Training structure EFFO Safety and good quality work Module 1: Ebola Virus Disease Module 2: Epidemic control on different levels Module 3: Standard precautions & disinfection Module 4: Screening & isolation Module 5: Personal protective equipment Module 6: Waste management & cleaning Support from the community Support from the hospital administration Support from the population 01.08.2017

Personal Protective Equipment (PPE) Module 5 - Concept adapted from Doctors Without Borders - 01.08.2017

Learning objectives module 5 General objectives To know how to put on and take off PPE Be prepared to work in PPE Specific objectives To know the principles of PPE To know the conditions for working in PPE Know how to use every element of PPE To be able to put on PPE To be able to take off PPE   01.08.2017 3

Principle of PPE Completely cover skin and mucosa → protection against contact with infectious agent Thereby: Protecting yourself Protecting hospital staff Protecting other patients Protecting the community 01.08.2017

Which PPE is the most suitable? Examples: Additional information: These are examples, and the skin is not protected here which is why they are not suited for the context of Ebola. PPE may need to be adapted depending on the situation and the equipment available. It is important to know the weaknesses of PPE and to consider them. Attention: Only when knowing the PPE and training regularly using it, you can be protected by it. This applies for every type of PPE. Source: RKI 01.08.2017 5

PPE requires training There are different types of each component of PPE, and several methods for doffing and donning. → EFFO: adapted concept of doctors without borders Repeated practice in using PPE is essential, because in critical scenarios, an error might be dangerous! Advantage of training: to learn by errors → Errors are important! Always work in pairs (buddies)! Additional information While donning PPE and while working in the red area, you work as buddies. One person takes on a job with which he / she can be possibly contaminated („dirty person“). The other person tries not to be contaminated („clean person“) et carries disinfection solution (e.g. in a spray bottle). Both persons in PPE are subsequently decontaminated and follow the different procedures of doffing. 01.08.2017 6

- concept adapted from Doctors Without Borders - Donning – How to dress PPE - concept adapted from Doctors Without Borders - 01.08.2017

Working with checklists Working with checklists enhances your safety! → This applies also for experienced personnel. Before start donning, everything that is needed must be prepared! 01.08.2017 8

Elements of PPE Note The single components of PPE that is used in the EFFO project: suit, gloves single-use (inner / outer pair), goggles, apron, hood, FFP-3 mask, boots 01.08.2017

Checklist: components of PPE PPE for one person: 1 liquid-proof suit (type 3) 2 pairs of appropriate gloves, long sleeves 1 mask (FFP-3) 1 pair of goggles 1 liquid-proof apron 1 hood 1 pair of boots Surgical cap (if necessary) 01.08.2017 10

Further equipment Adhesive tape 1 pen 1 waste bag 1 pair of scissors 1 large poster: Donning PPE 1 mirror List at entrance of the red area : name of persons in PPE, when PPE has been put on, when the red area has been left Additional information Monitoring the time people spend in PPE is important because work in PPE is exhausting (Attention: working safety and risk of accidents!) Wearing time: 45-60 minutes, this time must not be exceeded! 01.08.2017

Step 1 MSF MSF Additional information Cut the legs with scissors and remove the elastic band (take off the suit for this!)   → this will facilitate the doffing of the suit later on and ensures a proper lengths of the suit First put on the suit then the boots (in order not to soil the inner part of the suit with the boots) Have a chair in order to sit down (to save energy). MSF MSF 01.08.2017

Step 2 MSF Additional information Put the suit over the inner pair of gloves Close the zipper and the adhesive tape wrinkle-free Carefully enrolling the suit‘s hood By using the MSF-hood, the hood of the suit is not needed! Inner pair of gloves: covered by suit If there are thumb loops → Put them above the gloved thumbs (other fingers possible) This prevents both the slipping up of the suit and the loss of the gloves. If there are no thumb loops → insert a hole per sleeve (in the part of the sleeve) with a pen at the height of both thumbs MSF 01.08.2017 13

Step 3 MSF MSF Additional information Before the mask is put on, put on a hairnet (especially for long hair!) Hold the mask in one hand, put straps up Start by putting the mask on the face on the chin → Pull the bands over the head Adjust the nose clip with both forefingers The bands of the mask must not be twisted, too long or too short! MSF MSF 01.08.2017 14

Step 4 MSF Additional information Ensure correct placement, especially around the eye area (hood should be at about the height of the eyebrows - not higher!) First tie straps at front above the belly Then let tie the straps at the back of the head by your buddy Tie the hood as much as possible so that the front part (surgical mask) rests as close as possible to the FFP-3 mask (reduction of the dead space volume). All nodes should be tight, but later be easy to loosen! MSF 01.08.2017 15

Step 5 MSF MSF Additional information Chest part should be covered → tie up apron Pull an end of a band through the neck band → Tie loop with other string end on the back (firm, but easy to loosen!) MSF MSF 01.08.2017 16

Step 6 Use anti-fog spray against fogging of glasses MSF Additional information Careful check if there are uncovered areas (check with pen, for example) Correct the position of the glasses by careful movements Use anti-fog spray against fogging of glasses MSF 01.08.2017 17

Step 7 MSF Additional information Put on the outer pair of gloves 01.08.2017 18

Step 8 RKI RKI Additional information Use the mirror to check the fit of the entire PPE Use movements (such as light squats) to check whether you can move within PPE without problems Final check of the entire PPE by buddy (Caution: no free skin, no damage of PPE, all nodes in the proper position) Already think of how to doff the PPE during the donning process! With this you avoid difficulties during doffing. RKI 01.08.2017 19

Overview: Donning of PPE adapted from doctors without borders 01.08.2017 20

- concept adapted from Doctors Without Borders - Doffing – How to undress PPE - concept adapted from Doctors Without Borders - 01.08.2017

Checklist: Doffing of PPE Basin with 0.5% chlorine solution between red and yellow area Vessel with tap and chlorine solution 0.5% in the yellow area 1 large waste bin with waste bag Basin with 0.5% chlorine solution for reusable equipment 1 large mirror Sprayer with 0.5% chlorine solution Vessel with tap and chlorine solution 0.05% in the green area 1 large poster „Doffing - How to undress PPE?“ 1 PPE „light“ (for instructor) List of people in PPE Cellulose / Paper towels Waste bags → Is there enough chlorine solution? Additional information Instead of chlorine solution, another suitable disinfectant can be used. 01.08.2017 22

Before doffing MSF 01.08.2017 23

Step 1 MSF Additional information Stretch out arms to the right and left Careful spraying from the front, from the neck towards down horizontally MSF 01.08.2017 24

Step 2 MSF Additional information Walk slowly and carefully so as not to slip on the wet surface Spray horizontally downwards from the neck MSF 01.08.2017 25

Step 3 Additional information The correct removal of the gloves is important! 01.08.2017 26

Step 4 Additional information First, open the loop of the apron on the back → Bands must be completely detached from each other Take the neckband with both hands, right and left Bend over → Carefully pull the apron over your head Do not touch glasses and hood when taking off the apron! 01.08.2017 27

Schritt 5 MSF Additional information While looking in the mirror carefully grab the glasses with both hands on the left and the right Bend over, close eyes, carefully move glasses forward, then pull off over the head. MSF 01.08.2017 28

Step 6 MSF Additional information In bent over position: careful loosening the three loops on the back of the head (Attention: bands should be carefully put aside so that they do not touch the face later!) Loosen the loop on the front, if possible without touching the suit (otherwise: hand disinfection) → Hold these bands and pull the hood over your head with the bands MSF 01.08.2017 29

Step 7 MSF Additional information If possible, do not touch the suit from the outside → if so: additional hand disinfection! Open the adhesive tape and the zipper one after another while looking in the mirror, "Flaps" help If possible, keep the chin parallel to the floor so that the suit is not accidentally touched by bare skin. The mirror helps! MSF 01.08.2017 30

Step 8 MSF Additional information Take the suit with clean hands from the inside (without touching your own clothes) and pull it off over the shoulders Carefully move the upper body to shake off the suit MSF 01.08.2017 31

Step 9 MSF Additional information Continue to take off the suit; Avoid touching the boots or your own cloths With careful foot movements finally take off the suit with the boots (not with the hands!) This step is much easier when the suit’s legs and the elastic band have been cut off MSF 01.08.2017 32

Step 10 Additional information Subsequently, make sure to grab the suit only on the inner side in order to put it in the waste 01.08.2017 33

Step 11 MSF Additional information While looking in the mirror, grasp the FFP3 mask on the right and left of the valve with both hands Bend over, close eyes, pull mask forward and then over head MSF 01.08.2017 34

Step 12 MSF Additional information The correct removal of the gloves is important! MSF 01.08.2017 35

Step 13 MSF 01.08.2017 36

Step 14 MSF Additional information Move carefully to avoid falling on the slippery floor! MSF 01.08.2017 37

Step 15 01.08.2017 38

Overview: Doffing – how to undress PPE 01.08.2017

Instructor The instructor uses the PPE poster to give clear instructions on how to undress PPE. Attention: Not all concepts of PPE include the role of an instructor. Source: RKI 01.08.2017

Storage of PPE Store PPE in its original packaging Store it above ground Store it in a dry place The recommended temperature range is -10 °C to + 40°C. Follow instructions on package Additional information The recommended temperature range for PPE depends on the producer 01.08.2017 41

Maximum working time in PPE Work 45 - 60 minutes max in PPE because… … The respiratory mask leads to exhaustion because it causes resistance during breathing. … wearing PPE provokes sweating a lot and you risk dehydration.. … concentration decreases which is often accompanied by an elevated risk for errors. 01.08.2017

Thank you for your attention! Copyright Images © Fiedels - Fotolia.com 01.08.2017 43