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 on

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 will see are three key modules; number 1 how to put on

or don personal protective equipment; number 2 how to take off

or doff personal protective equipment, and number 3 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 use a powered air purifying respirator or PAPR and a coverall.

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 provider 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 a sole responsibility

of ensuring adherence to the entire donning process.

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 the healthcare provider 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 and tell you how to put everything on properly.

I am here to keep you safe.

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.

>> 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, cell phones, pagers,

pens should be brought into patient room.

>> The first thing I need you to do is remove any jewelry, earings, rings, watches,

anything that might be around your neck or waist.

Please make sure that you also don't have your ID badge on

or pens or cell phones in your pocket.

Let's make sure that your hair is pulled back off of you face

and also off of your neck and back.

[ Silence ]

Let's take a look at your equipment and make sure that everything is intact.

>> Visual inspect of 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 worker.

Some PAPR models are self-contained.

It is important to follow the manufactures instructions carefully

for the specific PAPR model you are using.

Test the PAPR to ensure the battery is fully charged and the airflow is working properly.

Visually inspect the PAPR hood to ensure there are not cracks

in the face shield and the hood is intact.

The trained observers reviews the donning sequence

with the healthcare provider before the healthcare provider begins the donning process

and reads it to the healthcare provider in a step-by-step fashion using a check list.

>> Do you see any problems with your equipment?

No? Great.

[ Silence ]

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

Go ahead and use the alcohol-based hand rub, make sure that you get in between your fingers,

the backs of your hands, and you wrists.

Great, now make sure that your hands are completely dry before we move to the next step.

[ Background Sounds ]

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 covers on;

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

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

Do this as you normally would, it does not need to done in a sterile fashion.

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

[ Silence ]

Now you're going to put on your coverall, please inspect it

and make sure there are no holes or tears.

Take your time; put the coverall on slowly and methodically.

>> If available, coveralls with thumb hooks helps secure the cuffs of the gown

over the inner glove to help ensure there's not a gap

between the glove and cuff of the coverall.

Put on your coverall with the zipper in the front.

Pull up the zipper completely, ensure the coverall is large enough

to allow unrestricted freedom of movement.

Ensure cuffs of inner gloves are tucked under the sleeve of the coverall,

if a coverall with thumb hooks is not used facilities may consider taping the sleeve

of the coverall 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 ]

Attach the hose to the PAPR battery pack and filter.

The trained observer will hold the respirator at the small of the back while you fasten the belt

around your waist snuggly and secure any loose straps.

The PAPR battery pack and filter unit should be on the outside

of the gown to ensure proper airflow.

[ Silence ]

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

If you need help with this just let me know.

>> Put on the second pair of gloves with extended cuffs.

Some facilities may choose to use outer gloves of a different color

to easily identify rips or tears.

Ensure the cuffs are pulled up and over the sleeves of the coverall.

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

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

and during the personal protective equipment removal process.

Put on the single-use PAPR hood so that it fully covers the neck and extends over the shoulders.

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

>> Be sure that the hood covers the head and all of the hair, neck,

and ears and that it extends past the neck to shoulders.

The trained observer will turn on the PAPR and attach the PAPR blower tube to the PAPR hood

and make sure that the tube is snapped and fits.

If a PAPR unit should stop during patient care you must leave the patient area immediately.

The trained observer should do a final check that all areas are covered

and no hair is protruding from the hood.

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.

After completely the donning process,

the integrity of the ensemble is verified by the trained observer.

>> I'm going to check to make sure that you comfortably able to move with this equipment on.

>> The healthcare provider 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

which all areas of the body remain covered.

The healthcare provider should have an unobstructed field of vision through the hood.

A mirror in the room can be a useful tool

for the healthcare provider while donning personal protective equipment;

when moving in the PAPR equipment, be sure to move slowly.

>> Okay, everything looks great.