Hand Hygiene and Personal Protective Equipment

Personal Protective Equipment (PPE): Overview

• Also called garb

  • Proper garbing of PPE is one of the three major components to prevent contamination of compounded sterile preparations (CSPs)

  • Consists of all protective equipment worn when compounding hazardous and nonhazardous CSPs

Purpose

Properly worn PPE helps minimize the risk of contaminations from areas (skin, clothes, excretions, etc.), and getting into your CSP

Items

• Shoe covers prevent dirt on the bottom of shoes from contaminating the cleanrooms

  • Avoid wearing pointy shoes to prevent rips in shoe covers

    • Hair covers (bouffant caps) cover the hair on head

  • Must still be worn even if bald

  • A hood must be worn if hair can’t be fully contained in a hair cover

    • Beard covers cover certain facial hair (goatees, etc.)

  • A hood must be worn with a full beard

    • Face mask covers nose, mouth, and chin

  • Ensure mask wire molds around bridge of nose, and mask folds face “down” so exhaled breath is caught properly

    • Face shield protects entire face from irritants

  • Worn on top on the face mask

  • May be optional to wear, but check your facility’s SOP’s for more info

    • Eye shields protect eyes from irritants

  • May be optional to wear with nonhazardous CSPs, but check your facility’s SOP’s for more info

  • Do not use safety glasses since these don’t offer adequate protection

    • Low-lint gown covers your clothes and body, including your neck and arms, up down to your wrists

    • Sterile gloves cover your hands up to your wrists

  • Prevent contaminations from your hands and fingernails from entering your CSP

Donning Order

• No official donning order, according to USP <797>

  • Donning order is required to be outlined by facility’s SOPs

    • As a best practice, don PPE from dirtiest to cleanest areas

    • 1. Shoe coverings

    • 2. Hair/Hood cover

    • 3. Beard cover (if needed)

    • 4. Face mask/face shield/eye shields

    • 5. Gown

    • 6. Sterile gloves (usually donned in buffer room)

Doffing

• Removal of PPE when sterile compounding is complete

  • Doffing order is defined your facility’s SOPs

  • As a best practice, doff PPE from dirtiest to cleanest items

  • 1. Sterile gloves

  • 2. Gown

  • 3. Face/eye shield (if worn)

  • 4. Face mask

  • 5. Beard cover (if worn)

  • 6. Hair/hood cover

  • 7. Shoe coverings

    • The gown can be reused and hung in the anteroom, as long as it’s clean and kept at least 6 feet away from water sources

    • Wash hands after doffing

Hand Hygiene: Overview

• Varies from regular handwashing

  • Critical to prevent contaminated of CSPs

Hand Hygiene Prep

• Remove unnecessary items (coats, jewelry, electronic devices, etc.)

  • Nails should be natural, with no nail polish, as well as clean and trimmed

  • Longer nails harbor microbes and can increase the chance of a glove tear

    • If eyeglasses are worn:

  • Frames need to be wiped with an EPA-registered bactericidal cleaner

  • Lenses cleaned with a lens cleaning wipe

    • Wash hands with soap and water if visibly dirty, or clean with ethyl alcohol if not

  • Either procedure, clean hands for at least 30 seconds

    • Garb shoe covers, head/hood cover, beard cover (if needed), and face/eye shield (if needed)

  • Ensure all items are put on correctly before moving on

Procedure

• Wet hands, and using a nail pick, clean underneath each nail

  • Using soap during this process can help gather dirt and help make the nail picking more effective

    • Apply soap (antimicrobial or nonantimicrobial) and lather hands and arms up to the elbow

  • Clean hands, fingers, webbing, and arms

  • Lathering process must last at least 30 seconds (can sing happy birthday song at a normal pace twice)

  • Avoid using scrub brushes, since they can cause micro abrasions of the skin

    • Rinse soap off arms and hands

    • Use low-lint towels to dry your arms and hands

  • Electric dryers are no longer allowed to be used

    • Continue to the garbing procedure by donning gown, ensuring it doesn’t touch the floor or walls

Sterile Glove Donning

• 1. Grasp the inner part of the glove cuff

• 2. Pull glove cuff over your wrist and sleeve of the sterile gown

• 3. Repeat with the other glove

  • Use sterile isopropyl alcohol if you need to sterilize your gloves

  • Do not use regular alcohol-based hand rub, since it can damage the glove