Best Way To Donn (Wearing) And Doff (Putting Off) PPE

Personal protective equipment

Donning (wearing) and doffing (putting off) of personal protective equipment (PPE) is not the concern of many Nigerians. They are only concerned with how to use facemask. To them, that is the concern of front line staff fighting covid-19. That is true. However, it is not only the concern of front line staff in the fight against covid-19 that is used in hard hit countries. Community pharmacies and their staff have learned to use them as they tend to protect themselves. So it is good to learn how to use a PPE as a health care worker. Because you do not know when it may be necessary when we consider the rate at which the infection is spreading. It may get to that level soon.

Most PPE are disposable. Especially the gown and the gloves. Some facemask, boots and goggles are reusable. The proper use of the PPE ensures health care workers are safe. Most of the health care workers that got infected confess that they did not know the proper way to use the PPE. That makes it very important. Wrong use of the PPE is as dangerous as living with a covid-19 patient.

There are three important processes. Donning, use and doffing. Any stage that fails to meet the proper criteria is a sign of danger. However, donning is the least of the worries. Use and doffing is the major point health care workers get caught up with covid-19.

PPE

Choose the right size of all the PPE. Using the wrong size can affect your workflow. Also, choose the right place to wear them. It is always outside the ward or patient room.
Read Also: How pharmacist can protect themselves and their staffs against covid-19

A full PPE consists of a gown that the sleeves reach the wrist and legs, a boot, gloves, goggles, face shield and facemask.

PPE

Donning (Wearing) PPE

The hand gloves are the last thing to wear. First thing is to practice hand hygiene. Wash the hands with soap and water. If it is not available, use an alcohol based hand sanitizer. Place the boot on top of a chair. Take your legs off your shoe and insert it into the boot. Do the same to the other leg. For boots with lace, tie it very well.

Wear the gown. For some with hooks at the finger, fix it to the right finger. Most come with a hock at the thumb finger. This prevents the gown from slipping into the hand gloves during use. Take hands backwards to make a bow with the roles attached. Tie it properly but make it easy to lose. Some have two ropes. Tie them.
Drop the face or head shield from the top to cover the head down to the shoulder.
Put on a full face shield over the N95 respirator and surgical hood to provide additional protection to the front and sides of the face, including skin and eyes. Bending forward, hold on to the face shield with both hands, expand the elastic with your thumbs and place the elastic behind your head, so that the foam rests on your forehead. Once the shield is situated, check to make sure it covers the front and sides of the face and no areas are left uncovered...CDC guide.

Facemask comes next. The type of design will determine the method to wear it. However, make sure it covers nose and mouth. For ties, secure it with a bow at the back. For those with two ties, secure the lower one at the top of the head and the upper one at the bottom of the neck. Same thing too with band styles. Ear loops are easy to use. Some come with a single tie or band. Just send it to the back of the head. For ladies with heads, ensure that the tie and band do not hang on the hair. This will help to prevent it from slipping off and making the facemask untight during use..

To double check, exhale out deeply and feel the sides air escape out. It must not be by the front. If it is a facemask with an exhalation vent, air must not escape through any other means.

Apply goggles to the face. Use the rope to secure it. It is best if the goggles rest on the facemask. Some prefer to use their medical eyeglasses. They can use it provided they are ready to disinfect it after usage.
Both the facemask and the goggles band hell to hold the face or head shield in place.
Time to wear the hand gloves. Pretty easy.

Use Of PPE

During use, avoid touching surfaces. This helps to reduce contaminating the hand gloves and reduce risk of infection. Also, avoid touching your PPE. If any of the PPE gets damaged, leave the ward immediately for a change. This can happen when the gown is torn by a sharp object or goggles break due to an accident.

Doffing (Putting off) PPE

This is the most complicated of all the situations. This is where most health staff make mistakes. One thing is that PPE should be removed in the ward or in a corner approved for that. The only exception is the facemask. Facemask I'd the last thing to remove.

Assume that some part of the PPE has been contaminated. Those places must never be touched with bare hands. They are the front of the gown, the outside of the hand gloves, the front of the face shield, the front and under of the boot, the facemask and goggles. Parts that are not contaminated are the rope and back of the gown, the rope of the facemask, the rope of the goggle, the tip of the boot at the back, back of the face shield, and the inside of the hand gloves.

To begin with, take off the hand gloves. It is technical. It needs practice. First is to use two fingers from one hand to grab the palm area of the hand glove of the other hand. Peel it off. Hold the peel off hand glove in the other hand with gloves. Now insert one or two fingers from the naked hand into the inside of the hand glove on the other hand through the wrist region still holding the first hand glove. Do this without touching the surface. Pull along the hand until all the hand gloves come out. Drop them into the waste bin. If your hand touches the outside of the hand gloves during this process, practice hand hygiene before proceeding to the next stage.
Read Also: Meaning Of Terms And Jargons Use During Covid-19

To remove the gown, take your hands to the back and avoid touching the front. Loosen the ties. Slide your hands into the sleeve of the gown inside without touching the outside. Technically pull out of your body and towards your hands. Towards the end, fold it inside out before rolling it together into a bundle. This helps to prevent touching inside of the gown.

There is another technique that can be used to remove it safely. The gown and hand gloves can be removed together. The front is contaminated. But you can touch it with your hand glove on. With the hand glove, loosen the ties and hold the front of the gown. Pull away from your body. Towards the end of the hand, turn it inside out. Fold and roll the gown into the arm. Hold the inside of the gown and use the inside of the gown to pull the hand gloves out of the hands. Leave the hand gloves inside the gown and dispose of it immediately.

Put legs on a dirty chair and hold the back top of the boot to pull it down. Put legs into a clean shoe. Do the same to the second leg.

Hold the rope of the goggle and bring it forward. If it is reusable, place it in a place for reprocessing.

Leave the ward to an approved place or outside. Take out the facemask. Do not touch the mask. Use the rope or tie and drop it on a disposable bin of it is not reusable.
For the face shield, pull away from the back. Slide your finger into the back and pull. Dispose off.
Practice hand hygiene by washing your hands with water and soap or use alcohol base hand sanitizer. Some hospital have a disinfectant in place for all those coming out of the ward. They are sprayed the disinfectant before going home.

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