Personal Protection Equipment (PPE)
Removing PPE order
1.) Gloves 2.) Eyewear/Goggles 3.) Gown 4.) Mask
Applying PPE order
1.) Gown 2.) Mask/Respirator 3.) Eyewear/Goggles 4.) Gloves
What will the nurse do first when preparing to apply personal protective equipment (PPE) before caring for a patient in isolation? A. Perform hand hygiene B. Put on the gown C. Put on clean gloves D. Apply eyewear
A. Perform hand hygiene Before applying PPE, the nurse should perform hand hygiene.
Where PPE when
Anticipated patient interaction indicates that contact with blood or bodily fluids may occur.
Assessment and Preparation
Assess the need for personal protective equipment (PPE) for each task you plan to perform and for all patients, regardless of their diagnoses. Review the patient's medical history for possible indications for isolation, for example, risk factors for TB, major draining wound, or purulent productive cough. Review laboratory test results. Consider the types of care measures you will perform while in the patient's room, such as medication administration or a dressing change. Review the nursing care plan and notes, or confer with colleagues regarding the patient's emotional state and his or her reaction and adjustment to being in isolation. Determine from the nursing care plan, medical record, or significant other if the patient and the family understand the purpose of isolation procedures.
The nurse is discussing the guidelines for proper use of PPE by nursing assistive personnel (NAP). Which statement made by the NAP requires follow-up by the nurse? A. "When in doubt, I wear gloves." B. "I really dislike wearing a mask, so it's the first thing I take off." C. "I always do hand hygiene when entering and leaving a patient's room." D. "I wear a mask whenever I am caring for a patient who's coughing."
B. "I really dislike wearing a mask, so it's the first thing I take off." Statement B requires follow-up because the gloves should be removed first when removing PPE, to minimize the chance of contaminating both the mask and the face. The remaining are appropriate statements and require no follow-up.
When delegating patient care that requires nursing assistive personnel (NAP) to use personal protective equipment (PPE), it is necessary for the nurse to do what first? A. Discuss what equipment and supplies to bring to the patient's room B. Document that the care was delegated to the NAP C. Review the patient's need for a specific isolation precaution D. Observe the NAP donning the appropriate PPE
C. Review the patient's need for a specific isolation precaution A first action the nurse will do is review with the assistive nursing personnel (NAP) the patient need for a specific isolation precaution and the necessary personal protective equipment (PPE). The nurse will review with the NAP what equipment and supplies to bring into the patient's room, but this will not be her first action. Documentation is not usually required. Observation is not necessary unless the nurse has sufficient doubt regarding the NAP's ability to select the appropriate PPE or execute the precautions.
When removing a gown worn as personal protective equipment (PPE) while caring for a patient in isolation, why does the nurse avoid touching the outside of the gown? A. To ensure that the gown can be reused B. To protect the nurse's uniform C. To prevent touching contaminated material with unprotected hands D. To fold the gown correctly for reuse by the same nurse
C. To prevent touching contaminated material with unprotected hands The nurse will avoid touching the outside of the gown to ensure that an ungloved hand does not touch the contaminated gown. Whether the gown is discarded or washed and reused is irrelevant. Precaution is not observed to protect the nurse's uniform. If the gown is to be reused, even by the same nurse, it must be washed first; folding after use is therefore unnecessary.
Pediatric Considerations
Children may be afraid of health care team members wearing masks. Drawing a smiling face on a face mask may decrease their fear.
Which personal protective equipment (PPE) will the nurse wear if there is a risk of a blood splash when caring for a patient? A. Gown B. Gown and gloves C. Gown, gloves, and mask D. Gown, gloves, mask, and eye protection
D. Gown, gloves, mask, and eye protection Wearing a gown, gloves, mask, and eye protection is the correct PPE to don. The eyes must be protected if there is risk of a blood splash. Wearing a gown is not enough personal protection in the event of a blood splash.
Documentation
Document any procedures performed and the patient's response to social isolation. Also document any patient education performed or reinforced. Document unexpected outcomes and related nursing interventions.
Removing PPE
First remove your gloves. Remove the first glove by grasping the cuff and pulling the glove inside out, over your hand. Hold the glove you've removed in your gloved hand. Slide the fingers of your ungloved hand under the remaining glove at the level of your wrist. Peel the glove off over the first glove. Then discard both gloves in the proper container. Remove your eye wear, face shield, or goggles. Handle the item by its headband or earpieces. The clear faceplate of a face shield may become contaminated with droplets; therefore, avoid touching the faceplate.6 Discard the item in the proper container. Remove the gown by first untying the neck strings and then untying the back strings. Allow the gown to fall from your shoulders; touch the inside of the gown only. Remove your hands from the gown sleeves without touching the outside of the gown. Hold the gown inside at the shoulder seams, and fold the gown inside out into a bundle; discard it in the linen bag. Remove your mask. If the mask is secured over your ears, remove the elastic from your ears and pull the mask away from your face. For a tie-on mask, untie the bottom string and then the top strings before pulling the mask away from your face. Then drop the used mask into the trash receptacle, being careful not to touch the outer surface of the mask.Note: for patients who are under airborne precautions, the mask or respirator should be removed outside of the patient's room for your protection. Perform hand hygiene.
Home care considerations
Instruct the patient and family about the specifics of when to apply cap, mask, and protective eyewear in the home. Determine ability of family caregiver to safely implement sterile procedure. Describe the signs and symptoms of infection to the patient and family; instruct them to report signs and symptoms of infection to the practitioner.
Place patients that require airborne isolation in a
Negative pressure airborne infection isolation room (AIIR)
Applying PPE
Prepare to enter the isolation room. Your choice of barrier protection will depend on the type of isolation the patient has been prescribed and on your agency's policy. For example, if Airborne Precautions are being observed for the patient, apply only a special mask and keep the room door closed. Apply a gown, making sure it covers all of your outer garments. Pull the sleeves down to the wrist, and tie the gown securely at the neck and waist. Apply either a surgical mask or a fitted respirator around your mouth and nose. The type of mask and fit-testing will depend on the type of isolation the patient has been prescribed and on your agency's policy. You must have a medical evaluation and be fit-tested before using a respirator. If eye wear or goggles are needed, fit them snugly around your face and eyes. If you wear prescription glasses, you may use a face shield. Apply clean gloves that are unpowdered. If you or the patient has a latex allergy, the gloves should be latex free. Bring the cuffs of the gloves cuffs down over the edge of the gown sleeves.
_______________________________ between patient care encounters and when moving from a contaminated site to a clean one.
Remove gloves and perform hand hygiene
Wash hands or use ABHR immediately after
Removing PPE
Delegation
The skill of caring for patients under isolation precautions can be delegated to nursing assistive personnel (NAP). However, you must first assess the patient's status and isolation indications. Be sure to inform NAP of the following: Special precautions regarding individual patient needs, such as transportation to diagnostic tests. Precautions about bringing equipment into the patient's room. High-risk factors for infection transmission that pertain to the assigned patient.
When there is a risk of excessive soiling
Wear a gown that is impervious to moisture
It may be agency policy for a nurse to wear a mask while accessing
an implanted venous access device or inserting a peripherally inserted central catheter (PICC).
Health care team members with symptoms of a cold or respiratory infection should either
avoid participating in a procedure or don a mask.
When performing bedside procedures, such as dressing changes for patients with burns...
caps should be worn to contain the hair.
Patient and family education
ducate family members on when and how to apply don and doff a cap, mask, and protective eyewear eye protection, if needed. Encourage questions and answer them as they arise.
If hands become contaminated while removing any article of PPE
hands should be washed before removing the next article.
The health care team member should wear a mask when caring for
immunosuppressed patients, patients with open wounds, or patients on isolation precautions when those precautions require covering the nose and mouth.
Wear gloves when
it is likely that you will touch blood, bodily fluids, secretions, excretions, nonintact skin, mucous membranes or contaminated items or surfaces.
Eye protection, such as goggles or a face shield,
protect the membranes of the eyes, nose, and mouth when performing tasks that could generate splashes or sprays of blood or other bodily fluids.
Hand hygiene must be performed after __________________ and before _______________________.
removal of PPE Contact with subsequent patients
Verify the health care provider's orders to determine
which isolation precautions need to be used (i.e., contact, droplet, airborne, etc.)