How to Safely Take off PPE, Selected Equipment: PAPR and Coverall

>> Hi. I'm Peter Pronovost the Johns Hopkins Medicine Senior Vice President

for patient safety and quality and the director of the Armstrong Institute.

One of the most important ways you can keep yourself safe in caring for patients

with Ebola is to make sure that you learn to put on

and take off personal protective equipment in the most appropriate way.

Now the Centers for Disease Control has provided us detailed guidance for how to do that.

But we needed training modules.

So we partnered with the CDC to do that.

We pulled together our infectious disease experts, human factors and systems engineers,

psychologists, instructional designers and technology experts

to come together to produce this content.

We've been here a week, working long hours to make modules for you

and now what you will see are three key modules.

Number one, how to put on or don personal protective equipment.

Number two, how to take off or doff personal protective equipment and number three,

how the observer can work together to help ensure your safety using teamwork behaviors

that were developed by the agency for health care research and quality.

Now we know these are anxiety filled times.

Believe me, I'm a critical care physician, I'm right with you.

But we also know that with proper training and when we ensure your competency in putting on

and taking off this equipment we could safely care for these patients.

So we hope you enjoy the training and from our colleagues at the Centers for Disease Control

and our colleagues at Johns Hopkins Medicine we thank you for all you do for patients.

>> In this video you will learn how to doff

or remove your personal protective equipment or PPE.

In accordance with CDC protocols.

Following the doffing protocol will minimize the risk for disease transmission.

So it's very important that you understand algorithms the steps.

Your trained observer will help you with the process.

Before you move to the patient's room and into the doffing area you will need

to take a few minutes to do some important things.

First get the attention of the trained observer.

Once he or she signals to you that it's clear, enter the doffing area.

Inspect your personal protective equipment.

Are there any obvious signs of contamination or materials on it?

If so you will need to disinfect the surface of the personal protective equipment

with an EPA designated disinfectant wipe.

Last, disinfect your gloves also with an EPA designated disinfectant wipe

or alcohol based hand rub.

You, your trained observer and the assistant are a team throughout the doffing process.

The trained observer will read each step aloud, giving you the time to take the required action.

The assistant will help you when necessary.

Remember, don't rush through the doffing process.

Take your time and be careful.

>> I'm here to help you through the doffing process.

You'll hear me give directions that are not part of standard practice

but are designed to keep you safe.

As you remove each item it is important to place it immediately

in the designated waste receptacle.

We're going to work through this together.

We need to check for any rips, tears or contaminates on your clothes.

[ Background sounds ]

Now I'd like you to disinfect your outer gloves.

>> The first thing you will do is use an EPA registered disinfectant wipe

or an alcohol based hand rub to disinfectant your outer gloves.

The wipe will be used to remove any visible contamination.

If you're using an apron you now need to remove it.

The assistant will assess the type of apron used and will assist with untying the strap.

Then you will remove the apron by breaking the strap or lifting the strap over your head,

rolling from the inside to outside and away from your body

and discarding it in the appropriate receptacle.

If the apron can be gently pulled away from the body by tearing it

at the neck this process should be used.

Once the apron is off inspect your personal protective equipment

for visible contamination, cuts, or tears.

If you see your personal protective equipment has been compromised or if there are any signs

of contamination disinfect it with an EPA registered disinfectant wipe.

>> Okay, great.

Now disinfect your gloves.

>> You will need to disinfect your outer gloves again

with an EPA registered disinfectant wipe or an alcohol based hand rub.

>> In the next step you're going to remove your outer gloves.

Please do this slowly and carefully to avoid contaminating or tearing your inner gloves.

>> In this example the boots are under the coverall

and are being removed later in the sequence.

However, depending on the personal protective equipment used

at your institution the boot cover may be removed at this point

in the sequence or later on in the sequence.

Now it's time to remove the outer gloves.

There are two very important things to remember.

First, pay special attention so that you don't contaminate or tear the inner glove.

Second, don't snap the gloves which could cause spray.

Hold one of your wrists so that your thumb points up, pinch that glove and lift

at the wrist, then roll it down until the glove is completely off your hand

in a ball in the palm of the other hand.

Then slide a finger down and inside the outer glove on the other hand and pull it off

until it's balled around the first glove.

Dispose of the gloves.

>> Good job.

Now inspect both sides of your inner gloves for visible tears or contamination.

>> If you do see a tear, hole or signs of contamination of the inner gloves disinfect

with an EPA registered disinfectant wipes or alcohol based hand rub.

Then remove the inner gloves making sure not to contaminate your bare hands.

Once the gloves are off perform hand hygiene with alcohol based hand rub on your hands.

Then put on the new set of gloves up to the edge of the coverall sleeve.

>> Okay, great.

Now disinfect your gloves.

>> Now use your EPA registered disinfectant wipes

or alcohol based hand rub to disinfect your gloves.

>> Now you're going to remove your respirator.

The assistant can help you with this.

>> In this step you will take off your [inaudible] respirator.

How you do this will vary from model to model of [inaudible] so you and your assistant will need

to refer to the manufacturer's specifications.

>> The assistant will detach the hose and turn of the system now.

>> Although the specifics will vary, you should do things in this order.

First, the assistant will detach the hose from the hood,

then while the assistant holds the belt unit in his or her hands you will unclasp the belt,

place all reusable [inaudible] components in a designated area

or container for later disinfection.

Next you will take off the hood.

The assistant will stand behind you and grab the outside of the hood.

And roll the hood up towards the top of the shoulders forming a cuff.

When your assistant tells you to do so you will grab the hood near the ears,

bend forward at the waist and pull the hood slowly and methodically down and away

from your head until it's at waist level.

Discard the hood into the trash receptacle.

It's very important that you don't touch your face after removing the hood.

>> Please disinfect your gloves now.

>> Now use your EPA registered disinfectant wipes

or alcohol based hand rub to disinfect your gloves.

>> Next you will remove your coverall.

Start by unzipping it completely and your assistant will help guide you from there.

>> If your coverall has a flap covering the zipper you must gently pull it open.

Then you will need to disinfect your gloves.

Next, tilt your head back and reach for the zipper at the top

of the suit using a mirror to avoid touching the skin.

Grasp the zipper with two fingers of one hand without using the other hand

on the front of the suit and pull down.

Unzip completely.

The assistant may help you unzip the coverall if necessary.

The assistant will stand behind you and grasp the outside of the coverall at the shoulders

and pull it off your body in a downward motion

until the coverall is off your shoulders completely.

The assistant will then reposition his or her hands and roll the suit outward

and down the back in a controlled fashion.

Removing your arms and slowly pulling it down until it's

at your waist being careful not to touch your scrubs or skin.

>> Be sure to move slowly and deliberately to avoid contamination of any exposed surfaces.

>> To get the coverall off the rest of the way, you may need to sit

down in a clean chair which will be marked clearly.

Grab the coverall and pull it away from your body one leg at a time.

Once the coverall is off completely dispose of it.

>> You're doing great.

Now go ahead and disinfect your gloves.

>> Now use our EPA registered disinfectant wipes

or alcohol based hand rub to disinfect your gloves.

>> Next I'd like you to remove your shoe covers.

You can sit down in the chair to make it easier.

>> Sit in the designated clean chair to take off your boot covers only.

Once you sit down be careful not to touch one leg with the other.

Grasp the outside of the boot cover and pull down toward your ankle.

Then lift the boot covers over you heel.

Pull it off your foot and dispose of it correctly.

The exact way to remove the boot cover will vary based on the manufacturer's instructions.

>> You're doing great.

Now go ahead and disinfect your gloves.

>> Now use your EPA registered disinfectant wipes

or alcohol based hand rub to disability your gloves.

>> Please have a seat in the clean chair so that you can disinfect your shoes.

>> To disinfect your shoes sit down in the clean chair.

This will be designated as the clean chair.

Once you're sitting down use the EPA registered disinfectant wipes

to thoroughly disinfect your shoes moving from top to bottom and including the soles.

Be sure not to touch your ankles.

[ Background sounds ]

>> We're getting near the end, you're doing great.

Now disinfect your gloves.

>> Now use your EPA registered disinfectant wipes

or alcohol based hand rub to disability your gloves.

>> Now we're going to remove your inner gloves.

Be careful to do this slowly to avoid tearing the gloves or contaminating your hands.

>> Now it's time to remove the inner gloves.

Like with the outer gloves there are two very important things to remember.

First, pay special attention so that you don't contaminate your hands.

Second, don't snap the gloves which could cause spray.

The process to remove the inner gloves is the same as it was with the outer gloves.

Hold one of your wrists so that your thumb points up.

Pinch that glove and lift at the wrist.

Then roll it down until the glove is completely off in a ball in the palm of the other hand.

Then slide a finger down and inside the glove on the other hand and pull it off

until it's balled around the first glove.

Dispose of the gloves.

Once your gloves are off it is very important that you don't touch your face.

Any exposed skin or any surface in the room.

>> Go ahead and perform hand hygiene.

>> Next perform hand hygiene using alcohol based hand rub on your bare hands.

>> Okay. One more important step.

We need to check for any rips, tears or contaminates on your clothes.

>> Now you, the assistant and your trained observer will do one last inspection

of your scrubs and inner clothing for holes, tears or contaminate.

>> Please hold your hands out to your side and slowly turn around.

>> Congratulations, you've now successfully finished the doffing process.

So you can leave the doffing area.

You need to find the closest designated shower

where you can remove your scrubs and bathe with soap and water.

A shower is recommended at the end of each shift for the comfort of the health care worker.