1. Use of Personal Protective Equipment – Pandemic Influenza
Presenter:

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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: and the factsheet available at:

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Sequence for Removing PPE
Gloves
Hand hygiene
Protective eyewear
Gown
Mask

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

20. 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

21. 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

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

23. 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

24. 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

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

26. 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

27. 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

28. For Further Information
Queensland Health factsheet – P2/N95 Mask Fit Checking
Department of Health and Ageing – Pandemic Influenza Preparedness, Safe Use of Personal Protective Equipment (PPE)
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

29. For Further Information
Centres for Disease Control (CDC) Protecting Healthcare Personnel