Amidst the global COVID-19 pandemic, it is now especially crucial that healthcare professionals are educated in the correct application and removal of personal protective equipment in order to protect both themselves and their patients.
Personal protective equipment (PPE) donning and doffing is a critical process that requires significant care.
This process, particularly the removal and disposal of contaminated PPE, is considered a highly important step in limiting exposure to pathogens (CEC 2020).
The term personal protective equipment refers to anything used to decrease the risk of harm to the health and safety of workers (Safe Work Australia 2017).
In healthcare settings, PPE is used to create a barrier between the worker and any infectious agents (spread through airborne, contact or droplet modes) they may come into contact with. The aim is to reduce the risk of touching, transmitting or being exposed to pathogens (MedlinePlus 2019).
Clothing (gowns, aprons, head covering, shoe covers);
Eye protection (face shields, goggles).
Using PPE Effectively
Healthcare workers must be thoroughly informed about any infections and updated on the current policies, procedures and protocols of their organisation.
Workers must have access to the necessary equipment to carry out the specified task correctly and safely.
You may consider having a second clinician present to supervise the donning and doffing process and ensure it is performed correctly.
Healthcare organisations must apply both standard and transmission-based precautions as they are applied individually.
Workers must have a thorough understanding of contact, droplet and airborne precautions.
Following a correct doffing procedure is especially crucial in the control and prevention of infection. It is the most important step of preventing infection transmission (CEC 2020).
The doffing of PPE should protect your clothing, skin and mucous membranes from contamination (CDC 2014).
Remember that all PPE is contaminated after use. Perform hand hygiene immediately after each step of doffing (Queensland DoH 2020).
Your gloves and gown should be removed before exiting the patient’s room (CDC 2014).
Using one hand, grasp the palm of the other 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 it off over the first glove.
Discard gloves in a waster container.
Perform hand hygiene.
Unfasten the ties, ensuring the sleeves don’t make contact with your body.
Pull the gown away from the neck and shoulders, touching the inside only.
Turn the gown inside out.
Fold or roll the gown into a bundle and discard in the waste container.
Perform hand hygiene.
Exit the patient’s room and close the door.
Remove goggles/face shield.
Remove from the back of the head by lifting headband or ear pieces.
If reusable, place in the designated reprocessing receptacle. If not, discard in waste container.
Perform hand hygiene.
Grasp the bottom ties/elastics, then the top ones, and remove without touching the front of the mask.
Discard in the waste container.
Immediately perform hand hygiene.
(Queensland DoH 2020; CEC 2020)
Note: PPE must be disposed of after use unless it is marked as reusable. Reusable PPE must be reprocessed before being used again (DoH 2020).
Appropriate PPE for Exposure to COVID-19 Patients
Transmission-based precautions should be used when dealing with confirmed or suspected COVID-19 patients.
Contact and droplet precautions should be used for routine care of COVID-19 patients.
Contact, droplet and airborne precautions should be used for:
Performing aerosol-generating procedures on COVID-19 patients; and
Caring for critically ill COVID-19 patients in ICU.
If PPE is not worn correctly, there is a high risk of contamination (Pyrek 2018). Always follow hospital protocol and notify your supervisor if necessary.
If goggles and masks are worn for too long, they may cause pressure injuries to the face. Ensure you protect bony prominences and/or change PPE frequently if possible.
Always remember to engage with the patient, as it can be quite confronting for them not to see the healthcare worker’s face.
Take regular breaks if you can.
Correct PPE use is crucial to infection control and prevention. You must always ensure correct procedures for donning and doffing are followed, and that staff are well-trained and competent (Pyrek 2018).
Always refer to your organisation’s policies and procedures.