Principles of Infection Control and

Personal Protective Equipment

A Brief Overview

Why Should I Care?

Because if you become sick or injured, you become part of the problem instead of being part of the solution.

Why Should I Care?

We would never intentionally send you into a situation requiring extensive PPE. However, basic PPE would be prudent if dealing with the general public during a pandemic or other situation where exposure to harmful substances could occur.

Why Should I Care?

You could find yourself in a situation where PPE would reduce your chances of being harmed. For example, think about the chemical fire in Marietta in May, 2014. Basic PPE could prevent inhalation of particulates, eye exposure.

But know what PPE can’t do!

Why Should I Care?

Lives will be saved if bystanders can provide initial care to survivors of an incident: manage bleeding, blocked airways, burns, hypothermia, drowning.

All MRC members should strive to be able to help in this way. Some basic PPE could protect you.

Transmission of Influenza Virus Among Humans

Droplet Most likely route.

Airborne Possible at close distances.

Contact Possible

Types of PPE

• Gloves

• Gowns/coveralls

• Masks/respirators

• Footwear Covers

• Eye protection

Types of PPE

Gloves

• Different kinds of gloves– Housekeeper gloves– Clean gloves – Sterile glove

• Work from clean to dirty

• Avoid “touch contamination”– Eyes, mouth, nose, surfaces

• Change gloves between patients

Types of PPE

Coveralls

• Cover torso, legs, arms

• May include attached foot coverings, hood, and/or gloves

Types of PPE

• Surgical masks– Cotton, paper– Protect against body fluids and large

particles

• Particulate respirators (N95)– Fit testing essential– Protect against small droplets and

other airborne particles

• Alternative materials (barrier)– Tissues, cloth

Masks and Respirators: Barriers and Filtration

PPE for Standard Precautions

Wear:• Gloves

• Gown or coverall

• Eye Protection and Mask

• ALL

If:• Touching respiratory secretions,

contaminated items or surfaces, blood, other body fluids

• Handling soiled clothes, linens, other items with patient body fluids, secretions, or excretions

• Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions

• IF IN DOUBT.

Sequence for Donning PPE

1. STOP! Assess the situation. Should I even be here???

2. Determine what level of PPE is needed.

3. Engage trained observer or buddy.

4. Carefully inspect all items. Look for rips, tears, any other sign of damage.

5. Don’t forget gravity!

6. Remove jewelry, trim nails if longer than ¼”

Sequence for Donning PPE 7. Hand hygiene

8. Shoe covers if not part of coverall

9. Inner gloves (inside gown/coverall cuffs)

10. Gown/coverall and hood

11. N95 Particulate respirator

12. If needed, outer gloves (outside cuffs)

13. Goggles or face shield

14. Verify

Hand Washing

Method • Wet hands with clean (not hot)

water• Apply soap• Rub hands together for about

20 seconds• Rinse with clean water• Dry with disposable towel or

air dry• Use towel to turn off faucet

Alcohol-based Hand Rubs

• Effective if hands not visibly soiled• More costly than soap & water

Method• Apply appropriate (3ml) amount to

palms• Rub hands together, covering all

surfaces until dry

Gloves

• Select correct type and size

• Insert hands into gloves

• Pull up so no wrinkles or sagging

Coverall

• Select appropriate type and size. If no attached hood or foot covering, consider whether they are needed

• This is not a fashion statement – choose a size that fits loosely and allows you to move freely.

• If separate, don foot covering before gloves, hood after respirator

Coverall• Sit down to pull on legs, then

put on arms and hood• If too large, roll sleeves

and/or legs under (so they won’t catch and retain any contaminant)

• Tape cuffs to gloves (fold tape end under)

• If separate foot covering, tape cuffs

N95 Particulate Respirator• Pay attention to size (S, M, L)• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with elastic (inside hood)• Adjust to fit and check for fit:

Inhale – respirator should collapse

Exhale – check for leakage around face

Facial hair a problem? Use PAPR.

Goggles

• Position goggles over eyes and secure to the head using the ear pieces or headband

• Adjust to fit comfortably

Gloves

• Don outer gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over gown cuffs and tape

Key Infection Control Points

• Minimize exposures– Plan before entering room

• Avoid adjusting PPE after patient contact– Do not touch eyes, nose or mouth!

• Avoid spreading infection– Limit surfaces and items touched

• Change torn gloves– Wash hands before donning new

gloves

Duration of PPE Use

Gloves–Never reuse

Surgical Masks/N95

Respirators–Wear once and discard–Discard if moist

Eye Protection–May wash, disinfect, reuse indefinitely

Sequence for Removing PPE

Remove in anteroom when possible

1. Engage trained observer or buddy.

2. Disinfect outer gloves, remove, discard

3. Inspect and disinfect inner gloves

4. Remove goggles

5. Disinfect inner gloves

6. Remove coverall (hood first if separate)

7. Disinfect inner gloves (replace if attached to coverall

Sequence for Removing PPE

8. Remove foot covering (if separate)

9. Change inner gloves

10. Remove N95 respirator

11. Disinfect new inner gloves

12. Disinfect shoes

13. Disinfect inner gloves

14. Remove and discard inner gloves

15. Perform hand hygiene

16. Review self for contaminants

17. Exit the doffing area.

Removing Gloves (1)

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand

Removing Gloves (2)

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• Discard

Removing Goggles

• Grasp where elastic band joins to goggle

• Pull gently away from face• Lift up over hood and back;

don’t let elastic snap!• Discard properly

Removing Coveralls

1. If particulate contamination, rinse or wipe coverall with damp towels

2. Gently pull any zipper cover away from zipper3. Use mirror to make sure you don’t touch bare skin4. Grasp zipper tab with two fingers of one hand and

gently unzip5. Disinfect gloves6. Peel away from neck and shoulder, rolling inside of

coverall over outside7. Once rolled down as far as practical while

standing, sit down on clean chair8. Remove one leg at a time, discard coverall

3. Turn contaminated outside toward the inside4. Fold or roll into a bundle5. Discard

Removing The N95 Respirator

• Don’t touch front of mask!

• Lift the bottom elastic over your head first

• Gently lift the top elastic over your head, allowing the mask to fall forward

• Discard

Hand Washing

• Wash thoroughly immediately after removing all PPE

• Use soap and water. An alcohol-based hand rub may be used only if soap and water are not available

Environmental Decontamination

• Cleaning MUST precede decontamination

• Disinfectant ineffective if organic matter is present

• Use mechanical force– Scrubbing– Brushing– Flush with water

Environmental Decontamination: Disinfecting

• Household bleach (diluted)

• Quaternary ammonia compounds

• Chlorine compounds (Chloramin B, Presept)

• Alcohol– Isopropyl 70% or ethyl alcohol 60%

• Peroxygen compounds

• Phenolic disinfectants

• Germicides with a tuberculocidal claim on label

• Others

Using Bleach Solutions 1• First, clean organic material from

surfaces or items – wash with soap or detergent and water, rinse, dry.

• The CDC recommends using 5 tablespoons of liquid bleach per gallon of water.

• Leave nonporous surfaces (tile, metal, hard plastics, etc.) wet at least 10 minutes and allow to air dry.

Using Bleach Solutions 2• Leave porous surfaces (wood, rubber,

soft plastics, etc.) wet for 2 minutes. Rinse and air dry.

• Use household chlorine bleach (5.25 - 6% sodium hypochlorite); do not use scented or color safe bleaches.

• Use fresh diluted bleach daily!

• Wear gloves and eye protection!

Waste Disposal

• Use Standard Precautions– Gloves and hand washing– Gown + Eye protection

• Avoid aerosolization

• Prevent spills and leaks– Double bag if outside of bag is contaminated

• Incineration is usually the preferred method

Managing Linens and Laundry

• Use Standard Precautions– Gloves and hand hygiene– Gown – Mask

• Avoid aerosolization – do not shake

• Fold or roll heavily soiled laundry– Remove large amounts of solid waste first

• Place soiled laundry into bag in patient room

• Wash with normal detergent

Summary• Contact with contaminants can be prevented

using correct PPE• Viruses can be inactivated with infection

control procedures• Hand washing is key• PPE must be donned and removed

appropriately to prevent contamination of wearers and environments

• Guidelines for using PPE and infection control measures should be practiced until they are routine

For Emergencies,you should keep on hand

• A fresh (no more than six months old) bottle

of household chlorine bleach

• Several N95 particulate respirators

• Several pairs of disposable gloves

• At least one disposable coverall or one you

can discard.

Remember…

Your first obligation is to protect yourself!

If you have any doubt about your safety in any situation, avoid that situation!

For more information

Standard Precautions

http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-gl-standared-precautions.html

For more information

Donning/Doffing PPE• http://

www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator_Coveralls/donning_01.html

• http://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator_Coveralls/doffing_01.html