Table of Contents Mosby s Skills Checklist... 2 Isolation Precaution: Ebola... 2 Copyright Elsevier Performance Manager All rights reserved. i
Mosby s Skills Checklist Caregiver: Observer: Date: S = Satisfactory U = Unsatisfactory NA = Not Applicable Isolation Precaution: Ebola 1 2 3 4 Removed personal clothing and items. a. Changed into hospital scrubs (or disposable garments) in a suitable, clean area. b. No personal items (e.g., jewelry, watches, cell phones, pagers, pens) were brought into the patient s room. Inspected PPE before donning. a. Visually inspected the PPE ensemble to be worn to ensure that it was in serviceable condition, that all required PPE and supplies were available, and that the sizes selected were correct for the health care personnel. Checked supplies for patients with latex allergy. b. The trained observer reviewed the donning sequence with health care personnel before the donning process began. Entered the designated area for donning PPE, and prepared for entry into the isolation room. If an anteroom was available, performed hand hygiene and entered the anteroom. Performed hand hygiene with alcohol-based hand rub (ABHR). Allowed hands to dry before moving to the next step. 5 Donned inner gloves. 6 7 Donned boot covers covering calves or donned leg covers. Alternatively, donned shoe covers over washable shoes when used in combination with a coverall with or without integrated socks. If a PAPR with a self-contained filter and blower unit integrated inside the helmet was used, put on the belt and battery before donning the impermeable gown or coverall so that the belt and battery unit were contained under the gown or coverall. Copyright Elsevier Performance Manager All rights reserved. 2
8 9 Donned a fluid resistant or impermeable gown. a. Gown extended to mid-calf or coverall without integrated hood, ensuring that the gown fully covered the torso from the neck to the knees. b. Pulled gown sleeves down to the end of the wrists to cover the cuff of the glove. c. Wrapped the back of gown and tied the gown securely at the neck and waist. If a PAPR with an external belt-mounted blower was used, attached tubing and donned a belted blower unit. Ensured the blower and tubing was outside the gown or coverall to ensure proper airflow. 10 If a N95 respirator was used, donned and completed a user seal check. 11 12 13 14 If a N95 respirator was used, donned a surgical hood over the N95 respirator. Ensured the hood completely covered the ears and all of the hair, and that it extended past the neck to the shoulders to completely cover the neck. Donned second pair of gloves. a. At a minimum, outer gloves had extended cuffs. b. Ensured the cuffs were pulled over the sleeves of the gown or coverall Donned a PAPR with a full face-shield, helmet, or headpiece. a. If PAPR with a self-contained filter and blower unit integrated inside the helmet was used, used a single-use (disposable) hood that extended to the shoulders and fully covered the neck. Was sure that the hood covered all of the hair and the ears, and that it extended past the neck to the shoulders. b. If PAPR with external belt-mounted blower unit and attached reusable headpiece was used, used a single-use (disposable) hood that extended to the shoulders and fully covered the neck was also used. Was sure that the hood covered all of the hair and the ears, and that it extended past the neck to the shoulders. Donned a waterproof apron covering the torso to the mid-calf if the patient was experiencing vomiting or diarrhea. If a PAPR was worn, considered selecting an apron that tied behind the neck to facilitate easier removal during the doffing procedure. 15 Disinfected outer gloves with ABHR. Allowed to dry before patient contact. Copyright Elsevier Performance Manager All rights reserved. 3
Trained Observer 1 Donned appropriate PPE: gown, double gloves, face shield, and shoe covers. 2 Observed, guided, and assisted with the health care personnel donning process. 3 Read out loud the checklist step-by-step to the health care personnel during the donning process. 4 Used a written checklist to confirm each step in donning PPE. 5 Visually confirmed that all PPE was serviceable and was donned successfully. 6 Assisted with ensuring and verifying the integrity of the ensemble. 7 8 Ensured that no exposed skin or hair of the health care personnel was visible at the conclusion of the donning process. After completing the donning process, verified the integrity of the ensemble. a. The health care personnel was comfortable and able to extend his or her arms, bend at the waist, and go through a range of motions to ensure there was sufficient range of movement while all areas of the body remain covered. b. If available, provided a mirror in the room for the health care personnel donning PPE. This checklist was adapted from the Centers for Disease Control and Prevention. (2014). Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing). Retrieved October 22, 2014 from http://www.cdc.gov/vhf/ebola/hcp/procedures-forppe.html Developed by: Mary Ann Liddy, RNC-OB, RNC-MN, MSN/Ed on October 27, 2014 Copyright Elsevier Performance Manager All rights reserved. 4