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Personal Protective EquipmentKate Boulter BAN (HONS) RN
Nurse Manager, The Nebraska Biocontainment Unit
Nebraska Medicine
Omaha, Nebraska
Sharon Vanairsdale, MS, APRN, ACNS-BC, NP-C, CENProgram Director for Serious Communicable Diseases
Emory University Hospital
Atlanta, GA
Personal Protective Equipment
• “Equipment worn to minimize exposure to workplace injuries and illnesses…” (Occupational Safety and Health Administration-OSHA)
• Workplace PPE is regulated under OSHA standard 29 CFR 1910.132: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9777
• Included in the standard is the requirement that employers are required to train every worker on:
When PPE is necessary
What type of PPE is necessary
How to properly put it on and take it off
Limitations of the PPE
Proper care, maintenance and disposal of PPE
And more…
Ebola Transmission
• Understanding how Ebola is spread is essential in knowing what barriers must be put in place to prevent transmission
• Use Contact/ Droplet Precautions
http://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf
Ebola Transmission
• Droplet: Infected droplets can be expulsed when an infected person coughs, sneezes, talks or through aerosolizing medical procedures
• Droplets do not remain suspended in air but can remain on surfaces
Is Ebola an Airborne Disease?
• Airborne: Droplet nuclei that remainsuspended in the air for long periods of time as a result of an infected person sneezing, coughing, talking or through aerosolizing medical procedures i.e. bronchoscopy
• Organisms transmitted by this mode are capable of surviving outside the body and are somewhat resistant to drying
• Infection occurs when the organism is inhaled into the upper or lower respiratory tract
http://phil.cdc.gov/phil/details.asp
Who is at Risk?
• Anyone who comes in contact with infected body fluids is at risk
• Mostly:
Healthcare workers
Household contacts
People who are involved in burial practices
• Infectiousness of body fluids (viral load) increases as the patient becomes more ill
• Remains from deceased infected persons are highly infectious
Based on what we know, a person with Ebola is not
contagious unless there are symptoms
Terminology
• Fluid resistant – Material resists liquid penetration but will allow penetration with pressure.
• Impervious / Impermeable – Does not allow fluid to pass through.
http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/
ANSI/AAMI Standards
Critical Zones
Areas where blood, body fluid or other infectious materials are most likely to occur
Surgical Gown
Classification of Barrier PerformanceLevel Test Methods Used Expected Barrier Effectiveness
1 Impact PenetrationMinimal water resistance (some
resistance to water spray)
2Impact Penetration &
Hydrostatic Pressure
Low water resistance (resistant
to water spray & some
resistance to water penetration
under constant contact with
increasing pressure)
3Impact Penetration &
Hydrostatic Pressure
Moderate water resistance
(resistant to water spray & some
resistance to water penetration
under constant contact with
increasing pressure)
4
ASTM F1670 Synthetic
Blood & ASTM F1671
Viral Penetration Test
Blood and viral penetration
resistance
Personal Protective Equipment
Masks
Respirators
Gowns
Coveralls
Gloves
Disposable Boots
Head Covers
Eye Protection
Personal Protective Equipment
Facilities may and do differ in the types and brands of PPE used
• What’s important is that the PPE must be effective, and procedures for donning and doffing must done in such a way that the healthcare worker is protected and not exposed to any contamination.
• Choose appropriate PPE based on patient’s clinical status.
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/
Dry - Person Under Investigation (PUI): Ebola infection not confirmed,
clinically stable patient without vomiting, diarrhea, or bleeding.
Wet - Confirmed Ebola patient or a PUI with vomiting, diarrhea, or bleeding,
or with condition warranting invasive or aerosol-generating procedure.
Tiered Approach Requirements
http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html
What’s required
• For the Person Under Investigation (PUI) and the confirmed patient:
Hospitals will have selected which type of PPE to manage PUI and confirmed patients with Ebola
Have protocols outlining procedures on how to use the PPE
• Hospitals are to be in compliance with all elements of OSHA Respiratory Protection Standards including:
Respirator fit testing
Medical evaluation, and training of healthcare providers
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/
Frontline Healthcare Facilities must have enough PPE to last at least for 24-48 hours of care
Assessment Hospitals must have enough PPE for 5 days of care
Ebola Treatment Centers must have enough PPE for 7 days and able to restock as needed
Recommended PPE for the Dry Patient
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/
Single Use (Disposable) Face Shield
Single Use (Disposable) Surgical Mask
Single use (disposable) fluid-resistant gown that extends to at least mid-calf or coverall without integrated hood
Single use (disposable) gloves with extended cuffs. Two pairs of gloves should be worn.
At a minimum, outer gloves should have extended cuffs and must completely cover the gown cuff.
Recommended PPE for the Wet Patient
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/
Single use fluid-resistant OR impermeable apron that covers the torso to the level of the mid-calf
Single use fluid-resistant or impermeable gown that extends to at least mid-calf OR coverall without integrated hood (not shown)
Two pairs of single use, disposable gloves. At a minimum, outer gloves should have extended cuffs.
Single use fluid-resistant or impermeable boot covers that extend to at least mid-calf OR single-use fluid-resistant or impermeable shoe covers, which are acceptable only if used with a coverall with integrated socks (not shown)
Single use face shield, surgical hood extending to shoulders, and N95 Respirator OR PAPR with a full face shield, helmet, shroud (not shown)
Training
• Healthcare workers on the biocontainment team and from all points of entry (ED, L&D, clinic) must receive repeated training
• Staff are required to demonstrate competency through assessment and testing on proper procedures for donning and doffing PPE
• Identify how new staff will be oriented to the biocontainment unit
Glove Removal Technique
http://youtu.be/BOAb_cy3HxM
Glove in Glove Technique
Drills
In addition to training on how to don and doff PPE, PPE should be used during drills to learn how to perform task while in PPE.
Standard Operating Procedures
• Provide consistency in how procedures are performed
• Need to be easy to follow
• Emphasize meticulous adherence to them
• SOP should include:
Where donning and doffing can safely occur
When PPE should be disposed
How to clean and disinfect reusable PPE
What type of PPE must be worn in specific areas
What to do if there is a breach in PPE
Donning and Doffing Areas
Serious Communicable Diseases Unit
Nebraska Biocontainment Unit
Resources
http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
http://www.who.int/csr/resources/publications/ebola/filovirus_infection_control/en/
https://www.youtube.com/watch?v=F2i0P-8fybQ&feature=youtu.be
https://www.youtube.com/watch?v=NLGPy0GmCc8&feature=youtu.be
http://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=105&src=yt
http://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=105&src=yt
