1. Removal of PPE – Contaminated Staff Infection Prevention & Control Team

2. Principles There has been some concern why healthcare staff in the US and Spain have acquired Ebola from repatriated patients and a significant number of healthcare staff have acquired the disease in West Africa Failure in the PPE or failure to follow protocols when getting out of PPE have been blamed but the cause of these healthcare acquired infections remains unclear

3. Principles (2) The purpose of this procedure is to ensure that staff in contact with an “at risk” patient remove PPE with the minimum contact of potentially contaminated PPE with themselves An “undresser” who will also be dressed in PPE will remove the PPE of contaminated staff Undressing will take place in a contaminated buffer zone, which is marked in amber on the floor plans (according to where the patient is isolated)

4. Step 1 Contaminated staff leave the patient’s room and enter the undressing area Undresser UNDRESSING AREA CLEAN ZONE

5. Step 2 Undresser unties the gown

6. Step 3 Placing hands beneath the gown, push the gown forwards over the arms If there is a second contaminated person, then repeat before proceeding further

7. Step 4 Roll the gown forwards, ensuring the outside of the gown does not touch the all-in-one oversuit If possible, take the outer gloves off with the all-in-one oversuit

8. Step 5 Dispose of the gown Staff member being undressed to keep their hands away from their body

9. Step 6 Remove outer gloves if they have not already come off, taking care not to pull inner gloves off Undresser dips hands in Actichlor plus (hypochlorite) solution

10. Step 7 Remove visor, pulling forwards and away from the face Dip hands in Actichlor plus (hypochlorite)

11. Step 8 Fully undo zip to all-in-one oversuit

12. Step 9 Roll all-in-one oversuit down, avoiding the outside of the oversuit touching either the scrubs or skin

13. Step 10 Continue to roll the all-in-one oversuit down, avoiding the outside of the oversuit touching either the scrubs or skin

14. Step 11 Roll all-in-one oversuit down the body NB: gloves may come off during this process

15. Step 12 Continue to roll all-in-one oversuit down to knees

16. Step 13 Person being undressed shuffles back to a chair on the clean/dirty line, ensuring gloved hands do not touch skin/scrubs

17. Step 14 One trouser leg of all-in-one oversuit, shoe and overboot removed and disposed of

18. Step 15 Person being undressed avoids putting foot on the floor, or puts foot on the INSIDE of the all-in-one oversuit

19. Step 16 Undressed person places foot into the clean area

20. Step 17 Undresser removes all-in-one oversuit, second shoe and overboot NB: a third person in the clean area can support the person sitting in the chair

21. Step 18 Undressed person places second foot into the clean area Gloved hands kept over contaminated area

22. Step 19 Inner gloves removed

23. Step 20 Straps to face mask and goggles can be cut by a 3 rd person in the clean area They are taken by the undresser and disposed of within the undressing area Individual can now leave clean area for shower