>> 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 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'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 Health Care 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 an N95 respirator with 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 health care 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 the sole responsibility of ensuring adherence to the entire donning process.
The donning process is conducted under the guidance and supervision of the trained observer
who confirms visually that all personal protective equipment is serviceable
and has been donned successfully.
The trained observer should suggest to the health care provider that he or she attended
to personal needs, such as using the restroom and hydration,
prior to donning personal protective equipment.
The trained observer uses verbal commands and a verbal 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.
>> Hi. Welcome.
We're ready to go see the patient.
Are you ready?
Oh great. So we're going to go into the unit and we're going to do this safely.
We're going to do everything slowly and methodically.
And if you have any questions at all, you can stop and ask.
>> 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,
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 no puncture the gloves.
Visually inspect the personal protective equipment ensemble to be worn to ensure
that it is in serviceable condition and that all required personal and protective equipment
and supplies are available and that the sizes selected are correct
for the health care provider.
The trained observer reviews the donning sequence
with the health care provider before the health care provider begins the donning process
and reads it to the health care provider in a step by step fashion using a checklist.
[ Pause ]
>> OK. Great.
Before we do any kind of procedure we're going to do proper hand hygiene.
Remember to do hand hygiene between your fingers and on the back of your hands and the palms.
And we're going to make sure that we let the alcohol gel dry before we proceed.
[ Pause ]
So next we're going to put on the booties.
We're going to pull up a chair for your safety and you're going
to sit down and put on the booties.
Once you get the booties on we want to make sure they're secured
around your ankle and your calves.
>> 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.
[ Pause ]
>> OK. Now we need to put on a pair of gloves.
This is not a sterile procedure.
>> Put on the first pair of gloves.
Make sure to get the cuffs of the glove as far up as possible.
[ Pause ]
>> Now I'd like you to put on the coverall.
>> If available, coveralls with thumb hooks help secure the cuffs over the inner glove
to help ensure there is no gap between the glove and the cuff of the coverall.
Pull up the zipper completely.
Ensure the coverall is large enough to allow unrestricted freedom of movement.
Ensure cuffs of the 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.
[ Pause ]
>> Now 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.
[ Pause ]
>> Now we're going to inspect the hood before we put it on.
>> Be certain the hood completely covers the ears and neck.
The trained observer should check to ensure the hood is in place and that all parts
of the skin are covered, no hair is hanging down, and the hood extends to the shoulders.
[ Pause ]
>> So now we're going to put on the apron.
We're going to take the apron, put it over our heads, methodically and solely,
and then we're going to tie it around the back.
>> If the patient is having vomiting or 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.
[ Pause ]
>> Now it's time to put on your outer gloves.
>> It may be necessary to ask your trained observer for assistance
when putting on the outer gloves.
Double gloving provides an extra layer of safety during direct patient care
and during the personal protective equipment removal process.
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.
[ Pause ]
>> Next you're going to put on your face shield.
In order to do this you're going to have to bend forward slightly.
With the face shield facing towards you,
take your thumbs inside the elastic straps placing the foam on your forehead
and stretching the elastic band and placing it behind your head.
>> Once the shield is situated check to make sure it covers the front and sides
of the face and no areas are left uncovered.
[ Pause ]
>> OK. Now I want to make sure you have full range of motion.
Can you move your arms?
Can you bend at the waist?
Can you turn around a little bit so I can make sure everything is just ready for you to go?
>> After completing the donning process the integrity
of the ensemble is verified by the trained observer.
A mirror in the room can be useful
for the health care provider while donning personal protective equipment.
>> Everything looks great.
Now we're ready to take care of the patient.