1. PPE donning and removal

2. During the SARS epidemic the use of Personal Protective Equipment (PPE) for healthcare workers (HCWs) caring for patients has been emphasized as part of the isolation measures to control the nosocomial spread of SARS-CoV, i.e. standard plus contact, droplet and airborne precautions.
However, in some instances it was suggested that some occupational infections might have occurred) as HCWs removed their PPE contaminated by the patients’ droplets and secretions.

3. In a reported cluster of cases of SARS among Canadian health care workers, infections occurred despite apparent compliance with recommended infection control precautions.
In the report it was noted that contact with a patient or with a contaminated environment might have led to HCW infecting themselves as they removed their PPE. (Can Commun Dis Rep 2003; 11:93-7)

4. Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers --- Toronto, Canada, April 2003
MMWR May 16, 2003 / 52(19);

5. Procedures for removing PPE worn in the care of SARS infected patients
Priority order
Canada
(1)
WHO Western Pacific (2)
Australia
(3)
Hong Kong ( 4)
Hong Kong
(5)
U. K
(6) 1.
Gloves (*)
Wash gloved hands
Gloves
Hair and shoe covers, gown 2.
Hand hygiene
Aprons, gowns, and shoe cover
Eye-protection
Hair cover
Mask 3.
Gown
Goggles 4. 5. 6.
Mask and Hand hygiene
1) Directives to all Ontario acute care hospitals regarding infection control measures for SARS units. Ministry of Health and Long Term Care - Directive 03-05( R). April WHO Western Pacific Regional Office. Interim guidelines for national SARS preparedness WHO, Manila, Philippines.
3) Australian Government Department of Health and Ageing. Interim Infection Control Guidelines for SARS,16 May ) Ahuja AT and Wong JKT. Infection control measures. Prince of Wales Hospital, Shatin, N.T., Hong Kong.
5) Ng PC, et al Infection control for SARS in a Hong Kong tertiary neonatal centre. Arch Dis Child Fetal Neonatal Ed. 2003; 88:F ) UK Health Protection Agency. Guidance for hospitals on the prevention of spread of SARS
…to the ante-room

6. Procedures for removing PPE worn in the care of SARS infected patients
Puro V, Nicastri E. SARS and the removal of personal protective equipment. CMAJ 2004; 170: 930
…to the ante-room

7. Order
Shoe
Hood
Hair
mask 1 4 2 3 5 6 7 8 9

8. The order on donning and removal depends on
the availability of anteroom
the PPE which are worn