenowmovinguptoyourfacialarea/mucousmembranes’PPEpieces.

Steps1-4aredoneinsidetheroom,wheretheareaiscontaminated.Inisolationrooms,thegarbageanddirtylinenhampersareinsidetheroomneartheexitsoyoucaneasilyremovethedirtiestpiecesofyourPPEandexittheroom.

5. Eyeprotectionisremovednextasitsitsoveryourmask.Ifyouremoveyourmaskfirst,youriskfumblingwithyoureyeprotection,whichmayresultincontamination.Usebothhandstoremoveyoureyeprotectionsothatitdoesnotfliporslipandpossiblycontaminateyourface.Bendingoverslightlywillallowgravitytoassistyouwiththeremoval.

6. ThelastpieceofPPEisyourmask.Alwaysusebothhandstoremovetoensurethatitdoesnotflipbackontoyourfacecreatingaerosolsand/orcontaminatingyourskindirectly.Theoutsideofyourmaskiscontaminated;so,topreventcontaminationofyourfaceandhands,onlyhandleyourmaskbytheearloopsorties.Again,leanforwardtoallowgravitytohelpthemaskgentlyfallfromyourfacetothewastereceptacle.(Duringthe2003SARSpandemic,themannerinwhichstaffdoffedtheirmasksresultedinself-contaminationandultimatelyinfectionwithSARS.SomestaffdiedorwereseverelycompromisedasaresultofbeinginfectedwithSARS.)

Thefinalstepisalwaystoperformhandhygienetomitigatethepotentialriskofcontaminationofyourhandsduringthedoffingprocess.

UniversityofCalgaryMedicalStudentsYear2 2017Jun30

References:AHSExternalwebsiteforInfectionPreventionandControl:PersonalProtectiveEquipment