PRELIM COVERAGE

CHAPTER 2

DONNING AND DOFFING OF Personal Protective Equipment (PPE)

(3 HOURS)
Intended Learning Outcomes:

At the completion of this coverage, the students shall be able to:

 Explain the rationale of wearing PPE

 Perform donning and doffing of PPE

Specific Instructions in the completion of this Chapter:

1. Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
2. Prepare the following materials:
 Disaster Nursing textbooks and other references
 Notebook, bond papers and writing materials
 Worksheets
3. Lecture notes are provided for you.
4. After the lecture, you are required perform a skills demonstration of PPE Donning and
Doffing.

Key Terms

Doffing
Donning
Infection Control
Personal Protective Equipment
Let’s Start

 Healthcare workers are at risk of contracting infectious diseases each time they enter their
workplace, and satisfactory infection control practices within the healthcare setting is a primary
responsibility among all healthcare workers.
 In nursing, this responsibility affects all interactions with patients, coworkers, equipment, and
the healthcare environment. It encompasses adherence to the following essential infection
control practices:
o scientifically accepted standards for handwashing;
o aseptic technique, use of gloves and other barriers for preventing bi-directional contact
with blood and body fluids;
o thorough cleaning followed by sterilization or disinfection of medical devices;
o disposal of non-reusable materials and equipment;
o cleaning of objects between patients that are visibly contaminated or subject to touch
contamination with blood or body fluids;
o injury prevention techniques or engineering controls to reduce the opportunity for
patient and employee exposures.
 Compliance can be increased with regular and high-quality training to understand how infection
control strategies work and why they are necessary, such as with the World Health Organization
(WHO, 2009) multimodal approach, “My 5 Moments for Hand Hygiene” (WHO, 2009).
 There can be detrimental consequences with poor compliance to infection control practices,
such as increased risk of illness or disease transmission for the healthcare worker, the patient,
and the public, poor health outcomes, misconduct consequences for the healthcare worker,
including disciplinary action, revocation of license, and professional liability.

Minimizing Risk for Exposure

 Handwashing is the single most effective way to decrease disease transmission, nurses have
much more risk of exposure than hands alone.
 Nurses are exposed through direct contact such as touching; indirect contact such as
equipment, eating utensils, or other vectors or vehicles of transmission; droplet transmission
such as coughing, sneezing, or spitting from the source to the eyes, nose, or mouth of others; or
airborne transmission with the spread of microorganisms by dust particles or small droplets (less
than 5 microns).
 The microorganisms become airborne and enter the host through a portal of entry (usually the
respiratory system).
 A portal of entry is the route by which microorganisms enter the host. Portals of entry include
skin, blood, and the respiratory, gastrointestinal, reproductive, and urinary tracts. Frequently,
microorganisms enter the host's body by the same route they exited the source.
 Nurses use PPE to decrease the risk of exposure by limiting the ability of microorganisms to
enter their bodies. PPE includes gloves, respirators, facemasks, eyewear, and/or gowns to
prevent the transmission of infectious materials found in blood, body fluids, secretions, and
excretions (CDC, 2019; WHO, 2009).
Disposable Gloves:

 Disposable gloves are made from a variety of polymers such as latex, nitrile rubber, polyvinyl
chloride (PVC, or more commonly referred to as vinyl), and neoprene.
 They are available as unpowdered or powdered. Both nonsterile and sterile gloves are used by
healthcare providers (HCPs) when delivering care to patients.
 Latex and nitrile mold to the hand and offer superior protection against pathogens.
 Nitrile gloves are preferred over vinyl for tasks that require a high degree of dexterity. Vinyl
gloves are acceptable when the risk of exposure to pathogens is lower, and a high degree of
dexterity is unnecessary (Potter et al., 2017).
 The following are important points to consider when using gloves.
o Wear clean, nonsterile gloves when touching blood, body fluids, secretions, excretions,
and contaminated items.
o Apply gloves before touching mucous membranes and non-intact skin.
o Gloves should fit comfortably and not be reused.
o The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of
hand hygiene does not eliminate the need for gloves (Potter et al., 2017).
 o Change gloves between tasks and procedures on the same patient after contact with a
material that may contain a high concentration of microorganisms (Potter et al., 2017).
o Remove gloves promptly after use, before touching non-contaminated items and
environmental surfaces, and before going to another patient. Wash hands immediately
to avoid transferring microorganisms to other patients or environments (Potter et al.,
2017).
o Wear sterile gloves when following the principles of surgical asepsis for keeping an
area/object free of all microorganisms. Thorough handwashing must be performed
before donning sterile gloves and after discarding the gloves (Potter et al., 2017).

Facemasks

 provide barriers to infectious materials and are often used with other PPE such as gowns and
gloves.
 When worn correctly, facemasks and eye protection provide protection for the mouth, nose,
and eyes during procedures where there is a potential for droplets or splashing of blood or body
fluids.
 The use of facemasks during spinal/epidural access procedures is included within the definition
of standard precautions.
 In addition to these standard precautions, transmission-based precautions are mandated by the
CDC for highly transmissible diseases such as COVID-19, measles, varicella, tuberculosis,
influenza, mumps, rubella, wound infections, scabies,

Type Use
Surgical Protect against large
masks droplets and splashes
(does not require fit-
testing)

N-95 Protects against dust,

respirators fumes, mists,
microorganisms
(requires fit-testing)

Half-mask Purifies air: protects

respirators against a variety of
particulates, vapors,
dust, mists, fumes;
depends on filter
cartridge used
(requires fit-testing)
 Full-face Same as half-mask,
respirators with greater
protection factor; eye,
mucus membranes,
and face protection;
depends on filter
cartridge used
(requires fit-testing)

Eye and Face Protection

 Eye protection is achieved by wearing eyewear specifically designed to reduce the risk of
exposure to chemical splashes, laser radiation, and/or flying debris.
 There are four primary types of eye protection — of which each has its own limitations —
including general safety glasses, laser safety glasses, chemical splash goggles and impact
goggles.
 Full face protection is achieved by wearing face shields.

Gowns or Aprons?

Gown/ apron

There are 3 factors influencing the selection of a gown or apron:

1. The purpose of use: Isolation gowns are generally the preferred PPE for clothing, but aprons are
occasionally used where limited contamination is anticipated. If contamination of the arms can
be anticipated, a gown should be selected. Gowns should fully cover the torso, fit comfortably
over the body and have long sleeves that fit snuggly at the wrist.
2. The material properties of the gown: Isolation gowns are made either of cotton or a spun
synthetic material which dictates whether they can be laundered and reused or must be
disposed of. Cotton and spun synthetic isolation gowns vary in their degree of fluid resistance,
another factor that must be considered in the selection of this type of PPE. If fluid penetration is
likely, a fluid-resistant gown should be used.
3. Patient risks and whether a clean, rather than a sterile gown, can be used. Clean gowns are
generally used for isolation precautions. Sterile gowns are only necessary for performing
invasive procedures, such as inserting a central line. In this case, a sterile gown is best for both
patient and healthcare worker protection.

For contact precaution, long-sleeved water-resistant gowns and gloves are recommended.[4]

Selection of Appropriate PPE

It is important to consider the following factors influencing the selection of PPE:

1. Type of anticipated exposure: Such as from touch or surfaces, splashes or sprays, or large
volumes of bodily fluids, which may seep through the clothing. PPE selection (and combinations
of PPE), is determined by the category of isolation of the patient being treated.
2. Durability and appropriateness of the PPE for the task. This will affect, for example, whether a
gown or apron is selected. If a gown is required, the type of gown is also important. Does it need
to be fluid resistant, fluid proof, both or neither?
3. Fitting. PPE must fit the individual user (form a proper seal). For example; if a glove is too large /
too small than the person's hand, it will compromise the level of protection while also affecting
the dexterity of the health care provider.
 There are also some limiting factors to consider when wearing PPE in a healthcare environment.
It is important to have a full understanding of the different types of PPE when making your
selection based on the purpose and goal of the protection.
 Using a head or full body ventilated PPE suit equipped with powered-air-purifying-respirators
was found to cause reduced dexterity due to multiple glove layering. Back pain related to the
respirator of the fully ventilated suit and impaired visibility by a flexible face shield may also be
an issue. The temperature of the work environment may also have an impact on healthcare
workers; working at a temperature of 28°C wearing a full-body ventilated PPE may cause heat
stress and dehydration, whereas a temperature of 22°C had no negative impact on the same
physical parameters.