Infection Control Part 5: Personal Protective Equipment (PPE) What You Need to Know and Do Course Handouts & Post Test To download presentation handouts, click on the attachment icon Course evaluation and post test are available from your course catalog To achieve credit for this course, close the video portion when completed and click on Start Test Part 5. Objectives At the end of this section, participants will be able to: 1. Identify different types of PPE and what each protects against. 2. Describe what PPE is needed for your specific job. 3. Identify the correct order for putting on and removing PPE. 4. Describe what a surveyor might look for, to ensure safe, effective use of PPE. 5. Choose effective responses to various hospice case study scenarios about PPE. 1
Personal Protective Equipment (PPE) --- What You Need to Know PPE s Definition and Purpose Your Tasks, Risks, & Needs for PPE Types of PPE and Their Uses PPE Is Specialized clothing or equipment worn by an employee to protect against a hazard. PPE is not your general X work clothes. PPE Does Not Allow Blood or other potentially infectious materials to pass through to or reach the employee s clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time the PPE is used. 2
Why it matters! Data from the Bureau of Labor Statistics shows: Of approximately 770 workers who suffered face injuries, only 1% were wearing face protection(99% were not). http://ehs.okstate.edu/training/oshappe.htm You, Me & PPE Protect Don t Infect Gloves Do not replace basic hand hygiene (wash your hands before putting on gloves) Protect against contact with any body fluids or contaminated surface Protect your patient, you, and potential cross-contamination with anyone else Are disposable, one-use only 3
Gowns, Aprons, Body Clothing Outer garments worn when soiling of hands or garments with blood or body fluids is anticipated. Garment type and characteristics depend on the task and degree of exposure anticipated Masks, Eye Protection, Face Shields, Caps Wear whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated Airborne Precautions Protects against airborne transmission of infectious agents, i.e., measles, severe acute respiratory syndrome (SARS), varicella (chickenpox), and mycobacterium tuberculosis. PPE can require personal respiratory protection (with fit testing), special ventilation and air handling. 4
PPE Uses [fill in the blank] Gloves protect your. Gownsand laboratory coats protect your. Face shields ormasks protect your. Mouthpieces, resuscitation bags, pocket masks, and other ventilations device protect your. Your Tasks and Risks for Exposure? Think about your job and consider any tasks you do that expose you to blood, body fluids, skin, or other potentially infectious materials. What Type of PPE Would YouWear? 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? 5
What Type of PPE Would YouWear? a bed bath? 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? Drawing blood from a vein? Gloves Cleaning an incontinent patient with diarrhea? Gloves and generally a gown Irrigating a wound? Gloves, gown, mask/goggles or a face shield Taking vital signs? Generally none PPE for the IDG (Interdisciplinary Group) What items should you get? What about your IDG mates? Counselor Hospice Aide Nurse Nurse Practitioner Physical Therapist Physician Social Worker Spiritual Caregiver Volunteer PPE for the IDG What items should you get? What about your IDG mates? Since job descriptions can differ between hospice organizations, your agency is required by OSHA to decide who needs what, and to make it available to you at no cost. 6
Right Sizes? Allergies? Your employer must supply right sizes, and have hypoallergenic items for employees needs. Gloves too small Gloves with powder for allergies Who Pays? Your Agency Know What To Take Where Hospital Hospice Residential Unit Home Care Long Term Care 7
Personal Protective Equipment What You Need to Do Use your PPE when an exposure is anticipated Put on your PPE correctly Use it to protect, not re-infect Remove your PPE correctly before you leave the work space Dispose your PPE correctly Sequence for Putting On PPE 1. Gown first 2. Mask or respirator 3. Goggles or face shield 4. Gloves Be practical! Think it through. Practice. How to Put On a Gown 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 the backinback 8
How to Put On a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit How to Put On 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 How to Put On Eye and Face Protection 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 9
How to Put On Gloves Put on gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs Gloves: you need to Wearfor reasonable expectations of contact with blood, other potentially infectious material. Inspectfor proper fit and no tears. Disposegloves and replace as soon as practical; if torn or punctured. Do not wash, decontaminate, or reuse. Gloves Do s & Don ts DO: work from clean to dirty limit opportunities for touch contamination X DON T: touch your face or adjust PPE with contaminated gloves touch environmental surfaces except as necessary during patient care 10
Gloves: you need to Change or remove gloves during patient care if you move from a contaminated body site to another body site. Never, ever use the same pair of gloves on more than one, individual patient. Decontaminate utility gloves and re-use only if the integrity of gloves is not compromised. Revisit PPE for the IDG Name a challenging case you ve already experienced. What did you do? Did you get it right? Patient: Has colon cancer; routine hospice visits IDG Needs What PPE: Nurse? Aide? Social Worker? Chaplain? Counselor? Volunteer? Patient: Has MRSA; routine visits What PPE does the IDG need? Nurse? Aide? Social Worker? Chaplain? Counselor? Volunteer? Patient: Has died from a bleed out; family is in turmoil What PPE does the IDG need? Nurse? Aide? Social Worker? Chaplain? Counselor? Volunteer? How did you do? Now, let s removeyour contaminated PPE. In what order? Protect. Don t re-infect! 11
Contaminated and Clean Areas 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 Sequence for Removing PPE Think Protect. Do Not Re-Infect. 1. Gloves 2. Face shield or goggles 3. Gown 4. Mask or respirator Order for Removing PPE Think Protect. Do Not Re-Infect. 12
How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal 13
Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard Removing a Mask Untie the bottom, then top, tie Remove from face Discard Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard 14
Decontaminating & Disposing of PPE If a garment is penetrated by blood, remove it immediately or as soon as possible. Wash your hands immediately or as soon as possible after your remove your gloves. Once PPE is removed, place it in an appropriately designated area or container for disposal. What are your agency s policies and procedures? How do you ensure you don t contaminate your patients supplies? A Surveyor Will Look For Your agency s Exposure Plan, and any related policies and procedures Staff Training Records for PPE Your Agency s Supply Storage Safe? Clean? Secure? Accessible by right persons? Appropriate sizes and quantities? Prevention of contamination? Is the employee s PPE appropriate to his/her role and patient care contact? A Surveyor Will Look For Employee s Storage, Retrieval, Handling, and Disposal Car trunk? Carry bag? Potential contamination? Proper use for patient s Plan of Care Disease specific factors (AIDS, MRSA, Scabies, TB, etc.) Correctly putting on and taking off Patient/caregiver education, supplies, and use Documentation of educating family Proper disposal, transport and waste 15
A Surveyor Will Look For Incident Reports related to PPE, with follow-up QAPI data and outcomes related to PPE Best practices for patient care! Summary Know & Do Know Purpose of PPE Types of PPE and what each one prevents/protects Your tasks that have risks for exposure The PPE provided for you by your agency Do Use your PPE when an exposure is anticipated Put on your PPE correctly and in order Use it to protect, not re-infect Remove your PPE correctly and in order Put It In Action What I m already doing well: What I need to improve: My personal action plan: 16
Additional Resources Questions? Clarification? Ask your Hospice s Quality and Compliance Department, and your supervisor. OSHA, Bloodborne Pathogens http://www.osha.gov/pls/oshaweb/owadisp.show_ document?p_table=standards&p_id=10051 CDC, http://www.cdc.gov Your state s laws Your accreditation standards (if applicable) Your agency s Exposure Control Plan Your agency s Policies and Procedures Your Job Description Course Handouts & Post Test Thank you for viewing this course on the Hospice Education Network The Course evaluation and post test are available from your course catalog page To achieve credit for this course, close the video portion when completed and click on Start Test Infection Control Module Overview Hand Hygiene Bloodborne Pathogens Standard and Transmission-Based Precautions Personal Protective Equipment (PPE) Still Ahead 6. Hepatitis B 7. Exposure Control Plan and Exposure Incidents 17