A Nurse's Checklist For Donning and Doffing Procedures

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

For a more in depth look at the donning, doffing and PPE procedures, visit the Centers for Disease Control at http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html