How to Safely Take off PPE, Selected Equipment: PAPR and Gown

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[ Silence ]>>Hi, Peter Pronovost the Johns
Hopkins Medicine senior vice president for patient safety and quality and the
director of the Armstrong Institute. One of the most important ways you can
keep yourself safe in caring for patients with Ebola is to make sure
that you learn to put on and take off personal protective
equipment in the most appropriate way. Now the Centers for Disease Control has provided
us detailed guidance for how to do that. But we needed training modules. So we partnered with the CDC to do that. We pull together out infectious disease experts,
human factors and system injures, psychologists, instructional designers and technology experts
to come together to produce this content. We’ve been here a week working
long hours to make modules for you. And now what you’ll see are three key modules. Number one, how to put on or don
personal protective equipment. Number two, how to take off or
doff personal protective equipment. And number three, how the
observer can work together to help ensure your safety using teamwork
behaviors that were developed by the Agency for Healthcare Research and Quality. Now we know these are anxiety filled times. Believe me, I’m a critical care physician. I’m right with you. But we also know that with proper training and
when we ensure your competency in putting on and taking off this equipment, we
could safely care for these patients. So we hope you enjoy the training. And from our colleagues at the Centers
for Disease Control and our colleagues at Johns Hopkins Medicine, we thank
you for all you do for patients.>>In this video, you will learn how to doff
or remove your personal protective equipment in accordance with CDC protocols. Following the doffing protocol will
minimize the risk for disease transmission. So it’s very important that you
understand all of the steps. Before you move to the patient’s
room and into the doffing area, you will need to take a few
minutes to do some important things. First, get the attention
of the trained observer. Once he or she signals to you that
it’s clear, enter the doffing area. Inspect your personal protective equipment. Are there any obvious signs of
contamination or materials on it? If so, you will need to disinfect the
surface of the personal protective equipment with an EPA designated disinfectant wipe. Last, disinfect your clothes also with
an EPA designated disinfectant wipe or alcohol based hand rub. You, the trained observer, and the assistant
are a team throughout the doffing process. The trained observer will read each step aloud,
giving you the time to take the required action. The assistant will help you when necessary. Remember, don’t rush through
the doffing process. Take your time and be careful.>>I’m here to help you through doffing process. You’ll hear me give directions that
are not part of standard practice but are designed to keep you safe. We need to check for any rips, tears,
or contaminates on your clothes. Remember to go slowly and be
careful not to touch your face. As you remove each item, it is
important to place it immediately in the designated waste receptacle. We’re going to work through this together. Now I’d like you to disinfect your outer gloves.>>The first thing you will do is use
an EPA registered disinfectant wipe or an alcohol based hand rub
to disinfect your outer gloves. The wipe will be used to remove
any visible contamination. If you’re using an apron,
you now need to remove it. The assistant will assess the type of apron
used and will assist with untying the strap. Then you will remove the apron by breaking
the strap or lifting the strap over your head, rolling from the inside to
outside and away from your body. And discarding it in the appropriate receptacle. If the apron can be gently pulled
away from the body by tearing it at the neck, this process should be used. Once the apron is off, inspect
your personal protective equipment for visible contamination, cuts, or tears. If you see your personal protective equipment
has been compromised or if there are any signs of contamination, disinfectant it with
an EPA registered disinfectant wipe.>>Okay, great. Now it’s time to disinfectant
your outer gloves again.>>You will need to disinfectant
your outer gloves again with an EPA registered disinfectant
wipe or an alcohol based hand rub.>>Next I’d like you to remove your shoe covers. You can sit down in the chair to make it easier.>>In the doffing area, you
will have two chairs. One will be where you sit to
take off your boot cover only. This chair will be designated
as the dirty chair. It is preferable for the healthcare
provider to remove their own boot covers but they may receive assistance if necessary. Once you sit down, be careful not
to touch one leg with the other. Grasp the outside of the boot cover
and pull down toward your ankle. Then, lift the boot cover over your heel. Pull it off your foot and dispose
of it into the trash receptacle. The exact way to remove your boot covers will
vary based on the manufacturer’s instructions. Now you will need to disinfectant
your outer gloves with an EPA registered disinfectant
wipe or an alcohol based hand rub.>>In the next step you’re going
to remove your outer gloves. Please do this slowly and carefully to avoid
contaminating or tearing your inner gloves. You’re doing great.>>You have two very important
things to remember. First, pay special attention so that you
don’t contaminate or tear the inner glove. Second, don’t snap the gloves
which could cause spray. Hold one of your wrists so that
your thumb points to the ceiling. Pinch that glove and lift at the wrist, then roll it down until the
glove is completely off your hand in a ball in the palm of the other hand. Then slide a finger down and inside the
outer glove on the other hand and pull it off until it’s balled around the first glove. Dispose of the gloves.>>Good job. Now inspect both sides of your inner
gloves for visible tears or contamination.>>If you don’t see any tears or signs
of contamination, then you will disinfect with EPA registered disinfectant
wipes or alcohol hand rub and proceed to the next step of removing your respirator. If you see a tear, hole, or signs
of contamination in the inner glove, disinfect with EPA registered
disinfectant wipes or alcohol based hand rub and then remove the inner gloves, making
sure not to contaminate your bare hands. Once the gloves are off, perform hand hygiene
with alcohol based hand rub on your hands. Then put on a new set of gloves
up to the edge of the gown sleeve. In this step you will be taking
off your belt mounted respirator. How you will do this will vary
from model to model of PAPR. So you and your assistant will need to
refer to your manufacturer’s specifications.>>The assistant will detach the
hose and turn off the system now.>>Although the specifics will vary,
you should do things in this order. First, the assistant will
detach the hose from the hood.>>Now I need you to unclip the belt.>>Then while the assistant holds the belt unit
in his or her hands, you will unclasp the belt. After removal, place all reusable
PAPR components into a designated area or container for later disinfection. Next you will take off the hood. The assistant will stand behind you and will
grab the outside of the hood and roll the hood up towards the top of the
shoulders, forming a cuff.>>Next slowly remove the hood.>>Then when the observer signals both of
you, you will grab the hood near the ears, bend forward at the waist, and pull the
hood slowly and methodically down and away from your head until it’s at waist level. Then discard the hood into the trash receptacle. It’s very important to avoid touching your face
at this point after the hood has been removed. Then both you and the assistant will disinfect
your hands with alcohol based hand rub.>>Okay. Go ahead and remove your gown.>>Next you will remove your gown. First release the tie. Then pull the gown away from your body, being
careful not to touch the inside with your hands.>>Be sure to move slowly and deliberately to
avoid contamination of any exposed surfaces.>>Once the gown is off your shoulders, pull
the gown down one arm and then the other. Roll the gown inward as you progress
downward until it’s a tight ball. [ Silence ] Dispose of it like you’ve disposed of everything
else to this point into the trash receptacle.>>You’re doing great. Now go ahead and disinfect your gloves. [ Silence ] Please have a seat in the clean chair
so that you can disinfect your shoes.>>To disinfect your shoes
sit down in the clean chair. Once you’re sitting down, use the
EPA registered disinfectant wipes to thoroughly disinfect all
the surfaces of your shoes. Moving from top to bottom
and including the soles. Be sure not to touch your ankles.>>We’re getting near the end. You’re doing great. Now disinfect your gloves. [ Silence ] Now we’re going to remove your inner gloves. Be careful to do this slowly to avoid tearing
the gloves or contaminating your hands.>>As with the outer gloves, you have
two very important things to remember. First, pay special attention so that
you don’t contaminate your hands. Second, don’t snap or pop the
gloves which might cause spray. Pinch that glove and lift at the wrist. Then roll it down until the glove
is completely off your hand, in a ball in the palm of the other hand. Then slide a finger down and
inside the glove on the other hand, and pull it off until it’s
balled around the first glove. Dispose of the gloves. Once your gloves are off, it’s very
important that you don’t touch your face, any exposed skin, or any surface in the room.>>Go ahead and perform hand hygiene.>>Next perform hand hygiene using
alcohol based hand rub on your bare hands. [ Silence ]>>Okay one more important step. We need to check for any rips, tears,
or contaminates on your clothes. Please hold your hands out to
side and slowly turn around.>>Now you, the assistant, and your trained
observer will do one last inspection of your scrubs and inner clothing
for holes, tears, or contamination. Congratulation, you’ve now successfully
finished the doffing process. So you can leave the doffing area. You need to find the closest designated shower where you can remove your scrubs
and bathe with soap and water. A shower is recommended at the end of each
shift for the comfort of the healthcare worker. [ Silence ]

 

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