Nurse Aide Increased Infection Control
Module 3: Personal Protective Equipment

 

 Thank you for joining us

Welcome

 

Welcome to Module 3: Personal Protective Equipment. We are glad you're here!

 

What you learn in this class will help keep you, and your residents, safe. 

 

Module 3 will present you with information on PPE and the proper usage of PPE.

 

 

 

System requirements

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At the end of this course, you will need to verify that you've fulfilled the course requirements and obtain a learning certificate.

 

Before we begin...

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To access a specific page, click on the desired page number at the top of the screen.

 

Throughout the training, you will have the opportunity to click on highlighted words to view the definition, or to click on hyperlinks to view external sources.

Order of Modules

This course is designed to increase your infection control knowledge in long-term care environments. Information from this CBT can be directly applied to your daily activities as a nurse aide. 

 

This course has five modules. You must save or print the certificate at the end of each module. Keep these certificates as proof of completion. 

 

  • Module 1: Introduction to Pathogens
  • Module 2: Chain of Infection/Modes of Transmission
  • Module 3: PPE
  • Module 4: Standard and Transmission-based Precautions
  • Module 5: Cleaning and Disinfection

 

There is no way to create a lost certificate of completion without taking or retaking the course. If you do not keep a copy for your records, you will need to repeat this course.

 

Let's get started!

 

Lesson Objectives

In this CBT, you will:

  • Identify types of PPE
  • Identify the steps in donning and doffing of PPE
  • Identify the factors influencing PPE selection

 

target

What is PPE?

PPE, or Personal Protective Equipment, includes many different pieces of clothing or equipment designed to protect you from contact with pathogens. PPE is used to protect your mucous membranes, skin, and clothing. The most commonly used pieces of PPE include:

  • Gloves
  • Face coverings
    • Masks
    • Respirators
    • Goggles
    • Face shields
  • Gowns
  • Shoe coverings

 

It is important to note that not all types of PPE will be used in every situation. The PPE required will be determined by the known pathogens present.

 

Gloves

gloves

Gloves are designed to protect your hands from pathogens and to prevent the spread of pathogens. Unintentionally transferring a pathogen to your bare hands is an easy way to spread a contagion through your facility.

 

It is worth noting that gloves are not a magical cure for transferring pathogens from surface to surface. Anytime you touch an object, pathogens can be transferred, gloves or no gloves.

 

Gloves can help to prevent contamination from body fluids, non-intact skin, and contaminated surfaces and equipment. Your need to wear non-sterile vs. sterile gloves will depend on the procedures you intend to complete. Usually, non-sterile gloves are appropriate. However, sterile procedures will require a sterile set of gloves.

 

Gloving Protocol

One of the most critical components to donning gloves is hand hygiene. You must perform hand hygiene before resident contact, even though you are wearing gloves. The way YOU use gloves can influence the risk of disease transmission in your healthcare setting.

 

DO:

  • Perform hand hygiene before and after resident contact, even when gloves are worn.
  • Work from clean to dirty.
  • Perform hand hygiene after glove removal.
  • Change gloves as needed during resident care activities.

 

DON'T:

  • Touch yourself while wearing contaminated gloves. This limits opportunities for cross-contamination.
  • Handle clean materials, equipment, or surfaces while wearing contaminated gloves.
  • Wear the same pair of gloves for the care of more than one resident.
  • Wash disposable gloves.

 

It is important to note that gloves can spread illnesses just like bare hands. Wearing gloves does not stop the transfer of pathogens. It is very easy for cross-contamination to occur even when wearing gloves. Be mindful of the order in which you touch things (remember clean to dirty) and when you may need to change gloves mid-procedure.

 

Example: You have entered Mrs. Johnson's room to provide care of an open wound. While preparing the materials you will need, you accidentally touched the rim of the trash can. What should you do?

Face Coverings: Masks

Surgical masks help to protect you against certain pathogens. More importantly, they serve to protect others from being exposed to pathogens leaving your nose and mouth area.

 

For masks to be effective, they should fit snuggly and fully cover both your nose and mouth.

 

DO:  Change a facemask if it becomes damaged or soiled.

 

DON'T: Confuse face masks with respirators.

 

Face Coverings: Respirators

 

Respirators (ex., N95 or higher-level filtration) are worn to prevent inhalation of airborne pathogens.

 

Respirators form a tight seal around your nose and mouth and requires a specific evaluation (fit-test) to ensure the safety, fit, and adequate protection.

 

Face Coverings: Goggles

goggles

Goggles provide protection to the mucous membranes in your eyes from blood and other bodily fluids.

Goggles should fit snuggly over and around the eyes.

 

DON'T:

Use personal prescription eyeglasses as a substitute for goggles.

 

Face Coverings: Face Shields

Face shields protect the face, mouth, nose and eyes from blood and bodily fluids.

 

They can be used as an alternative to goggles if extensive splash or spray is anticipated.

 

Face shields should cover the forehead, extend below the chin and wrap around the side of the face.

 

When skin protection (in addition to mouth, nose, and eye protection) is needed or desired a face shield can be used as a substitute for wearing a mask or goggles.

 

An example of this would be when irrigating a wound or suctioning copious secretions.

 

face shield

Gowns

gown

Gowns are worn to protect arms, exposed body areas and clothing from contamination with blood, bodily fluids, or other infectious materials. Some visitors will wear gowns when visiting a person in isolation due to an extremely infectious illness.

 

Gowns should fully cover the torso and have long sleeves. If fluid exposure is anticipated, a fluid-resistant gown should be used.

 

DO:

  • Remove and properly dispose of gowns before leaving the resident care area.

 

DON'T:

  • Reuse or save gowns for later use, even during care for the same resident.
  • Use clinical or lab coats as a substitute for isolation gowns.

 

Donning PPE

Donning (or putting on) PPE is an essential skill that you must master to fully protect yourself and your residents from pathogens. Quality infection control hinges on proper PPE usage. The order that you don is important so that you are not introducing pathogens to sanitized areas. The steps are as follows:

  • Identify and gather the proper PPE.  Ensure choice of gown size is correct (based on training).
  • Perform hand hygiene using hand sanitizer or soap and water.
  • Put on isolation gown.  Tie all the ties on the gown. Assistance may be needed by other healthcare personnel.
  • Put on NIOSH-approved N95 filtering face piece respirator or higher (use a facemask if a respirator is not available).  If the respirator has a nosepiece, it should be fitted to the nose with both hands, not bent or tented. Do not pinch the nosepiece with one hand. Respirator/facemask should be extended under chin. Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between patients.
    • Respirator:  Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.
    • Facemask:  Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your ears.
  • Put on face shield or goggles.  When wearing an N95 respirator or half face piece elastomeric respirator, select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging is common.
  • Put on gloves.  Gloves should cover the cuff (wrist) of gown.
  • Healthcare personnel may now enter patient room.

 

Note: More than one donning method may be acceptable. Please follow your facility's guidelines.

Doffing PPE

Doffing (or taking off) PPE is just as critical of a step at preventing the spread of infectious disease. Proper doffing can prevent cross-contamination of clean areas and stop pathogens from inadvertently leaving the area.

  • Remove gloves.  Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).
  • Remove gown.  Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle. *
  • Healthcare personnel may now exit patient room.
  • Perform hand hygiene.
  • Remove face shield or goggles.  Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles.
  • Remove and discard respirator (or facemask if used instead of respirator).  Do not touch the front of the respirator or facemask.
    • Respirator:  Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.
    • Facemask:  Carefully untie (or unhook from the ears) and pull away from face without touching the front.
  • Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing reuse.

 

 

Donning and Doffing PPE

Practicing proper protocol in both donning and doffing PPE can ensure that you, and your residents, remain safe when faced with an infectious disease. By not following these guidelines, you may open the door to an infectious disease outbreak that could have been prevented with proper PPE usage.

 

  • To view CDC recommendations on PPE Sequence, click here.
  • To view CDC recommendations on the use of PPE when caring for someone with COVID-19 , click here.

 

Factors Influencing PPE Selection

Decisions about what PPE to use should be determined by the type and level of contact you will have with the resident. Not all PPE is necessary with every contact. Type of exposure anticipated, fit and durability of PPE, and the need for transmission-based precautions are all needed in determining which PPE should be utilized.

 

Consider the following:

  • Will I be touching the resident? Will I be touching potentially contaminated items in their environment?
  • Is there a likelihood that I will encounter splash from blood or bodily fluids?
  • Is the resident coughing? Sneezing? Vomiting? Do they have diarrhea?
  • What is the diagnoses of the resident's illness?
  • Are they infectious? What is the pathogen that is to be encountered?
  • What is the mode of transmission of the pathogen?

 

These are examples of basic questions you should answer before deciding which PPE to use.

 

Factors Influencing PPE Selection

Gloves

You should wear gloves when you will have to touch a client in a way that might lead to exposure to blood or body fluids or touch objects in their environment that may be contaminated.

 

Face Coverings

You should wear a mask, respirator, or face shield when there is a risk of being splashed or sprayed with blood or body fluids (secretions and/or excretions) or being exposed to airborne pathogens.

 

Gowns

You should wear a gown when there is a risk of your clothing or exposed skin meeting anything wet or weeping. This includes blood, bodily fluids, secretions and/or excretions.

 

Factors Influencing PPE Selection

Listed here are several patient care activities that could indicate a need to wear PPE. Practice identifying what PPE you would you wear for each scenario.

Cross-contamination of PPE

Cross-contamination of PPE occurs when "clean" areas encounter "dirty" areas.

 

Generally, contaminated areas of PPE consist of any area that may have been exposed to a resident, or the resident's blood or bodily fluids. These include:

  • The outside of gloves
  • The outside of goggles or face shield
  • Gown front and sleeves
  • The front of mask/respirator

 

Because these areas are considered dirty, encountering them during the doffing (removal of PPE) sequence requires you to stop and wash your hands. Failing to do so could cause a cross-contamination of the pathogen you have been exposed to and spread of the contagion could occur.

 

Reusing PPE

PPE is generally designed to be disposable and used only once. There may be times, however, that you will be asked to reuse certain items. There are 2 scenarios that you may encounter with PPE.

 

The first, extended use, refers to the practice of wearing the same item for repeated close contact encounters with several patients, without removing the PPE between patient encounters. This is generally better suited to patients who are infected with the same infectious disease.

 

The second, reuse, refers to the practice of using the same item for multiple encounters with patients but removing it (doffing) after each encounter. The PPE is stored in between encounters to be put on again (donned) prior to the next encounter with a patient. 

 

N95 respirators are common examples of pieces of PPE that are reused or used on an extended-use basis.

 

When determining if an N95 respirator should be used one-time only, or reused, depends on the specific situation within your facility. The decision to implement these practices should be made on a case by case basis, considering respiratory pathogen characteristics (e.g., routes of transmission, prevalence of disease in the region, infection attack rate, and severity of illness) and local conditions (e.g., number of disposable N95 respirators available, current respirator usage rate, success of other respirator conservation strategies, etc.).

 

Some healthcare facilities may wish to implement extended use and/or limited reuse before respirator shortages are observed, so that adequate supplies are available during times of peak demand.  

 

Be sure to speak with your facility's Infection Control Preventionist for guidance on reusing PPE. Each facility will have slightly different recommendations and guidance for reuse.

 

Case Study

John is a CNA at Blushing Pines and is performing incontinent care on a resident. John washes his hands, dons clean gloves, and removes the soiled brief. After discarding the brief in the trash can, John reaches to push his hair out of his eyes and tucks it behind his ears. Still wearing the same gloves, John grabs clean wipes and begins cleaning the resident. John's hair falls back into his face, so he removes his soiled gloves and pushes his hair out of his face again. Then, he pulls up his pants that are falling below his waist and dons clean gloves to complete care.

Objectives Review

So far in module 3, you have:

  • Identified the different types of PPE
  • Identified the steps in donning and doffing of PPE
  • Identified the factors influencing PPE selection

 

The following slides will include a short concept check to help you demonstrate your understanding of the content provided.

 

   

 

 

CONGRATULATIONS!

You have successfully completed Module 3: Personal Protective Equipment

FINAL STEPS

Please review your score.

 

Save or print your certificate for your records.

 

Remember, there is no way to create a lost certificate of completion without retaking the course. If you do not keep a copy for your records, you will need to repeat this course.

 

THANK YOU!

 

Next up:

 

 

Module 4: Standard and Transmission-based Precautions