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>> Hi, 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 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 pull together out infectious disease experts, human factors and system injures, 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.
>> In this video, you will learn how to doff or remove your personal protective equipment
in accordance with CDC protocols.
Following the doffing protocol will minimize the risk for disease transmission.
So it's very important that you understand all of the steps.
Before you move to the patient's room and into the doffing area,
you will need to take a few minutes to do some important things.
First, get the attention of the trained observer.
Once he or she signals to you that it's clear, enter the doffing area.
Inspect your personal protective equipment.
Are there any obvious signs of contamination or materials on it?
If so, you will need to disinfect the surface of the personal protective equipment
with an EPA designated disinfectant wipe.
Last, disinfect your clothes also with an EPA designated disinfectant wipe
or alcohol based hand rub.
You, the trained observer, and the assistant are a team throughout the doffing process.
The trained observer will read each step aloud, giving you the time to take the required action.
The assistant will help you when necessary.
Remember, don't rush through the doffing process.
Take your time and be careful.
>> I'm here to help you through doffing process.
You'll hear me give directions that are not part of standard practice
but are designed to keep you safe.
We need to check for any rips, tears, or contaminates on your clothes.
Remember to go slowly and be careful not to touch your face.
As you remove each item, it is important to place it immediately
in the designated waste receptacle.
We're going to work through this together.
Now I'd like you to disinfect your outer gloves.
>> The first thing you will do is use an EPA registered disinfectant wipe
or an alcohol based hand rub to disinfect your outer gloves.
The wipe will be used to remove any visible contamination.
If you're using an apron, you now need to remove it.
The assistant will assess the type of apron used and will assist with untying the strap.
Then you will remove the apron by breaking the strap or lifting the strap over your head,
rolling from the inside to outside and away from your body.
And discarding it in the appropriate receptacle.
If the apron can be gently pulled away from the body by tearing it
at the neck, this process should be used.
Once the apron is off, inspect your personal protective equipment
for visible contamination, cuts, or tears.
If you see your personal protective equipment has been compromised or if there are any signs
of contamination, disinfectant it with an EPA registered disinfectant wipe.
>> Okay, great.
Now it's time to disinfectant your outer gloves again.
>> You will need to disinfectant your outer gloves again
with an EPA registered disinfectant wipe or an alcohol based hand rub.
>> Next I'd like you to remove your shoe covers.
You can sit down in the chair to make it easier.
>> In the doffing area, you will have two chairs.
One will be where you sit to take off your boot cover only.
This chair will be designated as the dirty chair.
It is preferable for the healthcare provider to remove their own boot covers
but they may receive assistance if necessary.
Once you sit down, be careful not to touch one leg with the other.
Grasp the outside of the boot cover and pull down toward your ankle.
Then, lift the boot cover over your heel.
Pull it off your foot and dispose of it into the trash receptacle.
The exact way to remove your boot covers will vary based on the manufacturer's instructions.
Now you will need to disinfectant your outer gloves
with an EPA registered disinfectant wipe or an alcohol based hand rub.
>> In the next step you're going to remove your outer gloves.
Please do this slowly and carefully to avoid contaminating or tearing your inner gloves.
You're doing great.
>> You have two very important things to remember.
First, pay special attention so that you don't contaminate or tear the inner glove.
Second, don't snap the gloves which could cause spray.
Hold one of your wrists so that your thumb points to the ceiling.
Pinch that glove and lift at the wrist,
then roll it down until the glove is completely off your hand
in a ball in the palm of the other hand.
Then slide a finger down and inside the outer glove on the other hand and pull it off
until it's balled around the first glove.
Dispose of the gloves.
>> Good job.
Now inspect both sides of your inner gloves for visible tears or contamination.
>> If you don't see any tears or signs of contamination, then you will disinfect
with EPA registered disinfectant wipes or alcohol hand rub and proceed
to the next step of removing your respirator.
If you see a tear, hole, or signs of contamination in the inner glove,
disinfect with EPA registered disinfectant wipes or alcohol based hand rub
and then remove the inner gloves, making sure not to contaminate your bare hands.
Once the gloves are off, perform hand hygiene with alcohol based hand rub on your hands.
Then put on a new set of gloves up to the edge of the gown sleeve.
In this step you will be taking off your belt mounted respirator.
How you will do this will vary from model to model of PAPR.
So you and your assistant will need to refer to your manufacturer's specifications.
>> The assistant will detach the hose and turn off the system now.
>> Although the specifics will vary, you should do things in this order.
First, the assistant will detach the hose from the hood.
>> Now I need you to unclip the belt.
>> Then while the assistant holds the belt unit in his or her hands, you will unclasp the belt.
After removal, place all reusable PAPR components into a designated area
or container for later disinfection.
Next you will take off the hood.
The assistant will stand behind you and will grab the outside of the hood and roll the hood
up towards the top of the shoulders, forming a cuff.
>> Next slowly remove the hood.
>> Then when the observer signals both of you, you will grab the hood near the ears,
bend forward at the waist, and pull the hood slowly and methodically down and away
from your head until it's at waist level.
Then discard the hood into the trash receptacle.
It's very important to avoid touching your face at this point after the hood has been removed.
Then both you and the assistant will disinfect your hands with alcohol based hand rub.
>> Okay. Go ahead and remove your gown.
>> Next you will remove your gown.
First release the tie.
Then pull the gown away from your body, being careful not to touch the inside with your hands.
>> Be sure to move slowly and deliberately to avoid contamination of any exposed surfaces.
>> Once the gown is off your shoulders, pull the gown down one arm and then the other.
Roll the gown inward as you progress downward until it's a tight ball.
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Dispose of it like you've disposed of everything else to this point into the trash receptacle.
>> You're doing great.
Now go ahead and disinfect your gloves.
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Please have a seat in the clean chair so that you can disinfect your shoes.
>> To disinfect your shoes sit down in the clean chair.
Once you're sitting down, use the EPA registered disinfectant wipes
to thoroughly disinfect all the surfaces of your shoes.
Moving from top to bottom and including the soles.
Be sure not to touch your ankles.
>> We're getting near the end.
You're doing great.
Now disinfect your gloves.
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Now we're going to remove your inner gloves.
Be careful to do this slowly to avoid tearing the gloves or contaminating your hands.
>> As with the outer gloves, you have two very important things to remember.
First, pay special attention so that you don't contaminate your hands.
Second, don't snap or pop the gloves which might cause spray.
Pinch that glove and lift at the wrist.
Then roll it down until the glove is completely off your hand,
in a ball in the palm of the other hand.
Then slide a finger down and inside the glove on the other hand,
and pull it off until it's balled around the first glove.
Dispose of the gloves.
Once your gloves are off, it's very important that you don't touch your face,
any exposed skin, or any surface in the room.
>> Go ahead and perform hand hygiene.
>> Next perform hand hygiene using alcohol based hand rub on your bare hands.
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>> Okay one more important step.
We need to check for any rips, tears, or contaminates on your clothes.
Please hold your hands out to side and slowly turn around.
>> Now you, the assistant, and your trained observer will do one last inspection
of your scrubs and inner clothing for holes, tears, or contamination.
Congratulation, you've now successfully finished the doffing process.
So you can leave the doffing area.
You need to find the closest designated shower
where you can remove your scrubs and bathe with soap and water.
A shower is recommended at the end of each shift for the comfort of the healthcare worker.
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