Transcript Document

Oct 2014
Hand Hygiene and
Personal Protective Equipment (PPE)
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Purpose
• Proper hand hygiene
• Donning, doffing (removal), and
disposal of Personal Protective
Equipment (PPE)
Oct 2014
To provide guidance for:
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• DFR provides prehospital medical care to
the residents of and the visitors to the City
of Dallas
• Provision of this care potentially exposes
DFR personnel to infectious diseases
• Good hand hygiene, and the proper
selection, use and disposal of PPE are
critical to prevent the spread of disease
Oct 2014
Background
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• The human body produces many body fluids,
secretions and excretions that may contain
pathogens
• Potentially infectious body fluids include: blood,
vomit, feces, urine, sputum, saliva, and sweat, as
well as amniotic, spinal, vaginal, pleural,
pericardial, peritoneal, synovial fluids and semen
• To prevent exposure, ANY body fluid from any
patient must be treated as potentially infectious
Oct 2014
Background
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Oct 2014
Hand Hygiene: “5 Moments”
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Use soap and warm, running water
Keep fingers pointing down
Rub hands vigorously for 20 seconds
Wash all surfaces, including:
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Backs of hands
Wrists
Between fingers
Tips of fingers
Thumbs
Under fingernails
• Dry vigorously with paper or clean cloth towel
• Turn off faucet with towel and open door with towel
Oct 2014
Hand Hygiene: Soap & Water
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• If hands are visibly contaminated, soap and
water must be used first
• If hands are not visibly contaminated, or if soap
and water are not available, use alcohol-based
hand rub (gel, foam or wipes)
• Apply a generous amount of hand rub gel/foam
to the palm of one hand, or use an alcoholbased hand rub wipe
• Rub hands together, covering all surfaces of
hands and fingers until hand rub is absorbed
Oct 2014
Hand Hygiene: Sanitizer
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Isolation Precautions
• Standard Precautions (ALL patients)
• Contact Precautions (“blood/body fluid”)
• Droplet Precautions (think “flu”)
• Airborne Precautions (think “TB”)
• These categories may be combined in
certain cases
Oct 2014
• 4 Categories:
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• Disposable Gloves
• Disposable Gown (Impermeable or Fluid Resistant)
• Eye Protection
• Wraparound Goggles, Safety Glasses or Face Shield
• Respiratory Protection (must be worn with eye protection)
• Lowest: Standard surgical face mask
• Higher: N95 filter mask (respirator)
• Highest: Air-Purifying Respirator (“APR”) – powered or not;
half-face, full-face or hood
• Components for high volume fluid or high-risk conditions:
• Disposable Boot Covers (or Shoe Covers)
• Disposable Bonnets
Oct 2014
PPE Components
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Oct 2014
PPE = Gloves and….
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Oct 2014
Standard
Precautions
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Standard Precautions
• Disposable Gloves
• Hand Hygiene
• Additional PPE, as needed, to protect against
blood, body fluids, secretions and excretions:
• Eye protection (goggles or face shield)
• Respiratory protection (surgical face mask)
• Impermeable or fluid-resistant gown
Oct 2014
• All patients, all the time, any setting
• Minimum PPE required:
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Oct 2014
Contact
Precautions
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• Protection against viruses (such as Ebola),
Influenza, HIV, Hepatitis; plague, MRSA, VRE,
Strep; patients with diarrhea, vomiting, or
generalized rash
• Minimum PPE Required
Oct 2014
Contact Precautions
• Disposable Gloves (change if visibly soiled)
• Gown
• Hand Hygiene
• Disinfection of all equipment and surfaces
• Examples: monitor, glucometer, BP cuff, etc.
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Oct 2014
Droplet
Precautions
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• Large particles created by coughing, sneezing,
suctioning or intubation
• Disease examples: Influenza, meningitis,
pertussis, plague, Ebola, mumps, rubella, and
most viruses (including Enterovirus D68)
• Any patient with fever, respiratory
symptoms,
rash,
and/or
flu-like
signs/symptoms, such
as weakness,
vomiting, diarrhea, severe headache,
abdominal pain, or muscle and body aches
Oct 2014
Droplet Precautions
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Droplet Precautions
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Gloves
Gown
Eye Protection
Bonnet
Leggings/Boot Covers (or Shoe Covers)
Respiratory Protection….
Oct 2014
• Hand Hygiene
• Minimum PPE required:
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Droplet Precautions
• Healthcare Providers (with eye protection):
• At least standard surgical face mask
• N95 mask for “Aerosol-Generating Procedures”
or other high-risk procedures (e.g. CPR)
Oct 2014
• What level of respiratory protection?
• See UTSW/BioTel TB 14-007 PPE
• Patient (especially if coughing or sneezing):
• Standard surgical face mask or N95, if tolerated
• Add Nasal Cannula O2, if supplemental oxygen
needed
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Oct 2014
Airborne
Precautions
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• Small particles created by coughing, sneezing,
suctioning, intubation or even talking
• Disease examples: TB, measles, chickenpox,
disseminated Herpes zoster, smallpox
• Any patient known or suspected to be
infected with an organism spread through
the air, or for a patient “found down” with
unknown history
Oct 2014
Airborne Precautions
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Airborne Precautions
• Gloves
• Gown
• Eye Protection
• Bonnet
• Leggings/Boot Covers (or Shoe Covers)
• Respiratory Protection….
Oct 2014
• Hand Hygiene
• Minimum PPE required:
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• What level of respiratory protection?
• Healthcare Providers (with eye protection):
• At least N95 filter mask
• Air-Purifying
Respirator
for
“AerosolGenerating Procedures” or other high-risk
procedures (e.g. CPR)
Oct 2014
Airborne Precautions
• See UTSW/BioTel TB 14-007 PPE
• Patient (especially if coughing or sneezing):
• N95 mask, if tolerated
• Add Nasal Cannula O2, if supplemental oxygen needed
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Oct 2014
Donning/Doffing
Sequence
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Hand Hygiene
Leggings/Boot Covers (or Shoe Covers), if used
Gown (tie at waist and neck)
Gloves
• Double glove if gross contamination or large volume of body fluid
• Single or Inner Pair MUST completely cover gown cuff, so that
there is no exposed skin
Oct 2014
Donning Sequence
• Mask or Respirator (ensure proper fit)
• Eye and Face Protection (ensure proper fit)
• Bonnet
Remember: Do NOT touch your eyes, nose or mouth
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Most Provider
exposures occur
during PPE Removal
(doffing)!
Oct 2014
Doffing (Removal) = Critical Process
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• PPE must be removed in the proper sequence &
with extreme care/caution, to prevent
inadvertent exposure
• Basic Principle:
• Touch ONLY “clean to clean” and “dirty to dirty”
• Perform hand hygiene and replace gloves if
hands become contaminated during removal,
AND immediately after PPE removal
• PPE must be removed immediately after patient
care is transferred to hospital staff
Oct 2014
Doffing (Removal) = Critical Process
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“Buddy System”
• A trained observer shall monitor the doffing
procedure
• “Buddy” (in PPE) watches to prevent
compromises or other procedural breaches
• Any compromise/breach must be reported to
your EMS Field Supervisor immediately
Oct 2014
• Can be used during donning, as well
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Clean disposable gloves
Biohazard receptacle and bags (triple bag for high-risk)
Hand hygiene supplies
Lysol spray (bring can from Rescue, discard in E.D. after
use)
• 1 set or package of hospital “Standard Precautions” PPE
• Disposable gloves (at least two pairs per team)
• Disposable gown
• Standard surgical mask (preferably with attached face
shield or other eye protection, or equivalent)
Oct 2014
Doffing – Equipment Needed
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Doffing: Overall Sequence
• 1st member serves as “Buddy” for 2nd member during doffing
• 2nd member then dons fresh Standard Precautions and serves as
“Buddy” for 1st member during doffing
• 1st member then dons clean gloves and serves as “Buddy” for 2nd
member during doffing
• Both members shall use meticulous hand hygiene after all PPE is
removed
• NOTE: Proceed slowly and carefully to avoid breaches!
• NOTE: Gloves shall be removed, hand hygiene performed and fresh
gloves donned at any point in the procedure, if needed, because of
inadvertent contamination
Oct 2014
• 2 Members in Full PPE (including double gloves)
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Doffing Sequence Details
• Do NOT contaminate by crossing legs
• Lean against wall or sit in chair, if needed
• Outer Gloves: Do not contaminate inner gloves, remove 
Biohazard disposal
• Gown and Inner Gloves: Buddy unfastens from rear, then
wearer rolls away from body, down to wrists, rolls into small
bundle and removes without contaminating skin  Biohazard
disposal
• HAND HYGIENE: Allow hand gel to be fully absorbed
Oct 2014
• Buddy sprays member with Lysol (especially legs and feet)
• Boot Covers: Touch ONLY outside, remove  Biohazard
disposal, one at a time, as each is removed
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• Don TWO pairs of clean gloves
• Bonnet: With ONE hand, grasp as far to the rear as
possible and pull away from head and face  Biohazard
disposal
• Goggles: With OTHER hand, grasp as far to the rear as
possible and pull away from face  Biohazard disposal
• Outer Gloves: Remove without contaminating inner
gloves or skin  Biohazard disposal
• Respirator/Mask: Grasp from as far to the rear as
possible and pull away from face while actively exhaling
 Biohazard disposal
Oct 2014
Doffing Sequence (cont’d.)
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• Inner Gloves: Without contaminating skin, remove 
Biohazard disposal
• HAND HYGIENE: Allow hand gel to be fully absorbed
• Don Hospital Standard Precautions PPE
• Gown, Mask and TWO PAIRS of Disposable Gloves
• Wipe or Spray Lysol Can
• Outer Gloves: Without contaminating inner gloves,
remove  Biohazard disposal
• Serve as the “Buddy” for the Repeat Doffing Procedure
for the other DFR Member
Oct 2014
Doffing Sequence (cont’d.)
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• After 2nd Member has removed all PPE and performed Hand
Hygiene, (s)he dons a final pair of clean gloves and serves as a
“Buddy” one final time, to assist the 1st Member with doffing
of the Hospital Standard Precautions PPE
• Both Members wash hands and all at-risk skin surfaces with
soap and water, then perform thorough Hand Hygiene
Oct 2014
Doffing Sequence (cont’d.)
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• Once the contaminated PPE is placed in the
Biohazard bag and the bag is triple-sealed:
• At a hospital, follow directions of facility staff
• If the Biohazard bag must be returned to a DFR
station, deposit the bag in the contaminated
material box for processing through Waste
Management
Oct 2014
Disposal of Contaminated PPE
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Procedure Breach or
Contamination
• Stop work as soon as possible
• Wash the affected area thoroughly with soap and water
• Report the exposure as soon as possible to your EMS Field
Supervisor for follow-up
Oct 2014
• In the event of contact with patient blood, body fluids,
secretions or excretions during patient care:
• In the event of inadvertent contamination during doffing:
• Stop the doffing sequence immediately
• Wash the affected area thoroughly with soap and water, or with
alcohol-based gel or foam
• Report the exposure as soon as possible to your EMS Field
Supervisor for follow-up
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Summary
• Standard: ALL Patients
• Contact + Droplet: Sick Patients at risk for infectious diseases
• Airborne: Patients at risk for airborne-spread infection
• Doffing (removal) = greatest risk to Providers
• A “Buddy System” – especially during doffing – will
reduce the risk of compromise/breach
• PPE must be disposed of properly after removal
Oct 2014
• Hand hygiene is the single most important way
to prevent infection spread
• Proper selection of appropriate PPE is vital
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1. Contact your EMS Field Supervisor,
or
2. Contact M. Allison Green, RN
214-670-3220 Office
469-323-5775 Cell
Oct 2014
If you have any questions…
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