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  • >> Hi, I'm Peter Pronovost the John 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 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.

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

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