Module 5: Personal Protective Equipment in Healthcare
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Learning Objectives
By the end of this session, you should be able to:
1. Define Personal Protective Equipment
2. Outline the hierarchy of safety and hazard control Safety and Hazard Control
3. Outline factors influencing PPE selection
4. Outline different kinds of personal protective equipment
5. Describe how to correctly don and doff personal protective equipment
6. Identify when to use personal protective equipment and the type required for each situation
Personal Protective Equipment (PPE)
Personal Protective Equipment (PPEs) are specialized clothing or equipment
worn by an employee for protection against infectious materials such as blood,
body fluids, respiratory droplets, and contaminated surfaces
This photo shows a healthcare
worker donning different PPEs (Face
shield, Mask, Gown and Gloves)
Hierarchy of Safety and Hazard Controls
• The structures of the hierarchy
of control, from most effective
control to least effective
• Eliminating the risk/hazard is the
most effective level of control
• Reducing the risk through the
use of PPE is the lowest level of
control
• PPE is least in the hierarchy of
prevention, BUT it's the most
commonly used
Hierarchy of Safety and Hazard Controls…
● The protection of healthcare personnel from infectious disease exposures
in the workplace requires a combination of controls as indicated in the
pyramid.
● There are four major components to healthcare worker safety programs
that fall under the last parts of the pyramid.
1. Engineering controls
2. Awareness
3. Administrative controls
4. Personal protective equipment
Hierarchy of Safety and Hazard Controls…
1. Engineering controls; e.g. negative pressure rooms for patients with airborne
diseases such as TB.
2. Awareness; disseminating continuous information on the hazards
3. Administrative controls; e.g.
■ policies and procedures, like those procedures for recognizing patients
with a communicable disease before they expose health care workers,
patients and environment.
■ Work practice controls such as not recapping needles are also part of
administrative controls. These require the worker herself to DO
something. Training, such as you’re receiving today, is the primary activity
that falls under administrative controls.
Hierarchy of Safety and Hazard Controls…
4. Finally, there is personal protective equipment. While PPE is least
in the hierarchy of prevention, it is very important for protecting
healthcare workers from disease transmission.
● The 4 components of workplace safety programs is like a house that
requires 1. Foundation, 2. Walls, 3. Roof, and 4. Furniture to be
completely able to provide effective shelter.
Factors Influencing PPE Selection
When you are selecting PPE, consider three key things.
1. Type of exposure anticipated
Splash/spray versus touch
Category of isolation precautions
2. Durability and appropriateness for the task
3. Size: PPE must fit the individual use
With this as background, we will discuss how to select and use specific PPE from the next page.
A Guide for PPE Selection
Perform a quick Risk Assessment by asking yourself
the following 5 questions: If YES
1. Am I at risk of exposure to blood or
Q 2-5
body fluids?
FACIAL
2. Is my face at risk?
PPE
3. Are my hands at risk?
GLOVES
4. Are my clothes at risk?
5. Is the patient known or suspected to GOWN/APR
have infectious disease? ON
ADDITIONAL
PRECAUTIONS
Types of PPE Used in Healthcare Settings
1. Gloves Hands
2. Goggles Eyes
3. Face shields PROTECTS
Face, Mouth, Nose, Eyes
4. Masks and respirators Mouth, Nose, Respiratory Tract
5. Gowns/aprons Skin, Clothing
We’ll discuss this in more detail later.
1. Gloves
• Purpose: to protect hands
• Activity: patient care, environmental cleaning
• Material: can be vinyl, latex, nitrile,
• Sterile or non-sterile
For most patient • Single use or reusable(utility gloves)
care, a single pair of
nonsterile gloves is
sufficient.
2. Goggles
• Protect eyes
• Fit snugly over and around eyes
• Goggles must fit with personal glasses
• Has anti-fog feature which improves clarity of
vision
Personal glasses are not a substitute for
goggles
3. Face Shields and Hoods
• Face shields – protects face, nose, mouth, and eyes
✔ Should cover forehead, extend below chin and
wrap around side of face
✔ Made of transparent plastic material
• Hood – protects the whole head, face and neck
3. Face Shields and Hoods…
When skin protection, in addition to mouth, nose, and
eye protection, is needed or desired, for example, when
irrigating a wound or suctioning copious secretions, a
face shield can be used as a substitute to wearing a mask
or goggles.
4. Masks & Respirators
• Purpose: protect eyes, nose and
mouth
• Activity: Patient care, handling
hazardous materials
• Masks – protect nose and mouth
NB: The selection of facial PPE is – Fully cover nose and mouth and
determined by the precautions required prevent fluid penetration
for the patient and/or the type of
procedure being done
Masks & Respirators…
• Purpose: protect from inhalation of infectious aerosols
(e.g., Mycobacterium tuberculosis)
• Types of respiratory protection e.g N95, R95, N100
• Wear the right size and carry out a fit test
• Valved masks should not be used in Healthcare
setting
5. Gowns and Aprons
Three factors influence the selection of a gown or apron as PPE.
1. Activity; gowns are generally the preferred PPE for clothing. If
contamination of the arms can be anticipated, a gown should be
selected. Aprons can be used where limited contamination is
anticipated.
2. Material; Gowns are made either of cotton or a synthetic material that
dictate whether they can be laundered and reused or must be disposed.
If fluid penetration is likely, a fluid resistant gown should be used.
3. Patients’ risk; Clean gowns are generally used for clean procedures and
isolation. Sterile gowns are only necessary for performing invasive
procedures.
Gowns and Aprons…
• Purpose: to protect skin and clothing
• Activity: patient care
• Material: Cloth or synthetic
✔ permeable or impervious
• Reusable or disposable
• Clean or sterile
When to Use PPE
PPE for Standard Precautions
Assumes blood and body fluid of ANY patient could be infectious. Decisions
about PPE use determined by the patient care activity or procedure.
• Gloves – Use when touching blood, body fluids, secretions, excretions,
contaminated items, mucus membranes and non-intact skin
• Gowns – Use during procedures and patient care activities when there is
contact of clothing or exposed skin with blood/body fluids, secretions, or
excretions
PPE for Standard Precautions…
• Mask and goggles or a face shield – Use during patient care activities
likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions
PPE for Additional Precautions
Precaution PPE
Contact Gown or apron and gloves for contact with patient or
patient
Droplet Surgical masks if within 6 feet of patient
Airborne Respirator
Donning (putting on) PPE
Sequence for Donning Multiple PPE
Follow the numbering during donning process
1. Gown
2. Mask or respirator
3. Goggles or face shield
4. Gloves
How to Don a Gown
1. Select appropriate type and size
2. Inspect for defects
3. With the opening at the back, secure at neck and waist
4. If gown is too small, use two gowns
• Gown #1 ties in front
• Gown #2 ties in back
How to Don a Mask
1. Select appropriate type and size
2. Inspect for defects
3. Place over nose, mouth and chin
4. Fit flexible nose piece over nose bridge
5. Secure mask with ties or elastic as shown on the picture
6. Adjust to fit snugly
How to Don a Particulate Respirator (N95 Mask)
1. Select a fit-tested respirator
2. Inspect for defects
3. Place over nose, mouth and chin
4. Fit the flexible nose piece over nose bridge
5. Secure on head with elastic
6. Adjust to fit snugly
7. Perform a fit check as shown in the picture
• Inhale – respirator should collapse
• Exhale – check for leakage around face
How to Don Eye and Face Protection
1. Select appropriate type and size
2. Inspect for defects
3. Position goggles over eyes and secure to the head using
the ear pieces or headband
or
1. Position face shield over face and secure on brow with
headband
2. Adjust to fit comfortably
How to Don Gloves
1. Select appropriate type and size
2. Inspect for defects
3. Insert hands into gloves
4. Extend gloves over isolation gown cuffs
Do’s and Don’ts of Gloves Use
1. Limit opportunities for “touch contamination”
• Don’t touch your face or adjust PPE with contaminated gloves
• Don’t touch environmental surfaces except as necessary
during patient care
2. Change gloves
• During use if torn and when heavily soiled (even with the
same patient)
• After use on each patient
3. Discard gloves in appropriate waste receptacle
• Never wash or reuse disposable gloves
Doffing (Removing) PPE
Sequence of Removing PPEs
Follow the numbering during doffing process:
1. Gloves
2. Face shield or goggles
3. Gown
4. Mask or respirator
How to Remove Gloves
1. Grasp outside edge near wrist
2. Peel away from hand, turning glove inside-out
3. Hold in opposite gloved hand
4. Slide ungloved finger under the wrist of the
remaining glove
5. Peel off from inside, creating a bag for both
gloves
6. Discard appropriately
How to Remove Goggles and Face Shield
1. Grasp ear or head pieces with ungloved
hands
2. Lift away from face
3. Place in designated receptacle for
reprocessing or disposal
How to Remove Gown
1. Unfasten ties
2. Peel gown away from neck and shoulder
3. Turn contaminated outside toward the inside
4. Fold or roll into a bundle
5. Discard
How to Remove a Mask
1. Untie the bottom, then top tie
2. Remove from face
3. Discard
How to Remove a Particulate Respirator
1. Lift the bottom elastic over your head first
2. Then lift off the top elastic
3. Discard
Hand Hygiene after doffing PPE
• Perform hand hygiene immediately after removing PPE
• If hands become visibly contaminated during PPE removal, wash hands before
continuing to remove PPE
• Wash hands with soap and water or use an alcohol-based hand rub
Ensure that hand hygiene facilities, e.g. sink or alcohol-based hand
rub, are available at the PPE removal area
Take Home Messages
• PPE is available to protect health worker from exposure to hazards in
healthcare setting.
• PPE should be selected based on exposure risk
• Although PPE are most widely used in the healthcare they are the least
effective in hazard control
• It is essential to adhere to the order of donning and doffing PPE
• Use PPE cautiously to avoid compromising their integrity
• Valved respirators should not be used healthcare settings
The End
You have come to the end of this module, kindly participate in the
discussion forum and attempt the Quiz before proceeding to Module 6.
The pass mark for the quiz is 80%, only 3 attempts are allowed.