Use of Personal Protective Equipment – Pandemic Influenza Presenter:

Types of PPE used for Pandemic Influenza Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and P2/N95 respirators– protect mouth/nose P2/N95 Respirators – protect respiratory tract from airborne infectious agents Protective eyewear – protect eyes Face shields – protect face, mouth, nose, and eyes

Key points about PPE Follow a consistent sequence when donning and removing PPE Ensure your PPE is fitted correctly to provide maximum protection Take your time Don’t touch your face/mask/eyewear when in the isolation area

Key points about PPE Don before contact with the patient, before entering the room Use carefully – don’t spread contamination Remove and discard carefully; remove P2/N95 respirator (if used) outside room Immediately perform hand hygiene

Sequence for Donning PPE Perform hand hygiene Gown Mask (or P2/N95 respirator if aerosol generating procedures to be performed) Perform fit check if P2/N95 respirator worn Protective eyewear or face shield Gloves Stop & check

Step 1 - Perform Hand Hygiene Washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial OR Applying a waterless antimicrobial hand rub to the surface of the hands (e.g. alcohol-based hand rub) Refer to Hand Hygiene Australia for detailed instructions http://www.hha.org.au/home.aspx

Step 2 – Don gown Select appropriate type and size Opening is in the back Secure at neck and waist Ensure all clothing is covered If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back When non-impervious gowns being used, use a plastic apron over cloth gown

Step 3 – Don mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

OR Step 3 – Don P2/N95 Respirator A P2/N95 respirator should be worn whenever aerosol generating procedures are going to be performed Select a suitable P2/N95 respirator Ensure mask is not damaged in any way Place over nose, mouth and chin Follow the manufacturer’s instructions for fitting Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit For detailed information on donning a P2/N95 mask, please refer to the presentation available at http://www.health.qld.gov.au/chrisp/resources/Fit_Check.ppt

Step 4 – Perform fit check (if wearing P2/N95 respirator) Every time a P2/N95 respirator is worn a fit check must be performed: Inhale – respirator should collapse slightly Exhale – respirator should expand, check for air leakage around face If mask does not collapse, expand or air leakage or fogging of glasses/protective eyewear is observed, check seals around bridge of nose and check if mask is crooked, bunched or folded. Then fit check mask again For detailed information regarding fit checking P2/N95 masks, please refer to the presentation available at: http://www.health.qld.gov.au/chrisp/resources/Fit_Check.ppt and the factsheet available at: http://www.health.qld.gov.au/chrisp/resources/fit_check_factsheet.pdf

Step 5 – Don eye/face protection Put on prescription eyewear (if worn) Position protective eyewear over eyes/glasses and secure to the head using the arms of the eyewear Adjust to fit comfortably

Step 6 – Fit check mask (if wearing P2/N95 respirator) If wearing a P2/N95 respirator re-fit check mask after donning protective eyewear This will ensure protective eyewear is not affecting the fit of the mask Inhale – respirator should collapse Exhale – respirator should “puff out”, check for air leakage around face

Step 7 – Don gloves Select correct glove size Put the first glove over your hand, then pull the end of the glove over the cuff of your gown Repeat this for the other hand

Step 8 – Stop & check Do not touch your mask, protective eyewear or your face whilst in the isolation area Ensure you stop and check the placement of your PPE before entering the isolation area Ensure you are comfortable Remove gloves if they become torn; perform hand hygiene before donning new gloves

Safe removal of PPE PPE may have been contaminated with respiratory droplets Outside front of PPE most contaminated Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Most likely time you could accidentally infect yourself Minimise contact

Safe removal of PPE Remove PPE carefully – take your time Immediately dispose or place PPE in receptacles for reprocessing PPE removal principles and sequencing aims to protect the healthcare worker from contamination

Where to remove PPE Never remove mask inside the patient room Remove gloves, protective eyewear and gown at doorway, before leaving patient room or in anteroom* Remove mask/respirator outside room, after door has been closed* *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

Sequence for Removing PPE Gloves Hand hygiene Protective eyewear Gown Mask

Step 1 – Remove gloves Grasp cuff near wrist Peel away from hand, turning glove inside-out Hold in palm of gloved hand

Step 1 – Remove gloves Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard

Step 2 – Perform Hand Hygiene Washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial OR Applying a waterless antimicrobial hand rub to the surface of the hands (e.g. alcohol-based hand rub) Refer to Hand Hygiene Australia for detailed instructions http://www.hha.org.au/home.aspx

Step 3 – Remove eye/face protection Grasp arms of protective eyewear frames Lift away from face Place in designated receptacle for reprocessing or disposal

Step 4 – Remove gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard

Step 5 – Perform Hand Hygiene Washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial OR Applying a waterless antimicrobial hand rub to the surface of the hands (e.g. alcohol-based hand rub) Refer to Hand Hygiene Australia for detailed instructions http://www.hha.org.au/home.aspx

Step 6 – Remove mask Untie the bottom, then top, tie Remove from face – avoid touching the front Discard Do not reuse mask

Step 6 – Remove P2/N95 Respirator Never remove respirator inside the patient room Avoid touching the front of the respirator Remove by the straps Remove down and away from face Discard Do not reuse respirator

Step 7 – Perform Hand Hygiene Washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial OR Applying a waterless antimicrobial hand rub to the surface of the hands (e.g. alcohol-based hand rub) Refer to Hand Hygiene Australia for detailed instructions http://www.hha.org.au/home.aspx

For Further Information Queensland Health factsheet – P2/N95 Mask Fit Checking http://www.health.qld.gov.au/chrisp/resources/fit_check_factsheet.pdf Department of Health and Ageing – Pandemic Influenza Preparedness, Safe Use of Personal Protective Equipment (PPE) http://www.health.gov.au/internet/panflu/publishing.nsf/Content/safeuse-dvd-1 The World Health Organisation and 2014 AHMPPI assert that pandemic influenza patients should be managed using contact and droplet transmission-based precautions, however, the DoHA presentations do not currently reflect this P2/N95 respirators are necessary for aerosol generating procedures – staff caring for closed circuit ventilator patients may wish to consider wearing P2/N95 respirators Surgical masks provide sufficient protection for general care of pandemic influenza patients

For Further Information Centres for Disease Control (CDC) Protecting Healthcare Personnel http://www.cdc.gov/HAI/prevent/ppe.html