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Donning and doffing personal protective equipment: Clinical skills notes

Notes

Notes

Infection control

Donning and Doffing Personal Protective Equipment

Introduction

When providing client care, personal protective equipment, or PPE for short, should be used to avoid transmission of infection to and from the client. PPE should be used when there’s risk of exposure to: blood; all types of body fluids, secretions, and excretions; open skin lesions or rashes and mucosal surfaces; and possibly contaminated items or surfaces.

The PPE you need to wear can vary from situation to situation. This includes wearing:
  • non-sterile gloves
  • a waterproof gown if there’s a possibility that your clothes might get contaminated
  • a protective mask or respirator to protect you from inhaling microbes through your nose or mouth
  • goggles or a face shield for procedures where splashes of body fluids are likely

Not all the pieces are needed in every situation.

Figure 1: Types of personal protective equipment. A. Gown. B. Gloves. C. N95 respirator. D. Goggles.  

General Considerations

  • Wash your hands before putting on PPE and after removing it.
  • PPE items can come in various sizes, so make sure you pick the right size.
  • Remember to check that your PPE is intact and undamaged before putting it on.
  • If your gloves get torn or become heavily contaminated, take them off, wash your hands, and put a new pair on.
  • Once you have your PPE on, be sure to keep your hands away from your face and avoid touching surfaces unnecessarily.
  • PPE should be used only once, so remember to change all PPE between clients. Make sure you remove PPE at the doorway before leaving the client’s room, except for the mask or respirator.

Donning PPE

In this section, all the PPE is listed in the order in which you would put it on, if you needed all of it. Note, however, that not all the pieces are needed in every situation.

Gown

The first item we put on is the gown, which can be disposable or non-disposable.
  • The opening of the gown should be at the back while, at the front, the gown should fully cover your torso from the neck to knees as well as the entirety of the arms.
  • Make sure your gown is securely fastened to your body with the drawstrings snug.

Figure 2: A gown should cover everything in between your neck and knees, including the entirety of the arms. 

Surgical mask or respirator

The next step is putting on a mask or respirator, which covers the nose and mouth to limit transmission of respiratory droplets and airborne particles. To put on a mask correctly:
  1. Place it on your face with the stiff bendable edge on the top. 
  2. Masks may have ear loops, ties, or straps (Fig. 3). If your mask has
    • ear loops: place them around each ear. 
    • ties: first tie the top ones behind your head and then tie the bottom ones behind the nape of your neck. 
    • straps: first pull the top strap over your head so that it rests over the crown of your head and then pull the bottom strap so that it rests at the nape of your neck. 
  3. Mold the stiff bendable edge to fit your nose and extend the mask to fit above your nose and under your chin. 

Figure 3: Different types of masks. 

If you wear prescription eyeglasses, there are two main ways to prevent them from fogging up. The first way is to simply fold the top fourth of the mask before wearing it. The second way is to put a tissue at the top of the mask over the bridge of your nose.

When you need to protect against more hazardous or infectious aerosols, you should cover your nose and mouth using respirators, like N95 masks, which filter the air before it is inhaled. You should only use the respirator that has been fit-tested for you because this ensures  it’ll form a complete seal around your nose and mouth.

To put on the respirator:
  1. Place it on your face, pull the bottom strap around your head, and rest it below your ears. 
  2. Place the top strap on the crown of your head. 
  3. Mold the nose piece to fit your nose.

Figure 4: When wearing glasses, make sure the mask is properly molded to your face. A. Fold down the top fourth of your mask. B. Put a tissue at the top of the mask. 

Goggles or face shield

Goggles or a face shield can provide eye and face protection. Eye protection can even be worn over prescription eyeglasses and contact lenses. Make sure you have the right fit.
  • Eye protection should stay in place when you move your head front-to-back and side-to-side, and there shouldn’t be any uncomfortable pressure points on the nose, the side of the head, or behind the ears.
  • Goggles should fit snugly over and around the eyes. If the goggles have earpieces, secure and adjust them to fit your head.
  • If you want to cover your whole face, you can use a face shield. Again, be sure to secure and adjust it to fit your head using the headband.

Figure 5: Goggles and face shields. A. Goggles should fit well and comfortably and should not loosen with head movement.  B. Face shields should be adjusted to head size. 

Gloves

The last PPE item we put on is gloves. Make sure that the glove cuffs extend over the gown cuffs so that no skin is exposed.

Figure 6: Gloves should extend over gown cuffs. 

Removing PPE

Once you’re finished caring for a client, remember to remove the PPE starting from the most contaminated pieces to least contaminated; then, place the pieces in the appropriate disposal bins. There are two ways to do this. 

First method

  1. Remove the gloves first (Fig. 7a).
    • Use one gloved hand to grasp the palm area of the other gloved hand and peel off the glove.
    • Then, slide the fingers of the ungloved hand under the remaining glove and peel it off. 
  2. The goggles or face shield are removed by lifting the ear pieces or head band from the back (Fig. 7b).
  3. Remove the gown by unfastening the neck and waist ties and pulling it away, making sure you touch only the inside of the gown, and turning it inside out into a bundle (Fig. 7c). 
  4. Step out of the client’s room and remove your mask or respirator by grasping the bottom strap first, then the top strap (Fig. 7d).  
    • Remember to avoid touching the front.

Figure 7: First method of removing personal protective equipment. 

Second method

  1. Remove the gown and gloves at the same time. Keep in mind that this technique is only possible for disposable gowns (Fig. 8a). 
    • First, grasp the front of the gown from the outside with your gloves still on, and pull the gown away so that the ties break.
    • While removing the gown, peel off your gloves from the inside, and then turn everything inside out into a bundle.
  2. The goggles or face shield are removed by lifting the ear pieces or head band from the back (Fig. 8b).
  3. Step out of the client’s room and remove your mask or respirator by grasping the bottom strap first, then the top strap, while avoiding touching the front (Fig. 8c).

Regardless of the way you choose, once you have removed all PPE, remember to wash your hands immediately.

Figure 8: Second method of removing personal protective equipment (works only for disposable gowns).