Transcript Personal Protective Equipment - Massachusetts Health Officers

Personal Protective Equipment:
Protecting Yourself and the
Community from Infectious Disease
Presented by: The Massachusetts Department of Public Health
The Local Public Health Institute of Massachusetts
Fall 2005
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The purpose of this training is…

To promote a common-sense approach to infection control
in a community setting

To present basic, introductory information about the use of
personal protective equipment for protection against and
control of infectious diseases

NOT to create new policy or regulations concerning the
proper use of personal protective equipment
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Defining PPE
PPE Basics

Personal Protective Equipment (PPE) is specialized
clothing or equipment worn for protection against
dangerous or infectious materials

PPE prevents contact with an infectious agent, or body
fluid that may contain an infectious agent, by creating
a barrier between the potentially infectious material
and the public health responder
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Defining Additional Terms
PPE Basics
Using PPE

“Community setting” is any setting outside a
hospital or established health care clinic in which
a public health responder carries out medical
interventions

A “public health responder” is a public health
professional (either medical or non-medical)
serving in a public health capacity
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Defining Disease Transmission
PPE Basics

The spread of infectious disease requires a:
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
 Source
of infection
 Route of transmission
 Host susceptible to the infection
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Defining Disease Transmission
PPE Basics
Using PPE

Infectious diseases are spread through one or
more of the following routes of transmission:
 Contact (skin, fecal-oral, blood)

Hand Hygiene

Respiratory Hygiene
Standard
Precautions
Droplet (coughing, sneezing, talking: droplets
are large and only travel within 3 feet)



Final Quiz


Measles
Common vehicle (food, water, objects)
Other Uses of PPE
Comprehensive
Scenario
Meningoccocal Meningitis
Airborne (coughing, sneezing: particles are
small and travel more than 3 feet)
Expanded
Precautions

Hepatitis B
Salmonella
Vector-borne (mosquitoes, ticks)

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Lyme Disease
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Controlling Disease Transmission
PPE Basics
Using PPE

The spread of infectious disease can be controlled
by:
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions





Wearing PPE
Practicing Hand Hygiene
Promoting Respiratory Hygiene
Following Standard Precautions
Following Expanded Precautions, as necessary
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Wearing PPE
PPE Basics

PPE acts as a barrier between you and:
 Your client
 Objects in your client’s environment
 Infectious agents, substances, or materials

Wear PPE to:
 Stop the spread of illness/infection
 Protect your health
 Protect your client’s health
 Protect your family’s health
 Protect the community’s health
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Available PPE
PPE Basics

Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
A variety of PPE is available for your
protection, including:
 Gowns, Aprons, Cover-All Suits
 Masks
 Respirators
 Goggles
 Face shields
 Gloves
 Shoe covers (booties)
 Hair covers
Comprehensive
Scenario
Final Quiz
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Donning PPE
PPE Basics

Using PPE
Don PPE in the following order:
Hand Hygiene
1.
Respiratory Hygiene
2.
Standard
Precautions
3.
4.
Expanded
Precautions
Other Uses of PPE
5.
Gown (or apron/cover-all suit)
Shoe and/or hair covers (when worn)
Mask/Respirator
Goggles (or face shield in lieu of mask
and goggles)
Gloves
Comprehensive
Scenario
Final Quiz
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Donning Gowns
PPE Basics
The first piece of PPE you should
put on is the gown.
Using PPE
Hand Hygiene
1.
Respiratory Hygiene
2.
Standard
Precautions
3.
Expanded
Precautions
Other Uses of PPE
Click on Movie to Play
Make sure the opening is in
the back
Secure at the neck and
waist
If the gown is too small, use
two gowns:

Gown #1 ties in front

Gown #2 ties in back
Comprehensive
Scenario
Final Quiz
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About Masks
PPE Basics
Using PPE
Hand Hygiene



Respiratory Hygiene
Standard
Precautions

Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz

There are several types of masks that can be worn
to prevent the spread of infectious disease
Masks are not respirators
Masks vary by:

Shape (rectangular, round)

Method of securing (elastic, ties)
Select a mask you are comfortable wearing and
one that provides an adequate amount of
protection
Use common sense when donning and removing
masks, as the procedure may vary based on the
method of securing the mask to your face
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About Masks, Continued
PPE Basics

This training demonstrates the use of one
type of mask

Other common types of masks include:
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
Elastic tie
Back
Cloth ties
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Donning Masks
PPE Basics
Using PPE
1.
Hand Hygiene
2.
Respiratory Hygiene
Standard
Precautions
3.
Expanded
Precautions
4.
Place mask over your
mouth, nose and chin
Fit the flexible nose
piece over nose
bridge
Secure with ties or
elastic
Adjust to fit
Other Uses of PPE
Click on Movie to Play
Comprehensive
Scenario
Final Quiz
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About Respirators
PPE Basics

Using PPE
Hand Hygiene

Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE

There are several types of respirators that can be
worn to control the spread of infectious disease
Respirators vary by:

Size (small, medium, large)

Shape (oval, round)

Level of respiratory protection offered (N95
versus N100)
Unlike masks, respirators must be fit-tested before
use to ensure they fit your face properly
Comprehensive
Scenario
Final Quiz
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Fit-Testing Respirators
PPE Basics

Respirators must have a mask-to-face seal and
must be checked annually to ensure adequate
protection

Fit-testing is the procedure used to ensure a maskto-face seal and involves tests to make sure there
is no air leakage between the mask and the face

Contact your regional Health Educator for
additional information about respirator fit-testing

Remember: NEVER use a respirator that has not
been fit-tested for your face
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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About Respirators, Continued
PPE Basics

This training demonstrates the use of one
type of N95 respirator

Other common types or variations of the
N95 respirator include:
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
N95
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N100
N95
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Donning Respirators
PPE Basics
Select a fit-tested
respirator, such as an N95 respirator mask
Place the respirator over
your nose, mouth and chin
Fit the flexible nose piece
over your nose bridge
Secure on your head with
elastic
Adjust to fit
Perform a fit check:
1.
Using PPE
2.
Hand Hygiene
3.
Respiratory Hygiene
4.
Standard
Precautions
5.
Expanded
Precautions
6.
Other Uses of PPE
Click on Movie to Play

Inhale: Respirator should
collapse

Exhale: Check for
leakage around face
Comprehensive
Scenario
Final Quiz
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Donning Goggles
PPE Basics
1.
Using PPE
Hand Hygiene
2.
Respiratory Hygiene
Position goggles over
eyes and secure to the
head using the ear
pieces or headband
Adjust to fit comfortably
*If wearing a face shield
instead of a mask and
goggles, position the face
shield over face and
secure on brow with
headband
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Click on Movie to Play
Comprehensive
Scenario
Final Quiz
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Remember: Eyeglasses alone do
NOT provide adequate protection
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Donning Gloves
PPE Basics
1.
Using PPE
2.
Hand Hygiene
Respiratory Hygiene
3.
Standard
Precautions
4.
Expanded
Precautions
Put gloves on last
Select the correct
type and size
Insert hands into
gloves
If you are wearing a
gown, tuck the
gown cuffs securely
under each glove
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
Click on Movie to Play
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Removing PPE
PPE Basics
1.
Remove PPE in an area where you are not in
danger of exposure to the infectious agent

Separate room

Porch or garage

Breezeway or other entryway
2.
Identify “clean” and “contaminated” areas of PPE

Clean areas: Have NOT been in contact with
infectious agent

Contaminated areas: HAVE been in contact with
infectious agent
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Removing PPE
3.
PPE Basics
To limit self-contamination, remove PPE in the
following order:
1.
Using PPE
2.
Hand Hygiene
3.
4.
Respiratory Hygiene
Standard
Precautions
5.
4.
Discard PPE immediately and properly so as not to
contaminate the “clean” area
5.
Perform hand hygiene immediately after removing
PPE
Expanded
Precautions
Other Uses of PPE
Gloves
Goggles (or face shield in lieu of mask and goggles)
Gown (or apron/cover-all suit)
Shoe and/or hair covers (when worn)
Mask/respirator
Comprehensive
Scenario
Final Quiz
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Removing Gloves
1.
PPE Basics
2.
Using PPE
3.
Hand Hygiene
Respiratory Hygiene
4.
Standard
Precautions
5.
Expanded
Precautions
6.
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
Click on Movie to Play
7.
Back
Remove your gloves first
Hold the outside edge
near your wrist
Peel the glove away from
your hand, turning the
glove inside-out
Hold the glove in the
opposite gloved hand
Slide your ungloved finger
under the wrist of the
remaining glove
Peel off from the inside,
creating a bag for both
gloves
Discard in a plastic bag
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Removing Gowns
PPE Basics
1.
Using PPE
2.
Hand Hygiene
Respiratory Hygiene
3.
Standard
Precautions
4.
Expanded
Precautions
5.
Other Uses of PPE
Unfasten the ties
Peel the gown away
from your neck and
shoulder
Turn the
contaminated outside
toward the inside
Fold or roll into a
bundle
Discard in a plastic
bag
Click on Movie to Play
Comprehensive
Scenario
Final Quiz
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Welcome to
STANDARD PRECAUTIONS
PPE Basics
Using PPE

This section includes:
Hand Hygiene
Respiratory Hygiene
Standard
Precautions


An overview of Standard Precautions
PPE for Standard Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Overview
PPE Basics
Using PPE

Most of the time you respond in a public health role,
you will not have a confirmed diagnosis for the person
you might be dealing with

Use Standard Precautions regardless of diagnosis
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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PPE for Standard Precautions:
Determining What to Wear
PPE Basics

Decisions about PPE use are determined by the
type/level of contact you will have with the client

To determine what PPE to wear, ask yourself:
 Will I be touching the client or potentially
contaminated objects in their environment?
 Is there a likelihood of blood or body fluids spraying
or splashing?
 Is the client coughing, sneezing, or vomiting? Do
they have diarrhea?

When in doubt, applying the most conservative level of
PPE is the best protection
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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PPE for Standard Precautions

PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz

Use:
 Gloves: When you may touch a client in a way that
might lead to exposure to blood or body fluids or
touch objects in their environment that may be
contaminated, and/or
 Gowns: When there is a risk of your clothing or
exposed skin coming in contact with anything wet
or weeping, and/or
 Mask and goggles or a face shield: When there is
a risk of being splashed or sprayed with blood or
body fluids
Practice:
 Hand hygiene and promote respiratory hygiene (if
working with clients who have respiratory
symptoms) as a regular part of Standard
Precautions
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What PPE Would You Wear…
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions

When working with a client:
 With a skin infection, or an open wound?
 Who has incontinent diarrhea?
 For whom you deliver food and mail without
interaction?
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Welcome to
EXPANDED PRECAUTIONS
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions

This section includes:




An overview of Expanded Precautions
A description of Contact and Droplet Precautions,
and Airborne Infection Isolation
PPE for Expanded Precautions
Scenario demonstrating use of Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Overview
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions

Expanded Precautions are used in addition to
Standard Precautions to prevent the spread of
infection when you know or suspect:
 A client’s diagnosis
 What illness or infectious agent you may be
exposed to
 The client’s symptoms lead to a risk of contact
with blood or body fluids
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Overview
PPE Basics

Expanded Precautions is the use of PPE in
addition to Standard Precautions

Expanded Precautions include:
 Contact Precautions
 Droplet Precautions
 Airborne Infection Isolation
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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PPE for Expanded Precautions:
Determining What to Wear
PPE Basics

Decisions about PPE use are determined by the
diagnosis or suspected diagnosis of the client, the
client’s symptoms, or type of infectious agent or illness
you will encounter

To determine what PPE to wear, ask yourself:
 What is the client’s diagnosis or suspected
diagnosis?
 Is the client infectious?
 What is the infectious agent or illness I may
encounter?
 What is the mode of transmission of this agent or
illness?
 Does the client have symptoms which lead to
increased likelihood of transmission?
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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PPE For Expanded Precautions
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene

In addition to Standard Precautions, and based on
your assessment of the mode of transmission of the
agent or illness you may encounter, it may be
necessary to follow:

Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz


Contact Precautions
 Wear gown and gloves for all contact with client
and/or objects in the client’s environment
Droplet Precautions
 Wear appropriate respiratory protection within 3
feet of client
Airborne Infection Isolation
 Wear appropriate respiratory protection (e.g.,
N-95 respirator) when entering client’s
environment
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What Type of Expanded Precautions
Would You Follow When…
PPE Basics
Using PPE

Visiting with a client who has been diagnosed with:
 Hepatitis A and is incontinent/diapered?
 Influenza?
 Pulmonary tuberculosis?
 SARS?

What PPE would you wear?
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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What Type of Expanded Precautions
Would You Follow When…
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz

Visiting with a client who has been diagnosed with:
 Hepatitis A and is incontinent/diapered
Answer: Contact Precautions - Gown, gloves
 Influenza
Answer: Droplet Precautions - Appropriate
respiratory protection (e.g., mask)
 Pulmonary tuberculosis
Answer: Airborne Infection Isolation - Appropriate
respiratory protection (e.g., N-95 respirator)
 SARS
Answer: Contact Precautions, Droplet Precautions,
Airborne Infection Isolation - Gown, gloves, goggles,
appropriate respiratory protection (e.g., N-95
respirator)
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Other Uses of PPE
PPE Basics
Using PPE

Sometimes, PPE may be used to protect public health
responders from contact with a bioterrorism (BT)
agent or hazardous material, such as one
encountered during a bioterrorist event or other public
health emergency

PPE used for protection from exposure to biological
agents may not protect against exposure to chemical
agents
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Other Uses of PPE
PPE Basics
Using PPE

In these situations, you may hear terms such as:

Level A, B, C and D PPE
 Types of PPE used to protect against exposure to
hazardous materials and bioterrorism (BT) agents
 Special training needed to use levels A, B, and C

Hot, Warm and Cold Zones
 Terms to identify level of danger of a particular site
for control purposes during a chemical, biological,
or radiological event

Hazmat Teams
 Teams that are highly trained and fully equipped
to respond to a situation involving a hazardous
material
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Other Uses of PPE
PPE Basics

Using PPE
Hand Hygiene
http://www.cdc.gov/niosh/topics/emres/ppe.html
Respiratory Hygiene
Standard
Precautions
For more information about the PPE required for
protection against hazardous materials and infectious
agents, please visit:

Future training opportunities may be available on this
topic
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz
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Thank You
PPE Basics
Using PPE
Hand Hygiene
Respiratory Hygiene
Standard
Precautions
Expanded
Precautions
Other Uses of PPE
Comprehensive
Scenario
Final Quiz