A Nurse's Checklist For Donning and Doffing Procedures
Written by Julia Tortorice
In a continued effort to keep nurses safe when treating patients with Ebola, the Center for Disease Control recently updated their personal protective equipment procedures.
The CDC’s update covers the topic in great detail, including recommended administrative and environmental controls for healthcare facilities, training, and proper storage of equipment, but we’re going to focus specifically on the practice of Donning and Doffing.
Why We Don & Doff
Personal Protective Equipment (PPE) sort of looks like you’re preparing to walk on the moon—your head is covered with a helmet of sorts with a clear panel in the front so you can see and your body is covered, in most cases from head to toe. Funny looks aside, PPE is critical when dealing with Ebola, considering the fact that it’s spread through direct contact. If the virus comes in contact with broken skin or mucous membranes, including the eyes, nose or mouth, a nurse can become infected just like that. If an Ebola patient is on the premises, it’s a safe bet that nurses will be working extremely close to him or her, so PPE is really about keeping nurses safe so they can do their jobs effectively.
Before Using PPE Procedures
Before nurses interact with Ebola patients, it’s important that that she or he goes through extensive training of personal protective equipment procedures. Donning, the act of putting on protective equipment, and doffing, the act of removing the protective equipment, has to be done in separate, designated areas of the hospital. Nurses need to be able to don and doff without any distractions or interruptions. Each time it’s done, a trained observer should be watching the process closely to ensure that every precaution is taken.
CDC Recommended Equipment for PPE
PAPR (Powered Air Purifying Respirators) or N95 Respirator- A PAPR has a full face shield headpiece or helmet. It must be used with a disposable hood that covers the shoulders and neck. N95 Respirators are used with a disposable hood and a disposable, single use full face shield.
Single-use (disposable) Fluid-Resistant or Impermeable gown – Extends to at least mid-calf. Coveralls with or without integrated socks can be used.
Single-use (disposable) nitrile examination gloves with extended cuffs – CDC advises that two pair be worn.
Single-use (disposable), fluid-resistant or impermeable boot covers – Should extend to mid-calf and allow for ease of movement.
Single-use (disposable), fluid-resistant or impermeable apron – These should cover areas from the torso to mid-calf, to be used if Ebola patients have vomiting or diarrhea.
The Donning Procedure Shortlist:
Have trained observer present to be your second set of eyes
Remove clothing/personal items
Inspect equipment to ensure its not compromised before putting it on
Perform hand hygiene, put on inner gloves and boot or shoe covers
Put on a gown or coverall, then put on outer gloves
Put on a respirator and an apron
Verify the integrity of your ensemble with the trained observer on hand
Disinfect outer gloves before coming into contact with patient
The Doffing Procedure Shortlist:
Have trained observer to guide you through PPE removal
Inspect PPE for visible contamination (including blood, bodily fluids), cuts, tears before removal
Use EPA registered disinfecting spray if any contamination occurred
Disinfect the outer gloves and remove apron if one was used
Remove boot/shoe covers and re-disinfect outer gloves before removing them.
Inspect and disinfect inner glove
Remove respirator and disposable hood
Disinfect inner gloves and remove headpiece, tubing and other associated pieces of PPE (like a belt or battery pack), with assistance from trained observer, if needed
Remove your gown, disinfect gloves and disinfect shoes
Disinfect gloves and remove them
Perform hand hygiene and complete a final inspection with the trained observer to make sure no traces of infection were missed
Nurse can leave the PPE removal area wearing scrubs, showers recommended at the end of each shift