Donning and doffing personal protective equipment (for nursing assistant training)

When assisting with 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.

Now, 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 protective mask or respirator to protect you from inhaling microbes through your nose or mouth and goggles or a face shield for procedures where splashes of body fluids are likely not, all of the pieces are needed in every situation.

Now, there are some general considerations that must be undertaken by the nursing assistant when putting on or removing PPE.

First, don't forget to wash your hands before putting on PPE and after removing it, keep in mind that PPE items can come in various sizes.

So make sure you pick the right size. Remember to check that your PP is intact and without any damage 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. Finally, 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.

Let's get started. 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. The next step is putting on a mask or respirator to cover the nose and mouth from respiratory droplets and airborne particles to put on a mask correctly place it on your face with the stiff bendable edge at the top.

Next masks may have ear loops, ties or straps if your mask has ear loops, place them around each ear. If your mask has ties first tie the top ones behind your head, then tie the bottom ones behind the nape of your neck.

If your mask has straps, first pull the top strap over your head so that it rests over the crown of your head and pull the bottom strap so that it rests at the nape of your neck.

Finally mold the stiff bendable edge to fit your nose and extend the mask to fit above your nose and under your chin. One additional tip, 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 or respirator over the bridge of your nose.

Now, 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's inhaled.

You should only use the respirator that has been fit tested to you because this ensures it'll form a complete seal around your nose and mouth to put on the respirator, place it on your face, pull the bottom strap around your head and rest it below your ears.

Then the top strap goes on the crown of your head. Finally mold the nose piece to fit your nose.

Speaking of eyes, you can wear eye protection like goggles or a face shield. Eye protection can even be worn over prescription eyeglasses and contact lenses.

Now 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, there shouldn't be any uncomfortable pressure points on the nose, the size 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.

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.

Once you're finished caring for a client, remember to remove the PPE, starting from the most contaminated pieces to the least contaminated, then you should throw them in the trash.

There are two ways to do this for the first method. Remove the gloves.

First 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.

Next, the goggles or face shield are removed by lifting the earpieces or headband from the back. Then remove the gown by unfastening the neck and waist ties and pull it away.

Making sure you touch only the inside of the gown and turn it inside out into a bundle. Finally step out of the client's room and remove your mask or respirator by grasping the bottom strap first.

Then the top strap, remember to avoid touching the front. The second way to remove the PP starts by removing the gown and the gloves at the same time.

Keep in mind that this technique is only possible for disposable gowns 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 when removing the gown, peel off your gloves from the inside, then turn everything inside out into a bundle.

Next, the goggles or face shield are removed by lifting the earpieces or the headband from the back. Finally 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.

Now, regardless of the way you choose, once you have removed all PPE remember to wash your hands or use alcohol based sanitizer immediately.

All right, as a quick recap, personal protective equipment or PPE should be used to avoid transmission of infection to and from the client.

This includes wearing a gown, a mask or respirator goggles or a face shield and gloves as needed. You should put on your PPE items in this order and wash your hands before and after wearing it, make sure the PPE fits you and that its intact before putting it on 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 to put on a mask or a fit tested respirator, place it on your face with the stiff bendable edge at the top and mold it to fit your nose.

Eye protection should fit comfortably and be secured so that it stays in place when you move your head. Finally, the glove cuff should extend over the gown cuffs so that no skin is exposed.

Once you have your PPE on, be sure to keep your hands away from your face and avoid touching surfaces unnecessarily. Finally, remember to change all PPE between clients, make sure you remove PPE at the doorway before leaving the clients room except for the mask or respirator.