Title Page
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Select Patient Encounter Risk
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Employee
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Donning Time
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Donning Vitals
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Doffing Time
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Doffing Vitals
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Date
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Location
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Patient Encounter Risks:
• Lower Risk – no direct or potential direct contact with the patient’s blood or bodily fluids (e.g., sweat, vomit, feces, urine) and/or contact with linens, objects and environmental surfaces contaminated with the patient’s blood or bodily fluids. No participation in aerosol-generating medical procedures (e.g., endotracheal intubation, airway suctioning, bronchoscopy, aerosolized or nebulized medication administration, etc.). Patient is in early, mildly symptomatic stage of illness when virus levels are low.
• Higher Risk – direct or potential direct contact with the patient’s blood or bodily fluids (e.g., sweat, vomit, feces, urine), processing of laboratory specimens, and/or contact with linens, objects and environmental surfaces contaminated with the patient’s blood or bodily fluids. Also includes participation in aerosol-generating medical procedures (e.g., endotracheal intubation, airway suctioning, bronchoscopy, aerosolized or nebulized medication administration, etc.). Patient is in a later stage of illness, significantly symptomatic, when virus levels are high. -
Select Patient Encounter Risk
Checklist for Donning and Doffing Personal Protective Equipment (PPE) - Low Risk
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The goal in using this PPE is that no skin or mucous membranes be exposed while caring for a patient.
PPE for the trained monitor and assistant is, at minimum, the same as that required for lower-risk encounters. If the monitor and assistant assumes duties of staff wearing PPE for higher-risk encounters (e.g., nursing shift change), then the monitor/assistant must wear PPE for higher-risk encounters.
Pre-donning: (with a trained monitor, a separate health care worker who is well-trained in Ebola PPE can be used as an assistant in donning/doffing of PPE)
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Staff should be in surgical scrubs or disposable garments and have dedicated plastic or rubber footwear that can be disinfected.
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If staff wear glasses, they should be secured with a tie.
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Visually inspect PPE before donning to ensure that it is in serviceable condition, all required PPE supplies are available, and the sizes selected.
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Verify the size of the coverall suit is correct for your use.
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Staff should use the bathroom prior to donning PPE.
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Complete an equipment inventory.
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Verify the size of the coverall suit is correct for your use.
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Perform a vitals health check and record on this checklist.
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Remove all jewelry and watches.
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Long hair should be pulled back and secured using a hair net or hair band.
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Hydrate with at least a few ounces of water.
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Wash hands with soap and water or use hand sanitizer.
Donning: (with a trained monitor, a separate health care worker who is well-trained in Ebola PPE can be used as an assistant in donning/doffing of PPE)
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Be seated and pull on the shoe cover booties.
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Don the inner nitrile gloves.
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Put on the coverall suit, and zip to mid chest. The coverall must be large enough for unrestricted movement.
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Be sure the cuffs are over the inner gloves.
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The N-95 face mask is then donned as it will need to stay in place under the hood.
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Pull the hood up over the head and zip the coverall suit fully. If any skin is still exposed, an additional separate hood should be used.
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At this point, an optional outer plastic apron can be worn and tied by your monitor.
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Put on the outer nitrile gloves, pulling the glove over the cuffs of the coverall. Taping the outer gloves to the cuffs is optional.
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The full face shield should then be donned and adjusted for fit.
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With assistance, stretch to ensure the fit of the garments and gloves by reaching up and over the head and to the left and right.
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If your gloves have moved, tape the outer gloves to the cuffs of the coverall. Leave a tab for tape removal later.
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Record the time and complete the safety checklist of the PPE with your monitor
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Remember, while using PPE:
• Keep gloved hands away from face.
• Avoid touching or adjusting the PPE.
• Limit surfaces and items touched.
• Seek immediate assistance if any part of gloves, coverall or detachable hood becomes torn.
Doffing: (with a trained monitor, a separate health care worker who is well-trained in Ebola PPE can be used as an assistant in donning/doffing of PPE)
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• The removal of PPE using the appropriate methods is critical to preventing exposure from occurring.
• Remember, in general, the outside and sleeves of the coverall suit, the outside of the additional hood, and the external gloves are considered “contaminated,” regardless of whether there is visible soil.
• The areas considered “clean” that can be touched when removing PPE include inside the gloves, inside of the coverall suit and the inside of the additional hood. -
Have a monitor in place with appropriate protective equipment to observe your doffing process. If needed, a separate health care worker who is well-trained in Ebola PPE can be used as an assistant in donning/doffing of PPE. You will need a seat to complete the doffing.
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Using *bleach wipes*, clean the outer gloves.
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Then, using *bleach wipes* and starting at the top, wipe the full face shield, the additional hood, and the coverall suit.
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Using *bleach wipes*, again, clean the outer gloves.
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Remove plastic apron and disinfect outer gloves with *bleach wipes*.
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Remove outer gloves and place along with the bleach wipes in the biohazard bag
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Using *bleach wipes*, again, clean the inner gloves.
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Remove the face shield, lifting up and to the front, and hand to your monitor for further disinfection.
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Using *bleach wipes* again, to clean the inner gloves.
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Then, grasping at the top of the head, gently pull the additional hood up and to the front, away from your head, and place the hood into the biohazard bag.
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Then use *bleach wipes* to again clean the inner gloves.
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Unzip and carefully remove the coverall suit, starting at the neckline, folding and rolling inside out, away from the body and down to the ankles.
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Be careful that your gloved hands touch only the inside of the suit.
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Sit down.
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While seated, continue to roll the suit down and away from your shoes. The outer shoe cover booties will stay on the suit to be thrown away with the coverall. Place the suit and booties into the biohazard bag.
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Use *bleach wipes* to clean the inner gloves again.
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Remove the N-95 mask and place in the biohazard bag.
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Use *bleach wipes* again, clean the internal gloves again.
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Slowly remove the inner gloves using the glove-in-glove technique and place into the biohazard bag.
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Use hand sanitizer immediately, followed by hand washing with soap and water.
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Rehydrate, then take and record vitals and the time on your safety checklist.
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*In place of bleach wipes, other disinfectant wipes approved by the hospital and PPE manufacturer may be used providing they are labeled as a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus).
Checklist for Donning and Doffing Personal Protective Equipment (PPE) - Long Duration-Higher Risk
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The goal in using this PPE is that no skin or mucous membranes be exposed while caring for a patient. PPE for the trained monitor and assistant is at minimum of that required for lower-risk encounters. If the monitor and assistant assumes duties of staff wearing PPE for higher-risk encounters (e.g., nursing shift change), then the monitor and assistant must wear PPE for higher-risk encounters.
Pre-donning
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Staff should be in surgical scrubs or disposable garments and have dedicated plastic or rubber footwear that can be disinfected.
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Complete an equipment inventory and verify that the PAPR has a fully charged battery and perform an airflow check (per manufacturer’s recommendations).
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Visually inspect PPE before donning to ensure that it is in serviceable condition, all required PPE supplies are available, and the sizes selected.
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Verify the size of the coverall suit is correct for your use.
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If staff wear glasses, they should be secured with a tie.
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Perform a vitals health check and record on this checklist.
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Remove all jewelry and watches.
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Long hair should be pulled back and secured using a hair net or hair band.
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Hydrate with at least a few ounces of water.
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Wash hands with soap and water
Donning: (with a trained monitor)
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Put on the internal shoe cover booties that cover the lower leg.
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Put on the inner nitrile gloves.
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The coverall is a full-body, bonded-seam impermeable suit, with a hood and booties attached.
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Step into the coverall suit and zip up to waist level.
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While seated, put on external shoe cover booties and tape to the coverall suit, folding over the end of the tape to create a tab for removal later. Pre-cutting measured strips of tape will speed the donning process.
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Pull the coveralls onto your upper body and arms, zipping above the waist
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Pull the cuffs down over the gloves.
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Have your assistant tuck the coverall hood inside the neck of the coverall suit.
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Your assistant should assist in securing the vinyl PAPR belt with the battery pack against the small of your back and adjust the belt for a secure fit.
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Your assistant can now attach the air tube to the battery pack and the hood.
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Power on the battery pack.
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Don the hood, holding the outer layer of the cowl up. Your assistant can now tuck the inner layer of the cowl inside the neck of the coverall suit.
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The outer layer can now be lowered. Air should be comfortably flowing into the hood.
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Zip up the coverall suit fully and, starting at the bottom of the zipper, pull away the strip covering the built-in adhesive on the flap and seal the flap against the coverall.
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Don the outer nitrile gloves, over the cuffs of the coverall suit, and tape to the coveralls, leaving a tab for tape removal later.
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Your assistant can now place the plastic apron over the hood (over the PAPR tubing) and tie it in the back, over the PAPR tubing.
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To ensure the fit of the equipment and tape, stretch first by squatting, then place one knee to the ground, and with hands stretched up and over head, lean to both the right and left.
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Your assistant should record the time on this safety checklist.
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Remember, while using PPE:
• Keep gloved hands away from face.
• Avoid touching or adjusting the PPE.
• Limit surfaces and items touched.
• Seek immediate assistance if any part of gloves or coverall becomes torn.
Doffing: (with a trained monitor, a separate health care worker who is well-trained in Ebola PPE is used as an assistant in donning/doffing of PPE)
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Remember, in general, the outside and sleeves of the coveralls and outside front of the PAPR hood, and the external gloves are considered “contaminated,” regardless of whether there is visible soil.
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The areas considered “clean” that can be touched when removing PPE include inside the gloves, inside of the coverall suit and the inside of the PAPR hood.
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The PAPR hood should always be removed outside the patient room, after the door is closed.
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The most contaminated garments are the apron, the outer gloves and the outer shoe cover booties, so they will be removed inside the patient’s room.
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Inspect the PPE to assess for contamination, cuts or tears before starting to remove. If any PPE is visibly contaminated, then clean and disinfect using *bleach wipes*.
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Use *bleach wipes* to clean the outer gloves.
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Using both hands on one side of the neck ring of the apron, gently pull to break the neck ring and fold down the upper part of the apron; then using the same motion, break the back tie on the same side and pull the apron away. Place the apron in biohazard bag inside the patient’s room.
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After removal of the apron, inspect the PPE to assess for contamination, cuts or tears before starting to remove. If any PPE is visibly contaminated, then clean and disinfect using *bleach wipes*.
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Use *bleach wipes* to clean the outer gloves.
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Remove the outer shoe cover booties.
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Use *bleach wipes* once more to clean the outer gloves. Remove the tape and gloves, using glove-in glove technique and dispose of in the biohazard bag inside the patient’s room.
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Using *bleach wipes*, clean the inner gloves.
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Directly outside of the patient’s door, a tub lined with a biohazard bag should be stationed along with your monitor and assistant, who are also in appropriate PPE.
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Step directly into the tub with the biohazard bag, keeping your arms close to your sides over the bag.
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Your assistant should use *bleach wipes* on both your gloves and their gloves.
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All disposable items should be dropped directly into the biohazard bag in the tub.
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Keeping the PAPR powered on, your assistant should then remove the vinyl PAPR belt and place the battery pack onto a stable surface.
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Using *bleach wipes*, clean the inner gloves.
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The assistant will then clean the exterior of the battery pack, belt and tubing thoroughly with *bleach wipes*, not allowing the tubing to come in contact with the coverall suit and being careful not to get the battery pack and inlet/outlet ports wet with the bleach solution.
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Using *bleach wipes*, the assistant should clean their gloves.
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Your assistant should then roll the outer layer of the PAPR hood up, first in the back and then the front.
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You can use a mirror in addition to your assistant to avoid contaminating the skin or inner garments. Then unzip the coverall suit and, starting at the neck, assist with removal by folding and rolling the suit inside out, away from the body, pushing down to the ankles into the bottom of the tub.
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Once the coverall suit is pushed down as far as it will go, use *bleach wipes* to clean both persons’ gloves.
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Next, with the assistant holding the coverall suit down into the tub, carefully step out of the tub onto the floor, being careful not to touch the inside of the biohazard bag.
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Use *bleach wipes* to clean both of your gloves once more.
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You can now remove the internal shoe cover booties and place in the biohazard bag.
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Disinfect washable shoes using *bleach wipes*.
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Using *bleach wipes*, clean the inner gloves.
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You can now remove the hood using an up and over motion to the back. Your assistant then can take the hood, remove the air tube and place it into the tub.
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Both individuals should *bleach wipe* their gloves again.
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Your assistant can then switch off the PAPR, and disconnect the air tubing from the battery pack.
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Using *bleach wipes*, clean your gloves once more.
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Remove the inner gloves using the glove-in glove technique and place into the biohazard bag in the tub.
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Your assistant should then seal and dispose of the biohazard bag and attend to the reusable items.
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Use hand sanitizer immediately, followed by hand washing.
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Rehydrate, then take and record vitals and the time on your safety checklist.
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Proceed to the shower.
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*In place of bleach wipes, other disinfectant wipes approved by the hospital and PPE manufacturer may be used providing they are labeled as a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus).
Completion
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Additional Comments
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