cdc: ppe in healthcare settings, Summaries of Infectious disease

Download cdc: ppe in healthcare settings and more Summaries Infectious disease in PDF only on Docsity! This PDF has been retired. For updated information, please visit https://www.cdc.gov/infectioncontrol/pdf/strive/PPE103-508.pdf 1 Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings 4 Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings Personal protective equipment, or PPE, as defined by the Occupational Safety and Health Administration, or OSHA, is “specialized clothing or equipment, worn by an employee for protection against infectious materials.” 5 Regulations and Recommendations for PPE • OSHA issues workplace health and safety regulations. Regarding PPE, employers must: – Provide appropriate PPE for employees – Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use • OSHA also specifies circumstances for which PPE is indicated • CDC recommends when, what and how to use PPE PPE Use in Healthcare Settings OSHA issues regulations for workplace health and safety. These regulations require use of PPE in healthcare settings to protect healthcare personnel from exposure to bloodborne pathogens and Mycobacterium tuberculosis. However, under OSHA’s General Duty Clause PPE is required for any potential infectious disease exposure. Employers must provide their employees with appropriate PPE and ensure that PPE is disposed or, if reusable, that it is properly cleaned or laundered, repaired and stored after use. The Centers for Disease Control and Prevention (CDC) issues recommendations for when and what PPE should be used to prevent exposure to infectious diseases. This presentation will cover those recommendations, beginning with the hierarchy of safety and health controls. 6 Hierarchy of Safety and Health Controls • Training and administrative controls • Engineering controls • Work practice controls • Personal protective equipment PPE Use in Healthcare Settings The protection of healthcare personnel from infectious disease exposures in the workplace requires a combination of controls, one of which is the use of PPE. It is important to recognize that your protection as a healthcare worker also involves other prevention strategies. There are four major components to healthcare worker safety programs. First are training, such as you’re receiving today, and administrative controls, like isolation policies and procedures, and procedures for recognizing patients with a communicable disease before they expose workers. Second are engineering controls like negative pressure rooms for patients with airborne diseases such as TB; third are work practice controls such as not recapping needles, and finally personal protective equipment . While PPE is last in the hierarchy of prevention, it is very important for protecting healthcare workers from disease transmission. 9 Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or nonsterile • One or two pair • Single use or reusable PPE Use in Healthcare Settings Gloves are the most common type of PPE used in healthcare settings. As you can see here, there are several things to consider when selecting the right glove for a specified purpose. 10 Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or non-sterile • One or two pair • Single use or reusable PPE Use in Healthcare Settings Most patient care activities require the use of a single pair of nonsterile gloves made of either latex, nitrile, or vinyl. However, because of allergy concerns, some facilities have eliminated or limited latex products, including gloves, and now use gloves made of nitrile or other material. Vinyl gloves are also frequently available and work well if there is limited patient contact. However, some gloves do not provide a snug fit on the hand, especially around the wrist, and therefore should not be used if extensive contact is likely. Gloves should fit the user’s hands comfortably – they should not be too loose or too tight. They also should not tear or damage easily. Gloves are sometimes worn for several hours and need to stand up to the task. Who uses the other glove options? Sterile surgical gloves are worn by surgeons and other healthcare personnel who perform invasive patient procedures. During some surgical procedures, two pair of gloves may be worn. Environmental services personnel often wear reusable heavy duty gloves made of latex or nitrile to work with caustic disinfectants when cleaning environmental surfaces. However, they sometimes use patient care gloves too. 11 Do’s and Don’ts of Glove Use • Work from “clean to dirty” • Limit opportunities for “touch contamination” - protect yourself, others, and the environment – Don’t touch your face or adjust PPE with contaminated gloves – Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings Gloves protect you against contact with infectious materials. However, once contaminated, gloves can become a means for spreading infectious materials to yourself, other patients or environmental surfaces. Therefore, the way YOU use gloves can influence the risk of disease transmission in your healthcare setting. These are the most important do’s and don'ts of glove use. Work from clean to dirty. This is a basic principle of infection control. In this instance it refers to touching clean body sites or surfaces before you touch dirty or heavily contaminated areas. Limit opportunities for “touch contamination” - protect yourself, others and environmental surfaces. How many times have you seen someone adjust their glasses, rub their nose or touch their face with gloves that have been in contact with a patient? This is one example of “touch contamination” that can potentially expose oneself to infectious agents. Think about environmental surfaces too and avoid unnecessarily touching them with contaminated gloves. Surfaces such as light switches, door and cabinet knobs can become contaminated if touched by soiled gloves. 14 Face Protection • Masks – protect nose and mouth – Should fully cover nose and mouth and prevent fluid penetration • Goggles – protect eyes – Should fit snuggly over and around eyes – Personal glasses not a substitute for goggles – Antifog feature improves clarity PPE Use in Healthcare Settings A combination of PPE types is available to protect all or parts of the face from contact with potentially infectious material. The selection of facial PPE is determined by the isolation precautions required for the patient and/or the nature of the patient contact. This will be discussed later. Masks should fully cover the nose and mouth and prevent fluid penetration. Masks should fit snuggly over the nose and mouth. For this reason, masks that have a flexible nose piece and can be secured to the head with string ties or elastic are preferable. Goggles provide barrier protection for the eyes; personal prescription lenses do not provide optimal eye protection and should not be used as a substitute for goggles. Goggles should fit snuggly over and around the eyes or personal prescription lenses. Goggles with antifog features will help maintain clarity of vision. 15 Face Protection • Face shields – protect face, nose, mouth, and eyes – Should cover forehead, extend below chin and wrap around side of face PPE Use in Healthcare Settings When skin protection, in addition to mouth, nose, and eye protection, is needed or desired, for example, when irrigating a wound or suctioning copious secretions, a face shield can be used as a substitute to wearing a mask or goggles. The face shield should cover the forehead, extend below the chin, and wrap around the side of the face. 16 Respiratory Protection • Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) • PPE types for respiratory protection – Particulate respirators – Half- or full-face elastomeric respirators – Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings PPE also is used to protect healthcare workers’ from hazardous or infectious aerosols, such as Mycobacterium tuberculosis. Respirators that filter the air before it is inhaled should be used for respiratory protection. The most commonly used respirators in healthcare settings are the N95, N99, or N100 particulate respirators. The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameter. Respirators are approved by the CDC’s National Institute for Occupational Safety and Health. Like other PPE, the selection of a respirator type must consider the nature of the exposure and risk involved. For example, N95 particulate respirators might be worn by personnel entering the room of a patient with infectious tuberculosis. However, if a bronchoscopy is performed on the patient, the healthcare provider might wear a higher level of respiratory protection, such as a powered air-purifying respirator or PAPR. 19 PPE Use in Healthcare Settings: How to Safely Don, Use, and Remove PPE This next segment will address how to safely don, use, and remove PPE. NOTE TO TRAINER: Consider having a participant demonstrate donning and removing PPE as you go through this section. 20 Key Points About PPE • Don before contact with the patient, generally before entering the room • Use carefully – don’t spread contamination • Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room • Immediately perform hand hygiene PPE Use in Healthcare Settings There are four key points to remember about PPE use. First, don it before you have any contact with the patient, generally before entering the room. Once you have PPE on, use it carefully to prevent spreading contamination. When you have completed your tasks, remove the PPE carefully and discard it in the receptacles provided. Then immediately perform hand hygiene before going on to the next patient. 21 Sequence* for Donning PPE • Gown first • Mask or respirator • Goggles or face shield • Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings The gown should be donned first. The mask or respirator should be put on next and properly adjusted to fit; remember to fit check the respirator. The goggles or face shield should be donned next and the gloves are donned last. Keep in mind, the combination of PPE used, and therefore the sequence for donning, will be determined by the precautions that need to be taken. 24 How to Don a Particulate Respirator • Select a fit tested respirator • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with elastic • Adjust to fit • Perform a fit check – – Inhale – respirator should collapse – Exhale – check for leakage around face PPE Use in Healthcare Settings The technique for donning a particulate respirator, such as an N95, N99 or N100, is similar to putting on a pre-formed mask with elastic head bands. Key differences, however, are 1) the need to first select a respirator for which you have been fit tested and 2) fit checking the device, as you have been instructed, before entering an area where there may be airborne infectious disease. Be sure to follow the manufacturer’s instructions for donning the device. In some instances, the manufacturer’s instructions may differ slightly from this presentation. You may also be asked to wear an elastomeric or powered air purifying respirator, or PAPR. Guidance on how to use these devices is not included in this presentation. You will need instruction locally to properly use these devices. 25 How to Don Eye and Face Protection • Position goggles over eyes and secure to the head using the ear pieces or headband • Position face shield over face and secure on brow with headband • Adjust to fit comfortably PPE Use in Healthcare Settings If eye protection is needed, either goggles or a face shield should be worn. Position either device over the face and/or eyes and secure to head using the attached ear pieces or head band. Adjust to fit comfortably. Goggles should feel snug but not tight. 26 How to Don Gloves • Don gloves last • Select correct type and size • Insert hands into gloves • Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings The last item of PPE to be donned is a pair of gloves. Be sure to select the type of glove needed for the task in the size that best fits you. Insert each hand into the appropriate glove and adjust as needed for comfort and dexterity. If you are wearing an isolation gown, tuck the gown cuffs securely under each glove. This provides a continuous barrier protection for your skin. 29 “Contaminated” and “Clean” Areas of PPE • Contaminated – outside front • Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside • Clean – inside, outside back, ties on head and back • Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings To remove PEP safely, you must first be able to identify what sites are considered “clean” and what are “contaminated.” In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, respirator and face shield are considered “contaminated,” regardless of whether there is visible soil. Also, the outside of the gloves are contaminated. The areas that are considered “clean” are the parts that will be touched when removing PPE. These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield. 30 Sequence for Removing PPE • Gloves • Face shield or goggles • Gown • Mask or respirator PPE Use in Healthcare Settings The sequence for removing PPE is intended to limit opportunities for self- contamination. The gloves are considered the most contaminated pieces of PPE and are therefore removed first. The face shield or goggles are next because they are more cumbersome and would interfere with removal of other PPE. The gown is third in the sequence, followed by the mask or respirator. 31 Where to Remove PPE • At doorway, before leaving patient room or in anteroom* • Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings The location for removing PPE will depend on the amount and type of PPE worn and the category of isolation a patient is on, if applicable. If only gloves are worn as PPE, it is safe to remove and discard them in the patient room. When a gown or full PPE is worn, PPE should be removed at the doorway or in an anteroom. Respirators should always be removed outside the patient room, after the door is closed. Hand hygiene should be performed after all PPE is removed. 34 Remove Goggles or Face Shield • Grasp ear or head pieces with ungloved hands • Lift away from face • Place in designated receptacle for reprocessing or disposal PPE Use in Healthcare Settings Using ungloved hands, grasp the “clean” ear or head pieces and lift away from face. If goggle or face shield are reusable, place them in a designated receptacle for subsequent reprocessing. Otherwise, discard them in the waste receptacle. 35 Removing Isolation Gown • Unfasten ties • Peel gown away from neck and shoulder • Turn contaminated outside toward the inside • Fold or roll into a bundle • Discard PPE Use in Healthcare Settings Unfasten the gown ties with the ungloved hands. Slip hands underneath the gown at the neck and shoulder, peel away from the shoulders. Slip the fingers of one hand under the cuff of the opposite arm. Pull the hand into the sleeve, grasping the gown from inside. Reach across and push the sleeve off the opposite arm. Fold the gown towards the inside and fold or roll into a bundle. (Only the “clean” part of the gown should be visible.) Discard into waste or linen container, as appropriate. 36 Removing a Mask • Untie the bottom, then top, tie • Remove from face • Discard PPE Use in Healthcare Settings The front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle. 39 PPE Use in Healthcare Settings: When to Use PPE Thus far we have discussed the various types of PPE, considered various factors that go into selecting appropriate PPE, and described how to don, use, and remove PPE safely. This last segment of this presentation will discuss WHEN to use which PPE. 40 Standard and Expanded Isolation Precautions Decisions regarding when and which type of PPE should be worn are determined by CDC recommendations for Standard Precautions and Expanded Isolation Precautions. 41 Standard Precautions • Previously called Universal Precautions • Assumes blood and body fluid of ANY patient could be infectious • Recommends PPE and other infection control practices to prevent transmission in any healthcare setting • Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings Standard Precautions is an outgrowth of Universal Precautions. Universal Precautions was first recommended in 1987 to prevent the transmission of bloodborne pathogens to healthcare personnel. In 1996, the application of the concept was expanded and renamed “Standard Precautions.” Standard Precautions is intended to prevent the transmission of common infectious agents to healthcare personnel, patients and visitors in any healthcare setting. During care for any patient, one should assume that an infectious agent could be present in the patient’s blood or body fluids, including all secretions and excretions except tears and sweat. Therefore appropriate precautions, including use of PPE, must be taken. Whether PPE is needed, and if so, which type, is determined by the type of clinical interaction with the patient and the degree of blood and body fluid contact that can be reasonably anticipated and by whether the patient has been placed on isolation precautions such as Contact or Droplet Precautions or Airborne Infection Isolation. 44 What Type of PPE Would You Wear? • Giving a bed bath? • Suctioning oral secretions? • Transporting a patient in a wheel chair? • Responding to an emergency where blood is spurting? • Drawing blood from a vein? • Cleaning an incontinent patient with diarrhea? • Irrigating a wound? • Taking vital signs? PPE Use in Healthcare Settings Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following? Giving a bed bath? (generally none) Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used) Transporting a patient in a wheelchair? (generally none) Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, mask/goggles or a face shield) Drawing blood from a vein? (gloves) Cleaning an incontinent patient with diarrhea? (gloves and generally a gown) Irrigating a wound? (gloves, gown, and mask/goggles or a face shield) Taking vital signs? (generally none) NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves? If a question is raised about use of gloves for giving an injection, indicate that this is largely a matter of local or state policy. OSHA does not require use of gloves for giving an injection. 45 What Type of PPE Would You Wear? • Giving a bed bath? • Generally none • Suctioning oral secretions? • Gloves and mask/goggles or a face shield – sometimes gown • Transporting a patient in a wheel chair? • Generally none required • Responding to an emergency where blood is spurting? • Gloves, fluid-resistant gown, mask/goggles or a face shield • Drawing blood from a vein? • Gloves • Cleaning an incontinent patient with diarrhea? • Gloves w/wo gown • Irrigating a wound? • Gloves, gown, mask/goggles or a face shield • Taking vital signs? – Generally none PPE Use in Healthcare Settings Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following? Giving a bed bath? (generally none) Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used) Transporting a patient in a wheelchair? (generally none) Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, and mask/goggles or a face shield) Drawing blood from a vein? (gloves) Cleaning an incontinent patient with diarrhea? (gloves and generally a gown) Irrigating a wound? (gloves, gown, and mask/goggles or a face shield) Taking vital signs? (generally none) NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves? 46 PPE for Expanded Precautions • Expanded Precautions include – Contact Precautions – Droplet Precautions – Airborne Infection Isolation PPE Use in Healthcare Settings In some instances, healthcare personnel are required to wear PPE in addition to that recommended for Standard Precautions. The three Expanded Precaution categories (formerly called Transmission-Based Precautions) where this applies are Contact and Droplet Precautions and Airborne Infection Isolation.