Use of Personal Protective
Equipment – Pandemic Influenza
Presenter:
Types of PPE used for Pandemic
Influenza
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and P2/N95 respirators– protect
mouth/nose
• P2/N95 Respirators – protect respiratory tract
from airborne infectious agents
• Protective eyewear – protect eyes
• Face shields – protect face, mouth, nose, and
eyes
Key points about PPE
• Follow a consistent sequence when
donning and removing PPE
• Ensure your PPE is fitted correctly to
provide maximum protection
• Take your time
• Don’t touch your face/mask/eyewear when
in the isolation area
Key points about PPE
• Don before contact with the patient, before
entering the room
• Use carefully – don’t spread contamination
• Remove and discard carefully; remove
P2/N95 respirator (if used) outside room
• Immediately perform hand hygiene
Sequence for Donning PPE
1. Perform hand hygiene
2. Gown
3. Mask (or P2/N95 respirator if aerosol
generating procedures to be performed)
4. Perform fit check if P2/N95 respirator worn
5. Protective eyewear or face shield
6. Perform fit check if P2/N95 respirator worn
7. Gloves
8. Stop & check
Step 1 - Perform Hand Hygiene
• Washing hands with the use of a water and
soap or a soap solution, either nonantimicrobial or antimicrobial
OR
• Applying a waterless antimicrobial hand rub
to the surface of the hands (e.g. alcoholbased hand rub)
• Refer to Hand Hygiene Australia for detailed
instructions http://www.hha.org.au/home.aspx
Step 2 – Don gown
•
•
•
•
•
Select appropriate type and size
Opening is in the back
Secure at neck and waist
Ensure all clothing is covered
If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back
• When non-impervious gowns being
used, use a plastic apron over cloth
gown
Step 3 – Don mask
•
•
•
•
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with ties or elastic
Adjust to fit
OR
Step 3 – Don P2/N95 Respirator
• A P2/N95 respirator should be worn whenever
aerosol generating procedures are going to be
performed
• Select a suitable P2/N95 respirator
• Ensure mask is not damaged in any way
• Place over nose, mouth and chin
• Follow the manufacturer’s instructions for fitting
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• For detailed information on donning a P2/N95 mask,
please refer to the presentation available at
http://www.health.qld.gov.au/chrisp/resources/Fit_Ch
eck.ppt
Step 4 – Perform fit check
(if wearing P2/N95 respirator)
• Every time a P2/N95 respirator is worn a fit check must be
performed:
– Inhale – respirator should collapse slightly
– Exhale – respirator should expand, check for air leakage around face
• If mask does not collapse, expand or air leakage or fogging of
glasses/protective eyewear is observed, check seals around bridge
of nose and check if mask is crooked, bunched or folded. Then fit
check mask again
• For detailed information regarding fit checking P2/N95 masks,
please refer to the presentation available at:
http://www.health.qld.gov.au/chrisp/resources/Fit_Check.ppt and the
factsheet available at:
http://www.health.qld.gov.au/chrisp/resources/fit_check_factsheet.p
df
Step 5 – Don eye/face
protection
• Put on prescription eyewear
(if worn)
• Position protective eyewear
over eyes/glasses and
secure to the head using the
arms of the eyewear
• Adjust to fit comfortably
Step 6 – Fit check mask
(if wearing P2/N95 respirator)
• If wearing a P2/N95 respirator re-fit check
mask after donning protective eyewear
• This will ensure protective eyewear is not
affecting the fit of the mask
• Inhale – respirator should collapse
• Exhale – respirator should “puff out”,
check for air leakage around face
Step 7 – Don gloves
• Select correct glove size
• Put the first glove over your hand, then
pull the end of the glove over the cuff of
your gown
• Repeat this for the other hand
Step 8 – Stop & check
• Do not touch your mask, protective eyewear or
your face whilst in the isolation area
• Ensure you stop and check the placement of
your PPE before entering the isolation area
• Ensure you are comfortable
• Remove gloves if they become torn; perform
hand hygiene before donning new gloves
Safe removal of PPE
• PPE may have been contaminated with
respiratory droplets
• Outside front of PPE most contaminated
– 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
• Most likely time you could accidentally infect
yourself
• Minimise contact
Safe removal of PPE
• Remove PPE carefully – take your time
• Immediately dispose or place PPE in
receptacles for reprocessing
• PPE removal principles and sequencing
aims to protect the healthcare worker from
contamination
Where to remove PPE
• Never remove mask inside the patient room
• Remove gloves, protective eyewear and gown at
doorway, before leaving patient room or in
anteroom*
• Remove mask/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 rub
Sequence for Removing PPE
1.
2.
3.
4.
5.
6.
7.
Gloves
Hand hygiene
Protective eyewear
Gown
Hand hygiene
Mask
Hand hygiene
Step 1 – Remove gloves
• Grasp cuff near wrist
• Peel away from hand, turning
glove inside-out
• Hold in palm of gloved hand
Step 1 – Remove gloves
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for
both gloves
• Discard
Step 2 – Perform Hand Hygiene
• Washing hands with the use of a water and soap
or a soap solution, either non-antimicrobial or
antimicrobial
OR
• Applying a waterless antimicrobial hand rub to
the surface of the hands (e.g. alcohol-based
hand rub)
• Refer to Hand Hygiene Australia for detailed
instructions http://www.hha.org.au/home.aspx
Step 3 – Remove eye/face
protection
• Grasp arms of protective eyewear frames
• Lift away from face
• Place in designated receptacle for
reprocessing or disposal
Step 4 – Remove gown
•
•
•
•
•
Unfasten ties
Peel gown away from neck and shoulder
Turn contaminated outside toward the inside
Fold or roll into a bundle
Discard
Step 5 – Perform Hand Hygiene
• Washing hands with the use of a water and soap
or a soap solution, either non-antimicrobial or
antimicrobial
OR
• Applying a waterless antimicrobial hand rub to
the surface of the hands (e.g. alcohol-based
hand rub)
• Refer to Hand Hygiene Australia for detailed
instructions http://www.hha.org.au/home.aspx
Step 6 – Remove mask
• Untie the bottom, then top, tie
• Remove from face – avoid touching the
front
• Discard
• Do not reuse mask
Step 6 – Remove P2/N95
Respirator
• Never remove respirator inside the patient
room
• Avoid touching the front of the respirator
• Remove by the straps
• Remove down and away
from face
• Discard
• Do not reuse respirator
Step 7 – Perform Hand Hygiene
• Washing hands with the use of a water and soap
or a soap solution, either non-antimicrobial or
antimicrobial
OR
• Applying a waterless antimicrobial hand rub to
the surface of the hands (e.g. alcohol-based
hand rub)
• Refer to Hand Hygiene Australia for detailed
instructions http://www.hha.org.au/home.aspx
For Further Information
• Queensland Health factsheet – P2/N95 Mask Fit Checking
http://www.health.qld.gov.au/chrisp/resources/fit_check_factsheet.p
df
• Department of Health and Ageing – Pandemic Influenza
Preparedness, Safe Use of Personal Protective Equipment (PPE)
http://www.health.gov.au/internet/panflu/publishing.nsf/Content/safe
use-dvd-1
– The World Health Organisation and 2014 AHMPPI assert that pandemic
influenza patients should be managed using contact and droplet
transmission-based precautions, however, the DoHA presentations do
not currently reflect this
– P2/N95 respirators are necessary for aerosol generating procedures –
staff caring for closed circuit ventilator patients may wish to consider
wearing P2/N95 respirators
– Surgical masks provide sufficient protection for general care of
pandemic influenza patients
For Further Information
• Centres for Disease Control (CDC)
Protecting Healthcare Personnel
http://www.cdc.gov/HAI/prevent/ppe.html