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Guidance for the Selection and Use of Personal Protective Equipment(PPE)in Healthcare SettingsGuidance for the Selection andPPE Use in Healthcare Settings:Program GoalImprove personnel safety in the healthcare environment through appropriate use of PPE.PPE Use in Healthcare SettingsPPE Use in Healthcare SettingsPPE Use in Healthcare Settings:Program ObjectivesProvide information on the selection and use of PPE in healthcare settingsPractice how to safely don and remove PPEPPE Use in Healthcare SettingsPPE Use in Healthcare SettingsPersonal Protective Equipment Definition“specialized clothing or equipment worn by an employee for protection against infectious materials”(OSHA)PPE Use in Healthcare SettingsPersonal Protective Equipment Regulations and Recommendations for PPEOSHA issues workplace health and safety regulations.Regarding PPE,employers must:Provide appropriate PPE for employeesEnsure that PPE is disposed or reusable PPE is cleaned,laundered,repaired and stored after useOSHA also specifies circumstances for which PPE is indicatedCDC recommends when,what and how to use PPEPPE Use in Healthcare SettingsRegulations and RecommendationHierarchy of Safety and Health ControlsTraining and administrative controlsEngineering controlsWork practice controlsPersonal protective equipmentPPE Use in Healthcare SettingsHierarchy of Safety and HealthTypes of PPE Used in Healthcare SettingsGloves protect handsGowns/aprons protect skin and/or clothing Masks and respirators protect mouth/nose Respirators protect respiratory tract from airborne infectious agentsGoggles protect eyesFace shields protect face,mouth,nose,and eyesPPE Use in Healthcare SettingsTypes of PPE Used in HealthcarFactors Influencing PPE SelectionType of exposure anticipatedSplash/spray versus touchCategory of isolation precautionsDurability and appropriateness for the taskFitPPE Use in Healthcare SettingsFactors Influencing PPE SelectGlovesPurpose patient care,environmental services,otherGlove material vinyl,latex,nitrile,otherSterile or nonsterileOne or two pairSingle use or reusablePPE Use in Healthcare SettingsGlovesPurpose patient care,GlovesPurpose patient care,environmental services,otherGlove material vinyl,latex,nitrile,otherSterile or non-sterileOne or two pairSingle use or reusablePPE Use in Healthcare SettingsGlovesPurpose patient care,Dos and Donts of Glove UseWork from“clean to dirty”Limit opportunities for“touch contamination”-protect yourself,others,and the environmentDont touch your face or adjust PPE with contaminated glovesDont touch environmental surfaces except as necessary during patient carePPE Use in Healthcare SettingsDos and Donts of Glove UseWoDos and Donts of Glove Use(contd)Change glovesDuring use if torn and when heavily soiled(even during use on the same patient)After use on each patientDiscard in appropriate receptacleNever wash or reuse disposable glovesPPE Use in Healthcare SettingsDos and Donts of Glove Use(Gowns or ApronsPurpose of useMaterial Natural or man-madeReusable or disposableResistance to fluid penetrationClean or sterilePPE Use in Healthcare SettingsGowns or ApronsPurpose of usePFace ProtectionMasks protect nose and mouthShould fully cover nose and mouth and prevent fluid penetrationGoggles protect eyesShould fit snuggly over and around eyesPersonal glasses not a substitute for gogglesAntifog feature improves clarityPPE Use in Healthcare SettingsFace ProtectionMasks protectFace ProtectionFace shields protect face,nose,mouth,and eyesShould cover forehead,extend below chin and wrap around side of facePPE Use in Healthcare SettingsFace ProtectionFace shields Respiratory ProtectionPurpose protect from inhalation of infectious aerosols(e.g.,Mycobacterium tuberculosis)PPE types for respiratory protectionParticulate respiratorsHalf-or full-face elastomeric respiratorsPowered air purifying respirators(PAPR)PPE Use in Healthcare SettingsRespiratory ProtectionPurpose Elements of a Respiratory Protection ProgramMedical evaluationFit testingTrainingFit checking before usePPE Use in Healthcare SettingsElements of a Respiratory ProFor additional information on respirators.http:/www.cdc.gov/niosh/npptl/respirators/respsars.htmlhttp:/www.cdc.gov/niosh/99-143.htmlhttp:/www.cdc.gov/niosh/topics/respiratorsPPE Use in Healthcare SettingsFor additional information on PPE Use in Healthcare Settings:How to Safely Don,Use,and Remove PPEPPE Use in Healthcare SettingsKey Points About PPEDon before contact with the patient,generally before entering the roomUse carefully dont spread contaminationRemove and discard carefully,either at the doorway or immediately outside patient room;remove respirator outside roomImmediately perform hand hygienePPE Use in Healthcare SettingsKey Points About PPEDon beforeSequence*for Donning PPEGown firstMask or respiratorGoggles or face shieldGloves*Combination of PPE will affect sequence be practicalPPE Use in Healthcare SettingsSequence*for Donning PPEGown How to Don a GownSelect appropriate type and sizeOpening is in the backSecure at neck and waistIf gown is too small,use two gownsGown#1 ties in frontGown#2 ties in backPPE Use in Healthcare SettingsHow to Don a GownSelect appropHow to Don a MaskPlace over nose,mouth and chinFit flexible nose piece over nose bridgeSecure on head with ties or elasticAdjust to fitPPE Use in Healthcare SettingsHow to Don a MaskPlace over noHow to Don a Particulate RespiratorSelect a fit tested respiratorPlace over nose,mouth and chinFit flexible nose piece over nose bridgeSecure on head with elasticAdjust to fitPerform a fit check Inhale respirator should collapseExhale check for leakage around facePPE Use in Healthcare SettingsHow to Don a Particulate RespiHow to Don Eye and Face ProtectionPosition goggles over eyes and secure to the head using the ear pieces or headbandPosition face shield over face and secure on brow with headbandAdjust to fit comfortablyPPE Use in Healthcare SettingsHow to Don Eye and Face ProtecHow to Don GlovesDon gloves lastSelect correct type and sizeInsert hands into glovesExtend gloves over isolation gown cuffsPPE Use in Healthcare SettingsHow to Don GlovesDon gloves laHow to Safely Use PPEKeep gloved hands away from faceAvoid touching or adjusting other PPERemove gloves if they become torn;perform hand hygiene before donning new glovesLimit surfaces and items touchedPPE Use in Healthcare SettingsHow to Safely Use PPEKeep glovPPE Use in Healthcare Settings:How to Safely Remove PPEPPE Use in Healthcare Settings“Contaminated”and“Clean”Areas of PPEContaminated outside frontAreas of PPE that have or are likely to have been in contact with body sites,materials,or environmental surfaces where the infectious organism may resideClean inside,outside back,ties on head and backAreas of PPE that are not likely to have been in contact with the infectious organismPPE Use in Healthcare Settings“Contaminated”and“Clean”AreSequence for Removing PPEGlovesFace shield or gogglesGownMask or respiratorPPE Use in Healthcare SettingsSequence for Removing PPEGloveWhere to Remove PPEAt 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 rubPPE Use in Healthcare SettingsWhere to Remove PPEAt doorway,How to Remove Gloves(1)Grasp outside edge near wristPeel away from hand,turning glove inside-outHold in opposite gloved handPPE Use in Healthcare SettingsHow to Remove Gloves(1)Grasp How to Remove Gloves(2)Slide ungloved finger under the wrist of the remaining glovePeel off from inside,creating a bag for both glovesDiscardPPE Use in Healthcare SettingsHow to Remove Gloves(2)Slide Remove Goggles or Face ShieldGrasp ear or head pieces with ungloved handsLift away from facePlace in designated receptacle for reprocessing or disposalPPE Use in Healthcare SettingsRemove Goggles or Face ShieldGRemoving Isolation GownUnfasten tiesPeel gown away from neck and shoulderTurn contaminated outside toward the insideFold or roll into a bundleDiscardPPE Use in Healthcare SettingsRemoving Isolation GownUnfasteRemoving a MaskUntie the bottom,then top,tieRemove from faceDiscardPPE Use in Healthcare SettingsRemoving a MaskUntie the bottoRemoving a Particulate RespiratorLift the bottom elastic over your head firstThen lift off the top elasticDiscardPPE Use in Healthcare SettingsRemoving a Particulate RespiraHand HygienePerform hand hygiene immediately after removing PPE.If hands become visibly contaminated during PPE removal,wash hands before continuing to remove PPEWash hands with soap and water or use an alcohol-based hand rubPPE Use in Healthcare Settings*Ensure that hand hygiene facilities are available at the point needed,e.g.,sink or alcohol-based hand rubHand HygienePerform hand hygiePPE Use in Healthcare Settings:When to Use PPEPPE Use in Healthcare SettingsStandard and Expanded Isolation PrecautionsStandard and Expanded IsolatioStandard PrecautionsPreviously called Universal PrecautionsAssumes blood and body fluid of ANY patient could be infectiousRecommends PPE and other infection control practices to prevent transmission in any healthcare settingDecisions about PPE use determined by type of clinical interaction with patientPPE Use in Healthcare SettingsStandard PrecautionsPreviouslyPPE for Standard Precautions(1)Gloves Use when touching blood,body fluids,secretions,excretions,contaminated items;for touching mucus membranes and nonintact skinGowns Use during procedures and patient care activities when contact of clothing/exposed skin with blood/body fluids,secretions,or excretions is anticipatedPPE Use in Healthcare SettingsPPE for Standard Precautions(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 excretionsPPE Use in Healthcare SettingsPPE for Standard Precautions(What Type of PPE Would You Wear?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?PPE Use in Healthcare SettingsWhat Type of PPE Would You WeaWhat Type of PPE Would You Wear?Giving a bed bath?Generally noneSuctioning oral secretions?Gloves and mask/goggles or a face shield sometimes gownTransporting a patient in a wheel chair?Generally none requiredResponding to an emergency where blood is spurting?Gloves,fluid-resistant gown,mask/goggles or a face shieldDrawing blood from a vein?GlovesCleaning an incontinent patient with diarrhea?Gloves w/wo gownIrrigating a wound?Gloves,gown,mask/goggles or a face shieldTaking vital signs?Generally nonePPE Use in Healthcare SettingsWhat Type of PPE Would You WeaPPE for Expanded PrecautionsExpanded Precautions includeContact PrecautionsDroplet PrecautionsAirborne Infection IsolationPPE Use in Healthcare SettingsPPE for Expanded PrecautionsExUse of PPE for Expanded PrecautionsContact 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 patients environmentDroplet Precautions Surgical masks within 3 feet of patientAirborne Infection Isolation Particulate respirator*Negative pressure isolation room also requiredPPE Use in Healthcare SettingsUse of PPE for Expanded PrecauHand HygieneRequired for Standard and Expanded PrecautionsPerformImmediately after removing PPEBetween patient contactsWash hands thoroughly with soap and water or use alcohol-based hand rubPPE Use in Healthcare SettingsHand HygieneRequired for StandPPE Use in Healthcare Settings:Final ThoughtsPPE is available to protect you from exposure to infectious agents in the healthcare workplaceKnow what type of PPE is necessary for the duties you perform and use it correctlyPPE Use in Healthcare Settings
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