Infection CONTROL

PPE Assessment Study Guide

Define PPE

  • PPE (Personal Protective Equipment):

    • Specialized clothing or equipment worn to protect a person from exposure to infectious agents or hazards.

What is OSHA?

  • OSHA (Occupational Safety and Health Administration):

    • A U.S. government agency responsible for ensuring safe and healthy working conditions through setting and enforcing standards.

How does OSHA define PPE?

  • Definition of PPE by OSHA:

    • Equipment worn to minimize exposure to hazards that can cause workplace injuries or illnesses.

When should you use soap?

  • Use soap:

    • When hands are visibly dirty or soiled.

    • After using the restroom.

    • Before eating or preparing food.

    • After contact with blood or body fluids.

    • After removing gloves.

When is it okay to use hand sanitizer?

  • Use hand sanitizer:

    • When hands are not visibly dirty.

    • When soap and water are not available.

    • For routine hand hygiene between patient contacts.

Define Standard Precautions

  • Standard Precautions:

    • Infection control practices used with all patients to prevent the spread of infection, operating under the assumption that blood and body fluids may be infectious.

Define CDC

  • CDC (Centers for Disease Control and Prevention):

    • A U.S. public health agency that provides guidelines to prevent disease and promote health.

Definitions

  • Protection:

    • Actions or equipment used to reduce exposure to hazards or infectious agents.

  • Hygiene:

    • Practices that maintain cleanliness and prevent disease (e.g., handwashing).

  • Gowns:

    • Protective clothing worn to shield skin and clothing from contamination.

  • Sharps:

    • Objects capable of puncturing or cutting skin (e.g., needles, scalpels).

  • Contact:

    • Transmission of infection through direct or indirect physical touch.

  • Shields:

    • Face protection devices that cover the face to guard against splashes or sprays.

  • Goggles:

    • Eye protection that shields the eyes from fluids or debris.

  • Respirators:

    • Masks designed to protect the wearer from inhaling harmful airborne particles (e.g., N95).

Transmission-Based Precautions

  • Contact Precautions:

    • Used for infections spread by direct or indirect contact (e.g., MRSA).

    • Requires the use of gloves and gowns.

  • Droplet Precautions:

    • Used for infections spread by large respiratory droplets (e.g., flu).

    • Requires a surgical mask.

  • Airborne Precautions:

    • Used for infections that spread through the air (e.g., tuberculosis).

    • Requires an N95 respirator and special room ventilation.

Types of PPE and When to Use Them (Standard Precautions)

  • Gloves:

    • Wear when touching blood, body fluids, mucous membranes, or contaminated items.

  • Gowns:

    • Wear when clothing or skin may be exposed to fluids.

  • Masks:

    • Wear when splashes or sprays may occur.

  • Goggles/Face Shields:

    • Wear when eye or face exposure is possible.

  • Respirators (N95):

    • Wear when protection from airborne particles is required.

When to Wash Your Hands

  • Wash hands:

    • Before and after patient contact.

    • Before putting on and after removing PPE.

    • After contact with blood or body fluids.

    • After using the restroom.

    • Before eating.

Correct Order to DON and DOFF PPE (CDC – Old School)

  • DON (Put On PPE):

    1. Gown

    2. Mask or Respirator

    3. Goggles or Face Shield

    4. Gloves

  • DOFF (Remove PPE):

    1. Gloves

    2. Goggles or Face Shield

    3. Gown

    4. Mask or Respirator

    5. Hand Hygiene

SEQUENCE FOR PUTTING ON PERSONAL PROTECTIVE EQUIPMENT (PPE)

  • Overview of PPE Types:

    • Different types of PPE are utilized based on the precaution levels required, which may include:

    • Standard and contact precautions.

    • Droplet precautions.

    • Airborne infection isolation precautions.

    • The specific procedure for donning (putting on) and doffing (removing) PPE is tailored according to the type of PPE used.

Procedure for Donning PPE

  1. GOWN

    • Fully covers torso from neck to knees, arms to the end of wrists, and wraps around the back.

    • Fasten the gown in the back at 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 to ensure a snug fit against the face and below the chin.

    • Perform a fit-check for the respirator to ensure proper sealing and effectiveness.

  3. GOGGLES OR FACE SHIELD

    • Place goggles or face shield over the face and eyes, and adjust for a proper fit.

  4. GLOVES

    • Extend gloves to cover the wrist of the isolation gown, providing additional protection.

Safe Work Practices to Protect Yourself and Limit the Spread of Contamination

  • General Practices:

    • Keep hands away from the face to minimize contamination risk.

    • Limit the number of surfaces touched to avoid potential contamination.

    • Change gloves immediately when torn or heavily contaminated.

    • Regularly perform hand hygiene to reduce microbial presence.

HOW TO SAFELY REMOVE PERSONAL PROTECTIVE EQUIPMENT (PPE)

Example 1: Standard Sequence for Removal

  • Pre-removal Note:

    • All PPE should be removed before exiting the patient room, except for a respirator if it is being worn. The respirator should be removed after leaving the patient room and closing the door.

Sequence for Removing PPE:

  1. GLOVES

    • Note: The outside of gloves is contaminated.

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

    • Procedure:

      • Using a gloved hand, grasp the palm area of the other gloved hand and peel off the first glove.

      • Hold the 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 both gloves in a waste container.

  2. GOGGLES OR FACE SHIELD

    • Note: The outside of goggles or face shield is contaminated.

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

    • Procedure:

      • Remove goggles or face shield by lifting the headband or ear pieces from the back to avoid touching the front.

      • If reusable, place in designated receptacle for reprocessing; if not, discard in a waste container.

  3. GOWN

    • Note: The front and sleeves of the gown are contaminated.

    • If hands become contaminated during gown removal, wash hands or use alcohol-based hand sanitizer immediately.

    • Procedure:

      • Unfasten gown ties while ensuring that sleeves do not contact the body.

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

      • Turn the gown inside out and fold or roll into a bundle, discarding it in a waste container.

  4. MASK OR RESPIRATOR

    • Note: The front of the mask/respirator is contaminated—DO NOT TOUCH!

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

    • Procedure:

      • Grasp the bottom ties or elastics of the mask/respirator first, followed by the ones at the top, and remove without touching the front.

      • Discard in a waste container.

  5. FINAL HAND HYGIENE

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

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

Example 2: Alternative Sequence for Removal

  • Pre-removal Note:

    • Similar to Example 1, all PPE should be removed before exiting the patient room, except for a respirator if worn. The respirator should be removed after exiting and closing the door.

Sequence for Removing PPE:

  1. GOWN AND GLOVES

    • Note: The gown front, sleeves, and outside of gloves are contaminated.

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

    • Procedure:

      • Grasp the gown from the front and pull away from the body, allowing ties to break while only touching the outside with gloved hands.

      • Fold or roll the gown inside out into a bundle while removing the gown.

      • Peel off gloves simultaneously, only touching the inside of the gowns and gloves with bare hands.

      • Discard both gown and gloves into a waste container.

  2. GOGGLES OR FACE SHIELD

    • Note: Outside of goggles or face shield is contaminated.

    • If hands become contaminated during removal, wash hands or use an alcohol-based hand sanitizer immediately.

    • Procedure:

      • Remove goggles or face shield from the back without touching the front.

      • Place reusable items in designated receptacles for reprocessing; if not reusable, discard in a waste container.

  3. MASK OR RESPIRATOR

    • Note: The front of the mask/respirator is contaminated—DO NOT TOUCH!

    • If hands become contaminated during removal, wash hands or use an alcohol-based hand sanitizer immediately.

    • Procedure:

      • Grasp the bottom ties or elastics of the mask/respirator, followed by the top ties, and remove without touching the front.

      • Discard in a waste container.

  4. FINAL HAND HYGIENE

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

    • Perform hand hygiene between steps if hands become contaminated and immediately after all PPE has been removed.

Standard Precautions and Personal Protective Equipment (PPE)

Overview of Standard Precautions

  • Every body fluid must be considered a potentially infectious material.

  • All patients must be considered potential sources of infection, regardless of their diagnosis or disease.

  • Standard precautions are guidelines developed by the CDC to protect both workers and patients.

Situations for Using Standard Precautions

  • Standard precautions should be used in the following situations:

    1. Blood or any body fluid that contains blood.

    2. Body fluids such as:

    • Mucus

    • Sputum

    • Saliva

    • Cerebrospinal fluid

    • Feces

    • Emesis (vomit)

    • Amniotic fluid

    • Pus

    • Semen

    • Vaginal secretions

    • Breast milk

    1. Mucous membranes:

    • Oral

    • Vaginal

    • Eyes

    • Respiratory tract

    • Urinary tract

    1. Non-intact skin.

Definition and Importance of Personal Protective Equipment (PPE)

  • Personal Protection Equipment (PPE):

    • Any equipment used to protect healthcare workers from exposure to body fluids and infections while providing care.

    • Examples of PPE:

    • Gloves

    • Gowns

    • Masks

    • Goggles

    • Face shields

Standard Precaution Guidelines

  1. Needle Safety: Never recap a used needle with two hands; dispose of it in a sharps container immediately.

  2. Gloving Protocol: Wear gloves when touching blood, body fluids, or mucous membranes.

  3. Protective Gear: Wear a mask, goggles/face shield, and gown if body fluids are likely to splash or spray.

  4. Resuscitation Technique: Use resuscitation equipment instead of performing mouth-to-mouth resuscitation.

  5. Patient Placement: Private rooms should be utilized for patients who may contaminate the environment.

Types of Personal Protective Equipment (PPE)

Level 1 PPE

  • Components Include:

    • Fluid-resistant surgical mask

    • Disposable gloves

Level 2 PPE

  • Components Include:

    • Disposable eye protection (to be worn based on a risk assessment)

    • Protective disposable apron/gown

    • Fluid-resistant surgical mask or filtering facepiece respirator (N95/P2)

    • Disposable gloves

Level 3 PPE

  • Components Include:

    • Disposable eye protection (eye shield, goggles, or visor)

    • Long sleeve fluid-repellent disposable gown

    • Filtering facepiece respirator (N95/P2)

    • Disposable gloves

Donning and Doffing PPE

Donning Sequence (Putting on PPE)

  • Follow the steps below, starting from the bottom up:

    1. Gown

    2. Mask

    3. Goggles

    4. Gloves

Doffing Sequence (Taking off PPE)

  • Remove PPE in the following alphabetical order:

    1. Gloves

    2. Goggles

    3. Gown

    4. Mask

Use of PPE According to Isolation Levels

  • Always use only the articles required for each isolation level:

    • Contact

    • Droplet

    • Airborne

Additional Instructions

  • Consult CDC guidelines for proper application and isolation category before donning or doffing PPE.

1. Five Classes of Microorganisms

Bacteria – Single-celled organisms that can live independently; some are beneficial, others cause disease. Treated with antibiotics.

Viruses – Smaller than bacteria; require a living host cell to reproduce. Antibiotics do not work on viruses. Vaccines.

Fungi – Include yeasts and molds; can be single- or multicellular. Thrive in warm, moist areas (e.g., athlete’s foot).

Protozoa – Single-celled parasites that are larger and more complex than bacteria; often spread through contaminated water or food.

Helminths (Parasitic worms) – Multicellular organisms, parasitic worms, that infect humans through soil, food, or water; visible to the naked eye in some stages.

2. Definitions

Antisepsis – Use of chemicals on living tissue (skin) to reduce or prevent infection.

Disinfection – Use of chemicals on non-living surfaces to kill most microorganisms (not spores).

Sterilization – Complete elimination of all microorganisms, including spores and viruses.

3. Antibiotic-Resistant Organisms

MRSA (Methicillin-Resistant Staphylococcus aureus) – A staph infection resistant to many antibiotics.

VRE (Vancomycin-Resistant Enterococcus) – Enterococcus bacteria resistant to vancomycin.

MRAB (Multidrug-Resistant Acinetobacter baumannii) – A bacteria resistant to multiple antibiotics, often found in hospitals.

CRE (Carbapenem-Resistant Enterobacteriaceae) – Highly drug-resistant bacteria; difficult to treat and potentially fatal.

C. diff (Clostridioides difficile) – Bacteria causing severe diarrhea; commonly linked to antibiotic use. Spread via spores.

4. Endogenous vs. Exogenous Disease

Endogenous Disease – Caused by microorganisms already present in the body.

Exogenous Disease – Caused by microorganisms that come from outside the body.

5. Nosocomial Infection

Nosocomial Infection – An infection acquired in a healthcare setting (hospital-acquired infection).

6. Transmission-Based Precautions

Contact Precautions – Used for infections spread by direct or indirect contact. Requires gloves and gown.

Droplet Precautions – Used for infections spread by large respiratory droplets. Requires surgical mask.

Airborne Precautions – Used for infections spread through the air. Requires N95 respirator and negative-pressure room.

7. Personal Protective Equipment (PPE) and When to Use

Gloves – When touching blood, body fluids, mucous membranes, or contaminated items.

Gowns – When clothing or skin may be exposed to blood or body fluids.

Masks – When there is a risk of splashes, sprays, or respiratory droplets.

Goggles – When eye exposure to fluids may occur.

Face Shields – When full face protection from splashes or sprays is needed.

Respirators (N95) – When protection from airborne pathogens is required.

1. What is the definition of “PPE” as defined by OSHA?

Personal Protective Equipment (PPE) is specialized clothing or equipment worn by an employee to protect against exposure to workplace hazards that may cause injury or illness.

3. Match the piece of PPE with its main function

  • Gloves → D. Protects hands

  • Gowns → C. Protects skin/clothing

  • Masks → B. Protects mouth/nose

  • Goggles → A. Protects eyes

  • Respirators → F. Protects respiratory tract

  • Face Shield → E. Protects face

4. Match the types of PPE to the circumstance

  • A. You will have to touch a client or contaminated objects
    → Gloves

  • B. Risk of clothing or exposed skin contact with wet/weeping material
    → Gowns

  • C. Risk of splashing or spraying with blood or body fluids
    → Masks, Goggles, Face Shield

2. Fill in the blanks (Standard Precautions)

Standard precautions consist of the following practices:
hand hygiene before and after all patient contact; the use of personal protective equipment, which may include gloves, impermeable gowns, plastic aprons, masks, face shields and eye protection; the safe use and disposal of sharps.

5. TRUE or FALSE (Glove Usage)

  • Work from “dirty to clean.” → TRUE

  • Never wash or reuse disposable gloves. → TRUE

  • Do not touch your face or adjust PPE with contaminated gloves. → TRUE

6. Donning PPE (Put ON) – CDC Order

  1. Gown

  2. Mask or Respirator

  3. Goggles or Face Shield

  4. Gloves

7. Removing PPE (Take OFF) – CDC Order

  1. Gloves

  2. Goggles or Face Shield

  3. Gown

  4. Mask or Respirator
    👉 Hand hygiene last

8. Correct Order for Glove Removal

  1. Grasp the outer edge of one glove with a gloved hand and peel away while turning glove inside out.

  2. Ball up glove in your gloved hand and hold.

  3. Slide ungloved finger under the wrist of the remaining glove (touching only the inside).

  4. Peel off, turning it inside out to create a “bag” for both gloves.

  5. Discard gloves.

9. TRUE (T) or FALSE (F)

  • T Soap and water should be used when hands are visibly soiled.

  • T Standard Precautions assume blood and body fluids of ANY patient could be infectious

FEMA – Federal Emergency Management Agency; coordinates response to disasters and emergencies
CDC – Centers for Disease Control and Prevention; provides guidelines to prevent disease and protect public health
WHO – World Health Organization; international public health organization
R₀ (r-naught) – The average number of people one infected person will spread a disease to
Sulci – Grooves or folds on the surface of the brain
Incubation Period – Time between exposure to a pathogen and the appearance of symptoms
Susceptible – Likely to become infected; lacking immunity
Epidemic – Sudden increase in disease cases in a specific area
Pandemic – Worldwide spread of a disease
Endemic – Disease consistently present in a population or region
Chimeric – Organism or virus made from genetic material of multiple sources
Epidemiologist – Scientist who studies patterns, causes, and spread of disease
Vaccination – Introduction of weakened or inactive pathogens to stimulate immunity
Febrile – Having a fever

Infection Control

Pathogens – Microorganisms that cause infection and disease
Normal flora – Microorganisms that are a normal and beneficial part of the body
May be beneficial in one part of the body and pathogenic in another

Classifications of Pathogens

Bacteria – Simple, one-celled organisms that multiply rapidly
Protozoa – One-celled animals often found in contaminated water and decayed matter
Fungi – Simple, plant-like organisms that live on dead organic matter (yeasts, molds)
Parasites (helminths) – Parasitic organisms that cannot live outside another living organism
Viruses – Smallest pathogens; cannot reproduce unless inside another living cell
Prions – Misshapen proteins (controversial theory)

Two Viral Diseases of Major Concern to Health Care Workers

Hepatitis B – Caused by the HBV virus; transmitted by blood and body fluids; causes liver damage; vaccination available (3 injections)

AIDS / HIV – Caused by the HIV virus; weakens the immune system; no vaccine or cure

Conditions Favorable to Microorganism Growth

  1. Warmth

  2. Moisture

  3. Darkness

  4. Food / nutrients

Aerobic – Microorganisms that require oxygen to survive
Anaerobic – Microorganisms that do NOT require oxygen to survive

Ways Pathogens Cause Disease

  1. Destroy body cells

  2. Produce toxins

  3. Trigger immune/inflammatory responses

Additional Classifications of Infections/Diseases

Nosocomial infection – Infection acquired in a healthcare facility
Opportunistic infection – Occurs when the immune system is weakened
Localized infection – Infection limited to one area (redness, swelling, pain, warmth)
Systemic infection – Infection spread throughout the body (fever, elevated WBCs)

The Chain of Infection

#1 Causative Agent – Pathogen
#2 Reservoir – Human body, animals, environment, contaminated objects
#3 Portal of Exit – Urine, feces, saliva, blood, tears, mucus, sexual secretions, wounds
#4 Mode of Transmission

  • Direct contact – Person-to-person touch

  • Indirect contact – Contaminated objects (fomites)
    #5 Portal of Entry – Breaks in skin, mucous membranes, respiratory, digestive, urinary, reproductive, circulatory systems
    #6 Susceptible Host – Person at risk for infection

Breaking the Chain of Infection

Asepsis – Absence of pathogens
Contaminated – Any object or area that may contain pathogens
Medical asepsis – Methods used to maintain cleanliness and prevent contamination

Levels of Aseptic Control

  1. Antisepsis – Prevents or inhibits growth of pathogens; can be used on skin
    Examples: alcohol, betadine, iodine

  2. Disinfection – Destroys pathogens; used on objects, not skin
    Examples: bleach, germicidal wipes

  3. Sterilization – Destroys all microorganisms except prions; used only on objects
    Example: autoclave

Standard Precautions

Rules developed by the CDC
Every body fluid must be considered potentially infectious
All patients must be considered potentially infectious

When to Use Standard Precautions

Any situation involving:

  1. Blood

  2. Body fluids (mucus, saliva, feces, emesis, pus, semen, vaginal secretions, etc.)

  3. Mucous membranes

Personal Protective Equipment (PPE)

  1. Gloves

  2. Gowns

  3. Masks / respirators

  4. Goggles / face shields

Standard Precaution Guidelines

  1. NEVER recap a needle with two hands

    • Dispose of needles in a sharps container immediately

  2. Wear gloves when touching blood, body fluids, or mucous membranes

  3. Wear gown, mask, and eye protection if splashing or spraying may occur

  4. Use resuscitation devices instead of mouth-to-mouth

  5. Isolation precautions for patients who contaminate the environment

When to Wash Hands

1. Upon arrival and immediately before leaving medical facility

2. Before and after every patient contact

3. If hands become contaminated during a procedure

4. After removing gloves

5. After handling a specimen

6. After picking anything up off the floor

7. After contact with any contaminated object

8. After using the bathroom

9. After coughing, sneezing, or using tissue

10. Before eating, inserting or removing contact lenses