PPE Donning & Doffing

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Included In This Lesson

Study Tools For PPE Donning & Doffing

Isolation Precautions (Cheatsheet)
Nitrile Glove (Image)
Airborne Isolation (Image)
Contact Isolation (Image)
Droplet Precautions (Image)
Contact Isolation Gowns (Image)
Isolation Precautions (Image)
Standard Precautions (Picmonic)
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Outline

Overview

  1. Purpose
    1. Donning and doffing PPE correctly is important to make sure there is no cross contamination and that the nurse is protected from the infectious source

Nursing Points

General

  1. Supplies Needed
    1. Standard precautions
      1. Gloves
    2. Contact Isolation
      1. Gown
      2. Gloves
    3. Droplet Isolation
      1. Gloves
      2. Standard facemask
    4. Airborne Isolation
      1. Gloves
      2. N95 Respirator
    5. Can ALWAYS wear MORE than the minimum PPE if appropriate
      1. i.e. patient not in isolation, but you anticipate contact with large amounts of bodily fluids – wear a gown and maybe a face shield as well
    6. Ensure you have access to a trash can and a hand hygiene station when you are removing your PPE

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Gather supplies
      1. Determine appropriate PPE based on patient’s condition
    2. PPE should be donned and doffed in the doorway or ante-room
    3. Donning:
      1. Perform hand hygiene
      2. Apply gown
        1. Remove from package
        2. Open gown and place arms in sleeves – thumbs in holes
        3. Slip over head or tie behind neck
        4. Tie around waist
      3. Apply mask/respirator
        1. Elastic or ties should be secured at middle of back of head and base of neck
        2. Pinch nose bridge to form around nose
        3. Pull below chin
        4. If using a respirator – fit check for leaks by breathing deeply
      4. Apply goggles/face shield
        1. Place over eyes, adjust to fit
      5. Apply clean gloves
        1. Should cover wrists of isolation gown
    4. Doffing
      1. Remove gloves
        1. Grasp wrist of glove with opposite gloved hand, peel off (inside out)
        2. Ball up glove in gloved hand
        3. Slide finger(s) under cuff of gloved hand
          1. Careful not to touch gown sleeve
        4. Peel off over the first glove
        5. Discard in appropriate waste container
      2. Remove goggles/facemask
        1. Grasp the ties or earpieces
        2. Pull off forward and down
        3. Discard or place in appropriate location for cleaning
      3. Remove gown
        1. Unfasten ties around waist and neck – careful to only touch the ties
        2. Using the neck ties, pull gown away from neck and shoulders
          1. Touch only the ties or inside of gown
        3. Turn gown inside out
        4. Fold or roll into a ball and discard appropriately
      4. Remove mask/respirator
        1. Remove bottom elastic or ties first
          1. Bring over your head
        2. Remove top elastic or ties
        3. Pull mask off forward
        4. ONLY touching the ties – discard appropriately
      5. Perform Hand Hygiene
    5. If you need to clean your goggles:
      1. Apply NEW clean gloves
      2. Use appropriate cleaning wipes per facility policy
      3. Remove and discard gloves
      4. Perform hand hygiene
  2. Notes
    1. In AIRBORNE isolation – respirator should not be removed until you have left the room and closed the door behind you
      1. Or in an ante room
    2. Contaminated:
      1. FRONT of gown, goggles, and mask
      2. Sleeves of gown
      3. OUTSIDE of gloves
    3. Not contaminated:
      1. TIES of gown, mask, face shield
      2. INSIDE of gown, gloves
  3. ALTERNATIVE method (NOT the CDC method – but commonly accepted in clinical practice)
    1. Remove gown and gloves simultaneously by grasping the front of your gown and pulling forward to break the ties – works best with plastic gowns
    2. Roll the gown down, inside out, over your gloves and carefully remove one glove inside the balled up gown.  
    3. With your ungloved hand – slip your finger(s) inside the other glove (careful not to touch any other areas of the gown) – remove the glove inside out
    4. Discard in trash can, still only touching the INSIDE of the gown
    5. Remove face mask and goggles using the ties or earpieces ONLY
    6. Perform hand hygiene

Patient Education

  1. Purpose for isolation precautions or PPE
    1. Respect the client’s privacy and dignity at all times

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Transcript

In this video we’re going to talk about donning and doffing PPE. Now, this entirely depends on what type of isolation your patient is in, so make sure you know specifically what PPE to use. In this video, we’re going to assume our patient is in Droplet and Contact precautions and that there might be some splatter. So we’ll use a gown, gloves, goggles, and a mask.

For starters, remember that PPE should always be donned and doffed in a doorway or ante room. And you always start by performing hand hygiene.
The first thing you’re going to apply is your gown. Usually you have these plastic gowns in little plastic packages, so remove the gown, and open it up to find the sleeves. Put your arms in the sleeves, making sure your thumbs go in the thumb holes, then put your head through the head hole or tie the gown around your neck. Then tie the ties around your waist.
Next is your mask. For a standard surgical mask, you want the ties to be in the middle of the back of your head and at the base of your neck. If you have masks with ear loops, then simply loop them over your ears. Pinch the nose piece over the bridge of your nose and pull the bottom of the mask over your chin.
Next you’re going to apply your goggles. Remembering the order here is pretty easy, if your goggles were already on, you wouldn’t be able to get your mask on. So mask first, then goggles.
Finally you can apply your gloves. Just make sure that you pull the cuff of the gloves over the wrist of the gown so you’re fully protected.
Now, you’re ready to enter the patient’s room. Once you’re done in the patient’s room, you have to take all of the PPE off without cross-contaminating anything. So what you NEED to know now is what parts of the PPE are considered contaminated and what parts are clean?
First, the entire outside of the gloves are dirty, as well as the whole front of your gown, mask, and goggles. What IS still clean is the ties on the back of the gown and mask, the inside of the gown and gloves, and the earpieces of your goggles. So when you DOFF your PPE, you have to think about all of these things. We’re going to show you two ways. The first is the way the CDC has approved and teaches.
The very first thing you’re going to remove is your gloves – they are the most contaminated. Grasp the wrist of one glove and pull it off inside out, then ball it up in your other gloved hand.
Then, carefully slip a finger under the cuff of the other glove without touching the gown, if possible, and pull it off inside out over the other glove. Then throw them in the trash.
So now you have somewhat clean hands – you can take off your goggles by the earpieces, remember don’t touch the front!
Now you’ll remove your gown. Carefully reach back and untie the waist ties – touch ONLY the ties.
Now reach up and untie the neck ties, then you can pull the gown forward – still only touching the ties or the inside of the gown. You’ll peel the gown down and turn it inside out as you do. You may need to let your hands come inside the sleeves a bit so they don’t touch the outside. Then ball it up and throw it in the trash.
Now, you can remove your mask using JUST the ties or ear loops and throw it away. Remember, though – if your patient is in airborne precautions, you do not remove your mask until you are OUT of the room with the door closed behind you! Then, of course, perform hand hygiene.
Now, this is the CDC approved method, but you can see how there’s still a high risk of contamination. We want to show you another method that is NOT what the CDC recommends, but it is what most of us use in the real world.
So, same PPE – gown, mask, goggles, gloves. Now, this method only works with plastic gowns that break easily. If you have cloth gowns that tie, you have to use the other method. So, instead of removing your gloves first, you’re going to grab the front of the gown and pull forward. This should break the ties at the neck and around the waist.
Then you’ll begin to turn the gown inside out and ball it up. So the inside of the gown is what’s exposed – which is clean! Now you’ll carefully pull off the gown and glove inside out off of one hand and keep it balled up. Then you can reach your fingers under the glove on the other side and pull it off inside out as well.
Then, since it’s just the inside of everything that is exposed, you can ball it up and throw it in the trash.
NOW you can remove your goggles- still using the earpieces only. Then your mask by the ties or ear loops and throw them away. Then, perform hand hygiene and you’re done.

Not only is this more practical, but it is faster. Just make sure you aren’t mindlessly ripping PPE off – you still need to pay attention to what is and isn’t contaminated and protect yourself and your other patients!
We hope this was helpful. One of my favorite ways to practice this is to get a plastic gown and put shaving cream on the outside of my gloves and gown. If you can get it off without getting shaving cream on your skin, you know you did it right!

Alright guys, go out and be your best selves today! Happy nursing!

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Nursing Clinical 360

With the rapid expansion of the COVID-19 pandemic many schools, instructors and students are left wondering what just happened?Students can’t access the tools and onsite clinical help they desperately need and instructors are trying to piece together online learning that prepares their students for success.It is because of this uncertainty and abrupt change that we have developed the Nursing Clinical 360 Course.Featuring:38 Highly Detailed Nursing Skills Video Lessons18 Health Assessment Lessons26 IV Skills Videos42 Case Studies30+ Care PlansWe want to give students the practical knowledge they need to feel confident going into a clinical or practical situation, as well as give instructors a concise library of online resources to handle the sudden demand for distance learning.

Course Lessons

1 - Head to Toe and Health Assessment
Intro to Health Assessment
Barriers to Health Assessment
The 5-Minute Assessment (Physical assessment)
Adult Vital Signs (VS)
Pediatric Vital Signs (VS)
General Assessment (Physical assessment)
Integumentary (Skin) Assessment
Neuro Assessment
Head/Neck Assessment
EENT Assessment
Heart (Cardiac) and Great Vessels Assessment
Thorax and Lungs Assessment
Abdomen (Abdominal) Assessment
Lymphatic Assessment
Peripheral Vascular Assessment
Musculoskeletal Assessment
Genitourinary (GU) Assessment
2 - IV Insertion
Supplies Needed
Using Aseptic Technique
Selecting THE vein
Tips & Tricks
IV Catheter Selection (gauge, color)
IV Insertion Angle
How to Secure an IV (chevron, transparent dressing)
Drawing Blood from the IV
Maintenance of the IV
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Needle Safety
IV Drip Therapy – Medications Used for Drips
IV Drip Administration & Safety Checks
Understanding All The IV Set Ports
Giving Medication Through An IV Set Port
How to Remove (discontinue) an IV
IV Placement Start To Finish (How to Start an IV)
Bariatric: IV Insertion
Dark Skin: IV Insertion
Tattoos IV Insertion
Geriatric: IV Insertion
Combative: IV Insertion
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
3- Nursing Skills
Nursing Skills (Clinical) Safety Video
Bed Bath
Linen Change
PPE Donning & Doffing
Sterile Gloves
Mobility & Assistive Devices
Spinal Precautions & Log Rolling
Restraints
Starting an IV
Drawing Blood
Blood Cultures
Central Line Dressing Change
Inserting a Foley (Urinary Catheter) – Female
Inserting a Foley (Urinary Catheter) – Male
Trach Suctioning
Trach Care
Inserting an NG (Nasogastric) Tube
NG (Nasogastric)Tube Management
NG Tube Med Administration (Nasogastric)
Stoma Care (Colostomy bag)
Wound Care – Assessment
Wound Care – Selecting a Dressing
Wound Care – Dressing Change
Wound Care – Wound Drains
Pill Crushing & Cutting
EENT Medications
Topical Medications
Drawing Up Meds
Medications in Ampules
Insulin Mixing
SubQ Injections
IM Injections
IV Push Medications
Spiking & Priming IV Bags
Hanging an IV Piggyback
Chest Tube Management
Pressure Line Management
4- Nursing Care Plans
Purpose of Nursing Care Plans
How to Write a Nursing Care Plan
Using Nursing Care Plans in Clinicals
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Renal Calculi
5- Nursing Concept Maps
Concept Map Course Introduction
Coronary Artery Disease Concept Map
COPD Concept Map
Asthma Concept Map
Pneumonia Concept Map
Bowel Obstruction Concept Map
Gastrointestinal (GI) Bleed Concept Map
Congestive Heart Failure Concept Map
Hypertension (HTN) Concept Map
Breast Cancer Concept Map
Amputation Concept Map
Sepsis Concept Map
Stroke Concept Map
Depression Concept Map