Sterile Gloving and Personal Protective Equipment - Vocabulary

Sterile Gloving

• Purpose: Protect patient and healthcare provider; maintain a sterile field for procedures involving sterile items.

• When to touch sterile items: Only within the sterile field after donning sterile gloves.

• When not to touch: Do not touch anything outside the sterile field.

• Glove basics:

  • Single-use.

  • Available in many sizes to fit snugly.

  • Insides are powdered to ease donning.

  • Right and left gloves are labeled on the package.

• Related references (for context): See Promoting Safety and Comfort: Sterile Gloving; See procedure: Sterile Gloving, p. 238.

Transmission-Based Precautions: Overview

• Definition: Some infections require Transmission-Based Precautions in addition to Standard Precautions.

• PPE required (depending on the infection and route of transmission): gloves, gown, mask, goggles, or face shield.

• PPE and equipment choices:

  • Use disposable (single-use) equipment when possible.

  • Use dedicated equipment kept in the patient’s room if possible.

  • Dedicated equipment is used for one person only (example: thermometer, blood pressure equipment).

  • Shared equipment must be disinfected after each use.

  • For some tasks, a mechanical lift (Chapter 20) may be involved.

• Room setup and supplies:

  • PPE is kept in a cart or cabinet outside the room; restock as needed.

  • A sign outside the room alerts staff and visitors to use PPE.

  • A wastebasket and linen cart are inside the room.

  • Color-coded or biohazard bags (p. 251) are used for waste and linens.

  • Dedicated equipment, leak-proof plastic bags, and disinfectant are supplied.

• Procedures for removing linens, trash, and equipment:

  • May require double-bagging (p. 251).

  • Follow agency procedures to collect specimens and transport persons.

• Practical note:

  • The nurse may have you help set up an isolation room; follow agency procedures.

• Cross-reference: See Focused content on Precautions (p. 245).

• Related references: See Promoting Safety and Comfort: Precautions; See Focus: Precautions (p. 245).

Goggles and Face Shields: Protection and Use

• Purpose: Protect eyes and face from splashes or sprays of blood, body fluids, secretions, and excretions.

• Goggles:

  • Protect eyes from splashes; the front (outside) is contaminated.

  • The headband, ties, or ear-pieces used to secure the device are clean and used to remove the device after hand hygiene.

  • Remove by lifting ties/ear-pieces from the back.

  • Discard disposable goggles after use.

• Face shields:

  • Protect eyes and other facial areas; especially during care, cleaning items, or disposing fluids.

  • The front outside of the shield is contaminated; remove using back-handles or ear-pieces.

  • Reusable eyewear:

  • Clean between uses with soap and water.

  • Then disinfect with an appropriate disinfectant.

• Related reference: See Promoting Safety and Comfort: Goggles and Face Shields.

Promoting Safety and Comfort: Eye and Hand Protection

• Eye protection:

  • Safety eyeglasses or contact lenses do not provide adequate eye protection.

  • The face shield must fit over eyeglasses with minimal gaps.

• Gloves: key protective role

  • Gloves are a barrier to protect you from pathogens and to protect the patient from microbes on your hands.

  • Indications for wearing gloves:

  • When you will have contact with blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or other potentially infectious materials (OPIM).

  • When contact is likely with contaminated items or surfaces.

  • Glove use is the most common measure for Standard Precautions and Transmission-Based Precautions.

  • Donning/donout guidelines:

  • Treat the outside of gloves as contaminated.

  • Apply to dry hands; dry hands donning is easier.

  • Do not tear gloves when putting them on; long fingernails and rings can tear gloves, allowing exposure to blood or OPIM.

  • If torn, remove and discard immediately, perform hand hygiene, and put on a new pair.

  • Apply a new pair for every person.

  • Wear gloves once and discard after use.

  • Put on new gloves just before touching mucous membranes or non-intact skin.

  • Put on new gloves when gloves become contaminated with blood, body fluids, secretions, excretions, or OPIM.

  • A task may require more than one pair of gloves.

  • Change gloves when moving from a contaminated body site to a clean body site.

• Practical PPE tips:

  • Follow the sequence for donning and removing PPE tailored to the level of precautions required (standard, contact, droplet, airborne).

Donning Personal Protective Equipment (PPE) — Putting On

• The type of PPE varies based on the precautions required (standard, contact, droplet, airborne).

• The donning procedure should be tailored to the specific PPE and infection type.

• Steps for donning (in order): 1) GOWN

  • Fully covers torso from neck to knees, arms to end of wrists.

  • Fasten at the back of the neck and waist.
    2) MASK OR RESPIRATOR

  • Secure ties or elastic bands at the middle of the head and neck.

  • Fit the flexible band to the nose bridge.

  • Ensure the mask fits snugly to the face and is below the chin.

  • Perform a fit-check for a respirator.
    3) GOGGLES OR FACE SHIELD

  • Place over face and eyes and adjust to fit.
    4) GLOVES

  • Extend to cover the wrists of the isolation gown.

• Safety practices while donning:

  • Use safe work practices to protect yourself and limit the spread of contamination.

  • Keep hands away from the face.

  • Change gloves when torn or heavily contaminated.

  • Limit surfaces touched.

  • Perform hand hygiene.

• Visual aid: Figure 17-4 A shows the donning sequence (referenced as the standard CDC-based diagram).

Safe Removal of Personal Protective Equipment (PPE) — Doffing

• General principle: Remove PPE in a sequence that minimizes contamination of skin, mucous membranes, and clothing.

• Example procedure (Method 1, PPE removal): 1) GLOVES

  • Outside of gloves are contaminated.

  • If hands become contaminated during glove removal, wash hands immediately or use hand sanitizer.

  • Remove first glove by grasping the palm area of the other gloved hand and peeling it off.

  • Hold removed glove in the gloved hand.

  • Slide fingers of the ungloved hand under the remaining glove at the wrist and peel off the second glove over the first glove.

  • Discard gloves in a waste container.
    2) GOGGLES OR FACE SHIELD

  • Outside of goggles or face shield is contaminated.

  • If hands become contaminated during removal, wash hands immediately or use hand sanitizer.

  • Remove from the back by lifting the head band or ear pieces.

  • If reusable, place in designated receptacle for reprocessing; otherwise discard.
    3) GOWN

  • Gown front and sleeves are contaminated.

  • If hands are contaminated, wash hands or sanitize.

  • Unfasten gown ties, avoiding contact of sleeves with the body.

  • Peel gown away from neck and shoulders, touching the inside only.

  • Turn gown inside out and fold or roll into a bundle; discard in a waste container.
    4) MASK OR RESPIRATOR

  • Front of the mask/respirator is contaminated—do not touch!

  • If hands become contaminated during removal, wash hands immediately or sanitize.

  • Grasp bottom ties or elastics, then the top ones, and remove without touching the front.

  • Discard in a waste container.
    5) HAND HYGIENE

  • Wash hands or use an alcohol-based hand sanitizer immediately after removing all PPE.

  • Or perform hand hygiene between steps if hands become contaminated and immediately after removing all PPE.

• Visual aid: Figure 17-4, cont’d B, Method 1: Removing PPE (note from MIMAS/Mosby context).