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  • >> Hi I'm Peter Pronovost, the Johns Hopkins Medicine Senior Vice President

  • for Patient Safety and Quality, and the Director of the Armstrong Institute.

  • One of the most important ways you can keep yourself safe in caring for patients

  • with Ebola is to make sure that you learn to put

  • and take off personal protective equipment in the most appropriate way.

  • Now, the Centers for Disease Control has provided us detailed guidance for how

  • to do that, but we needed training modules so we partnered with the CDC to do that.

  • We pulled together our infectious disease experts, human factors and systems engineers,

  • psychologists, instructional designers, and technology experts

  • to come together to produce this content.

  • We've been here a week working long hours to make modules for you,

  • and now what you'll see are three key modules.

  • Number one, how to put on, or don, personal protective equipment.

  • Number two, how to take off, or doff, personal protective equipment.

  • And number three, how the observer can work together

  • to help ensure your safety using teamwork behaviors that were developed by the Agency

  • for Healthcare Research and Quality.

  • Now, we know these are anxiety filled times.

  • Believe me, I'm a critical care physician, I'm right with you.

  • But we also know that with proper training and when we ensure your competency in putting on

  • and taking off this equipment, we could safely care for these patients.

  • So we hope you enjoy the training and from our colleagues at the Centers for Disease Control

  • and our colleagues at Johns Hopkins Medicine, we thank you for all you do for patients.

  • >> This donning procedure assumes the facility has elected to us an N95 respirator with a gown.

  • An established protocol facilitates training and compliance.

  • Use a trained observer to verify successful compliance with the protocol.

  • The trained observer will read aloud to the healthcare worker each step

  • in the donning procedural checklist, and visually confirm and document

  • that the step has been completed correctly.

  • The trained observer in the donning process is a dedicated individual

  • with the sole responsibility of ensuring adherence to the entire donning procedure.

  • [ Silence ]

  • The donning process is conducted under the guidance and supervision of a trained observer

  • who confirms visually that all personal protective equipment is serviceable

  • and has been donned successfully.

  • The trained observer should suggest to the healthcare worker that he or she attend

  • to personal needs such as using the restroom and hydration prior

  • to donning personal protective equipment.

  • The trained observer uses verbal commands and a written checklist to confirm each step

  • in donning personal protective equipment, and can assist with ensuring

  • and verifying the integrity of the ensemble.

  • No exposed skin or hair should be visible at the conclusion of the donning process.

  • >> We're now going to work together, carefully, to put on your personal protective equipment.

  • I'm going to be here with you.

  • I'm going to help you and guide you.

  • We're going to do everything slowly and methodically.

  • If you have any issues or questions just stop and feel free to ask me whatever you need to.

  • I'm going to give you verbal instructions and you're going to acknowledge them back to me.

  • [ Silence ]

  • >> Before starting the donning procedure change into clean surgical scrubs

  • or provided disposable garments and dedicated washable footwear, such as plastic

  • or rubber materials, in a suitable, clean area.

  • All footwear should be closed toe and closed heel with no holes.

  • No personal items such as jewelry, watches, cellphones, pagers,

  • or pens should be brought into the patient room.

  • Ensure hair is pulled back, away from the face and off the neck and back.

  • Ensure that your nails are no longer than a quarter of an inch

  • so they do not puncture the gloves.

  • [ Silence ]

  • >> Now we're going to look at your PPE to make sure that everything is here and intact.

  • >> Visually inspect the personal protective equipment ensemble to be worn to ensure

  • that it is in serviceable condition, and that all required personal protective equipment

  • and supplies are available, and that the sizes selected are correct

  • for the healthcare provider.

  • The trained observer reviews the donning sequence with the healthcare worker,

  • before the healthcare worker begins the donning process, and reads it to the healthcare worker

  • in a step-by-step fashion using a checklist.

  • [ Silence ]

  • >> First, before any procedure, we need to perform proper hand hygiene.

  • Make sure that you get in between your fingers, the backs of your hands, and your wrist.

  • [ Silence ]

  • >> Now we're going to put on your boot covers.

  • For safety go ahead and sit in the chair and take your time.

  • >> Make sure that all areas of the foot are covered

  • and the boot covers are snug over your ankle and calf.

  • If your boot covers have a strap, wrap the strap around for a comfortable fit.

  • Try not to touch the floor or other areas with your hands while putting the boot cover on.

  • If you do, disinfect your hands before putting your inner gloves on.

  • [ Silence ]

  • >> Now we're going to put on our first pair of gloves.

  • Do this as you normally would.

  • It does not need to be done in a sterile fashion.

  • [ Silence ]

  • >> Make sure that the cuffs of the gloves go as far up your arm as possible.

  • These are going to be called your inner gloves.

  • [ Silence ]

  • >> Now I'm going to want you to put on your gown.

  • Go ahead and look at it to make sure there are no holes or tears.

  • Take your time.

  • Put the gown on slowly and methodically.

  • >> Ensure the gown is sized properly and large enough

  • to allow unrestricted freedom of movement.

  • If available, a gown with thumb hooks helps to secure the cuff of the gown over the inner glove

  • to help ensure there is not a gap between the glove and the cuff.

  • Tie the gown securely, but in a manner that it can be easily untied

  • when you begin the doffing process.

  • Leave some length of the tie so that it can be pulled and untied without much effort.

  • Ensure cuffs of the inner gloves are tucked under the sleeve of the gown.

  • >> We're going to tie the gown on the side, carefully, snug, but not too tight.

  • >> If your gown does not have thumb hooks, some facilities may consider taping the sleeve

  • of the gown over the inner glove to prevent potential skin exposure from separation

  • between the sleeve and inner glove during activity.

  • If taping is used a tab should be created by folding the tape over at the end.

  • This tab will help facilitate easy removal during the doffing process.

  • Care must be taken to remove tape gently.

  • Experience from some facilities suggests that taping may increase risk

  • by making the doffing process more difficult.

  • [ Silence ]

  • >> Now we're going to go ahead and put on the N95 respirator.

  • >> Hold the respirator in the palm of your hand with the straps facing the floor.

  • Place the N95 respirator on your face, covering your nose and mouth.

  • Pull the bottom strap up and over the top of your head,

  • and put it behind your head below your ears.

  • Take the upper strap and put it behind your head towards the crown of your head.

  • Mold the nose piece of the respirator over the bridge of your nose to obtain a tight seal.

  • Always follow the manufacturer's instructions for wearing a respirator.

  • Perform a fit check to ensure there is a good seal against the skin.

  • [ Silence ]

  • >> Now you're going to put on your surgical hood.

  • First you need to inspect it.

  • [ Silence ]

  • >> You're going to put on the surgical hood so that the opening is in the front.

  • Slowly pull the hood over your head and your shoulders.

  • >> The trained observer should give a check once the hood is in place to ensure that all parts

  • of the skin are covered, no hair is hanging down, and the hood extends to the shoulders.

  • [ Silence ]

  • >> If the patient is vomiting or has diarrhea, put on a single use, fluid resistant,

  • or impermeable apron that covers the torso to the level of the mid-calf.

  • The apron provides an additional layer of protection to the front of the body

  • against exposure to body fluids or excrement from the patient.

  • [ Silence ]

  • >> Now you're going to put on your outer gloves.

  • If you need help with this, just let me know.

  • >> Double gloving provides an extra layer of safety during direct patient care

  • and during the personal protective equipment removal process.

  • >> When putting on these gloves make sure that the cuffs extend as far up your arm as possible

  • and are over the cuff of your gown.

  • >> Some facilities have found that using different colored gloves

  • for the outer gloves is beneficial.

  • Utilizing different colored gloves for each layer helps

  • to rapidly identify any breaches in glove integrity.

  • [ Silence ]

  • >> Next you're going to put on your face shield.

  • Do this by placing the elastic strap behind your head,

  • making sure that the foam is resting on your forehead.

  • >> 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.

  • [ Silence ]

  • >> Can you please hold your arms out to your side and turn around for me?

  • I'm going to check to make sure that all of your skin is covered

  • and you are able to move comfortably.

  • >> The healthcare worker should be comfortable, and able to extend the arms, bend at the waist,

  • and go through a range of motions to ensure there is sufficient range

  • of movement while all areas of the body remain covered.

  • A mirror in the room can be useful

  • for the healthcare worker while donning personal protective equipment.

  • >> Okay. Everything looks great!

>> Hi I'm Peter Pronovost, the Johns Hopkins Medicine Senior Vice President

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