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