Donning and Doffing PPE and Isolation Precautions

Donning and Doffing Personal Protective Equipment (PPE)

  • Definition of PPE: Personal Protective Equipment (PPE) refers to protective clothing, helmets, goggles, or other garments designed to protect the wearer from injury or infection, especially when interacting with patients in healthcare settings.

1. How to Don PPE (Put it On)

  • Order of Donning PPE: The recommended order is:
      - Gown
      - Mask
      - Eyewear (goggles or face shield)
      - Gloves
  • Memory Aid: Use the mnemonic "GMEG" (Gown, Mask, Eyewear, Gloves) to remember the order.
  • Explanation: This order minimizes the risk of contamination while ensuring maximum protection for the healthcare worker.

2. How to Doff PPE (Take it Off)

  • Order of Doffing PPE: The recommended order is:
      - Gloves (first)
      - Eye protection (goggles or face shield)
      - Gown
      - Mask (last)
  • Reason for Order: Removing PPE in this order minimizes the risk of transferring contaminants from dirty to clean areas on the body.
  • Important Note: Avoid touching the outside of any PPE during removal; the outside is always considered contaminated regardless of contact with specific pathogens.
  • Post-Doffing: Perform hand hygiene immediately after doffing.

3. Transmission Precautions

A. Standard (Universal) Precautions
  • Definition: A set of practices to prevent healthcare-associated transmissions. Treat all patients as potentially infectious to protect both healthcare workers and patients.
  • Practices Include:
      - Hand hygiene (washing hands or using hand sanitizer)
      - Usage of clean gloves (not necessarily sterile)
  • Additional Practices: Safe injection practices and cough etiquette.
B. Contact Precautions
  • Definition: Used when a patient is known to have a pathogen that is transmitted via direct or indirect contact.
  • Pathogens Examples:
      - Clostridium difficile (C. diff)
      - Methicillin-resistant Staphylococcus aureus (MRSA)
      - Vancomycin-resistant Enterococcus (VRE)
      - Respiratory Syncytial Virus (RSV)
      - Lice and Scabies
  • Required PPE: Gown and gloves must be worn when entering the room.
  • Special Note for C. diff: Always use soap and water for hand washing; alcohol-based sanitizer is ineffective against C. diff endospores.
C. Droplet Precautions
  • Definition: Implemented for conditions spread through respiratory droplets that are larger than those related to airborne transmission and fall to the ground quickly.
  • Pathogens Examples:
      - Influenza
      - Pertussis (whooping cough)
      - Group A Streptococcus
      - Mumps
      - Diphtheria
      - Rubella
      - Bacterial meningitis
  • Required PPE: Gown, gloves, and surgical mask are needed if closer than three feet to the patient.
D. Airborne Precautions
  • Definition: Used for conditions transmitted through smaller, aerosolized particles that remain suspended in the air for longer periods.
  • Pathogens Examples:
      - Mycobacterium tuberculosis (TB)
      - Varicella (chickenpox)
      - Measles
  • Room Requirements: Patients need a private room with negative pressure airflow to prevent aerosolized particles from escaping.
  • Required PPE: Gown, gloves, and N95 respirator must be worn when entering the room.
  • Clarification on Masks:
      - N95 respirators protect the wearer (healthcare worker) from inhaling pathogens.
      - Surgical masks protect others from the wearer especially if the patient must leave the room, requiring a surgical mask.
E. Protective Isolation
  • Purpose: Protects patients who are immune-compromised from pathogens carried by healthcare workers and visitors.
  • Indicators for Use:
      - Neutropenia (low white blood cell count)
      - Recent radiation therapy or chemotherapy
  • Room Requirements: Private room with positive pressure airflow, where clean, filtered air is pumped into the room.
  • Required PPE: Appropriate PPE (mask, gown, gloves) to protect the patient from healthcare workers.
  • Visitor Guidelines: Restricting visitors, ensuring they are screened for illness; avoid live plants and flowers in the room due to potential pathogens.
F. Patient Education for Protective Isolation
  • Recommended Practices:
      - Avoid crowded areas.
      - Avoid contact with anyone known to be sick.
      - Do not share personal items (e.g., hairbrush, toothbrush).
      - Avoid raw foods and ensure all meats are cooked thoroughly to kill pathogens (e.g., only well-done steak).
      - Avoid live plants and gardening to limit exposure to bacteria and fungi.

Conclusion

  • The review discussed donning and doffing PPE as well as various isolation and transmission precautions necessary to protect both healthcare workers and patients. Understanding these concepts is crucial for maintaining safety in healthcare settings.