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Kaiser Ann Pajulas, USRN

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PPE Donning & Doffing

PPE Donning & Doffing

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2 PPE Donning & Doffing NCLEX Questions

Question 1 of 2

A 50-year-old client with measles has been admitted to the hospital and is in isolation. The client’s daughter asks the nurse, “How can I keep from catching this myself if I have been vaccinated?” Which answer from the nurse is most appropriate?

You should be fine if you consistently wash your hands

Make sure that you adhere to the isolation precautions when you are in close proximity

You are protected since you have received the MMR vaccine

I will have the doctor check a measles titer for you to see if you are immune

Question 2 of 2

The nurse is caring for a client with watery diarrhea following a course of clindamycin. The nurse suspects clostridium dificile. Which of the following isolation precautions are necessary for this client? Select all that apply.

Place the client in a private room

Place the client a negative airflow room

Obtain a door sign indicating the level of precaution and necessary personal protective equipment (PPE)

Obtain personal protective equipment outside the door for staff and family members

Educate the client and family members to use soap and water for hand washing instead of hand sanitizer

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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

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

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

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
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
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

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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Transition To Practice

Transition to Practice Course Introduction

Triage in the ER

Troponin I (cTNL) Lab Values

Types of Exercise

Types of Schizophrenia

Umbilical Hernia

Urinary Elimination

Using Aseptic Technique

Uterine Stimulants (Oxytocin, Pitocin)

Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations

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Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)

Vitals (VS) and Assessment

What Guides Nurses Practice

White Blood Cell (WBC) Lab Values

Working night shift

Working with a Preceptor

Wound Care – Assessment

Wound Care – Dressing Change

Wound Care – Selecting a Dressing

Wound Care – Wound Drains

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