>> 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 will 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,
or PPE, 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 the steps.
Your trained observer will help you with the process.
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 gloves, also
with an EPA-designated disinfectant wipe or alcohol-based hand rub.
You, your 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 the doffing process.
You'll hear me give you directions that aren't part of standard process,
but they're designed to keep you safe.
We need to check for any rips, tears, or contaminates on your clothes.
Remember, go slowly, and do not cut your face.
As you remove each item, remember to place it immediately
into the designated waste receptacle.
Let's work through this together.
Now, I'd like you to disinfect your outer gloves.
>> The first thing you will need to do is use an EPA-registered disinfectant wipe
or an alcohol-based hand rub to disinfect your outer gloves.
The wipe will be used for 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
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 comprised, or if there are any signs
of contamination, disinfect it with an EPA-registered disinfectant wipe.
>> Now, I'd like you to disinfect your outer gloves.
>> In this example, the boots are under the coverall
and are being removed later in the sequence.
However, depending on the personal protective equipment used at your institution,
the boots or shoe covers may be removed at this point
in the sequence or later on in the sequence.
There are 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.
>> In the next step, you're going to remove your outer gloves.
Please do this slowly to avoid contaminating or tearing the inner gloves.
>> How old one of your wrists so that your thumb points up,
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.
>> Now inspect both sides of your inner gloves looking for tears or contamination.
>> If you do see a tear, hole, or signs of contamination of the inner gloves,
disinfect with EPA-registered disinfectant wipes or alcohol-based hand rub.
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 the new set of gloves up to the edge of the coverall sleeve.
>> Now, you're going to take off your face shield.
As you move it forward over your head, avoid touching the front of the shield.
>> To remove the face shield, tilt your head forward slightly.
Grab the strap at the temples, and pull it forward and over your head,
which will let the face shield fall from your face.
Dispose of the face shield.
>> Disinfect your inner gloves again.
>> To remove the hood, tilt your head slightly.
Grasp at the crown of the head, and use one hand to pull the hood forward away
from the body and off of the head.
Dispose of it.
>> Disinfect your inner gloves.
Next, you will remove your coverall.
>> If your coverall has a flap covering the zipper, you must gently pull it open.
Then you will need to disinfect your gloves.
Next, tilt your head back and reach for the zipper at the top of the suit,
using a mirror to avoid touching the skin.
Grasp the zipper with two fingers of one hand without using the other hand
on the front of the suit and pull down.
Unzip completely.
The assistant may help you unzip the coverall, if necessary.
The assistant will stand behind you and grasp the outside of the coverall at the shoulders
and pull it off your body in a downward motion
until the coverall is off your shoulders completely.
The assistant will then reposition his or her hands and roll the suit outward
and down the back in a controlled fashion, removing your arms and slowly pulling it
down until it's at your waist, being careful not to touch your scrubs or skin.
To get the coverall off the rest of the way, you may need to sit down in a clean chair.
Grab the coverall and pull it away from your body, one leg at a time.
Once the coverall is off completely, dispose of it.
>> Because you just removed your coverall,
I'm going to ask you disinfect your gloves one more time before we change them.
>> Sit in the designated clean chair to take off your boot covers only.
Once you sit down, be careful not to touch one leg with the other.
Then, 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 correctly.
The exact way to remove the boot covers will vary based on the manufacturer's instructions.
>> Move slowly and deliberately to avoid contamination of exposed surfaces.
You're doing great.
Please do this slowly to avoid tearing the gloves or contaminating your hands.
>> It's important that you don't touch your face
or any other exposed skin with your bare hands now.
>> Now that your gloves are off, make sure you don't touch your face or any exposed skin.
>> Perform hand hygiene using alcohol-based hand rub only.
Then, put on a fresh pair of gloves, and you're ready for the next step.
Next, you will be removing your N95 respirator.
It's important that you not touch the front of the respirator.
Pull to the sides, then over your head.
Next, use both hands to grab the upper strap, pull to the sides, then over your head.
Keep tension on the upper strap as you remove it, which will let the mask fall forward.
Dispose of the mask.
>> You're doing great.
Now disinfect your gloves.
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.
Now it's time to remove the inner gloves.
Like with the outer gloves, there are two very important things to remember.
First, pay special attention so that you don't contaminate your hands.
Second, don't snap the gloves, which could cause spray.
>> Please do this slowly to avoid carry tearing the gloves or contaminating your hands.
>> Hold one of your wrists so that your thumb points up.
Pinch that glove and lift at the wrist.
Then, roll it down until the glove is completely off 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.
>> Now that your gloves are off, make sure that you don't touch your face or any exposed skin.
Okay, one more important step.
We need to check for any rips, tears, or contaminates on your clothes.
Please hold your hands out to your side, and slowly turn around.
Okay. Everything looks great.
>> Congratulations.
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.