>> Hi. My name is Kara Jacobs Slifka.
I'm a medical officer and part of the CDC COVID-19 response
in long-term care facilities.
Today we are going to talk
about using personal protective equipment, or PPE,
correctly for COVID-19.
This is a part of the key COVID-19 prevention messages
for frontline, long-term care staff.
Your health is important
and your residents need you to stay healthy.
Personal protective equipment, or PPE --
which includes items like gloves, gown, facemask,
respirators, and eye protection like face shields and goggles --
can help keep you safe from germs.
But PPE must be used correctly
or it will not work to keep you safe.
The virus causing COVID-19 spreads mainly
from person-to-person when they cough, talk, or sneeze.
But some people can spread the virus even
without having symptoms.
So you should wear a face mask while you are
at work all of the time.
This is called universal facemask use
and provides what we call "source control."
Because the facemask prevents germs from your mouth and nose
from spreading to other people when you talk, cough, or sneeze.
Which protects residents and other staff.
CDC recommends the use of cloth face coverings for everyone
who goes to public places for source control.
These may be able to be used by a nursing home staff
who are not interacting with residents.
However, cloth face coverings are not considered personal
protective equipment and should not be worn instead
of a respirator or facemask if more
than source control is required,
like whenever you're caring for residents.
What we have seen so far during the outbreak is
that COVID-19 enters into long-term care facilities
through the people who work there.
You could spread germs to residents and patients
without even knowing it.
And facemasks can protect you from germs by preventing germs
from touching your mouth and nose.
In order for your facemask to work,
you have to wear your facemask the correct way.
Do clean your hands before you put on
and take off your facemask.
Wear your facemask so that it completely covers your mouth
and your nose.
Remove the facemask touching only the straps.
And if you're reusing the mask, fold it in half
with the outer part of the mask folded in and store it
in a paper bag or breathable container.
Don't touch your facemask or your face.
And make sure that you don't pull your mask
down under your nose.
Your nose must be covered by the facemask.
Don't wear your facemask on the top of your head,
around your neck, or hanging off your ear.
And don't store your mask on your arm or in your pocket.
As soon as you become worried
that a resident may have COVID-19 or if you find
out that a resident has tested positive for COVID-19,
you should be using PPE.
A positive test result means
that a resident has confirmed COVID-19.
But that resident may or may not have symptoms.
If you are taking care of a resident with a temperature
of more than 100 degrees Fahrenheit
or multiple temperatures of 99 degrees Fahrenheit,
or has symptoms such as shortness of breath,
a new or different cough, sore throat, or muscle aches,
you should be using PPE because this resident might have
COVID-19 or they are suspected to have COVID-19.
Older adults may not show typical symptoms,
so be on the lookout for symptoms such as new
or worsening discomfort or tiredness,
new dizziness, or diarrhea.
And make sure that you are using PPE.
During an outbreak, when multiple individuals
in a building are sick or test positive, PPE may be required
to care for all residents on a wing,
in an area of the building,
or even throughout the entire facility.
Residents with suspected
or confirmed COVID should also be restricted to their room.
PPE for suspected or confirmed COVID-19 --
which, as a reminder, means
that the resident either has a positive test for COVID-19
or has an elevated temperature or symptoms concerning
for infection, or may be in an area of the building
where PPE is being used for all residents --
includes face shield or goggles.
Personal eyeglasses and contacts are not considered adequate
eye protection.
Goggles or a face shield that covers the front and the sides
of the face should be used.
An N95 or higher level respirator,
if your facility has a respiratory protection program,
fit-tested staff, and respirators or a facemask --
which is an acceptable alternative
if N95 respirators are not available.
A pair of gloves and a gown.
It's important to recognize the difference
between a facemask and an N95.
The facemask fits loosely over the face.
An N95 respirator filters the air and provides a seal
around the face but must be fit tested prior to use.
PPE is currently in short supply, so implementing ways
to conserve PPE right now is important
to help prevent running out.
Gloves should generally be worn for any contact
with a resident or their environment.
They should be changed and hand hygiene should be performed
before moving on to work with the next resident.
Gowns are recommended for use with each resident
but can be prioritized for activities
that might involve splashes or sprays
and for high contact care activities.
And these high contact care activities are the same
activities that have been discussed before
with enhanced barrier precautions
and include dressing, bathing or showering, transferring,
providing hygiene, changing linens,
assisting with toileting, device care or use
of a device, and wound care.
Extended use of eye protection and N95s or facemasks
if N95s are not available can be considered during shortages.
During extended use, eye protection and an N95 respirator
or facemask are worn for the care of multiple patients
without removing them.
Glove and gowns, if they are used,
should be changed between residents.
Personnel who don't come within six feet
of residents might not need all PPE
but should still wear a facemask for source control to keep them
from spreading germs to others.
And as a reminder, universal facemask use means
that you are wearing your facemask at all times in order
to prevent sharing germs.
The way that PPE is donned or put on is important.
But first before donning PPE, you should clean your hands.
You then put on a gown, and this should be wrapped
around the back of you and fastened
at the neck and at the waist.
Next you put on an N95 respirator or facemask
if respirator is not available, covering your nose and mouth.
You may already have this
on from the universal facemask use throughout the day whenever
you're in the facility.
And even more specific details on this are covered in videos
that can be found at the resource section
at the end of the presentation.
Goggles or face shield is put on next
and should be adjusted to fit.
And then last you should place on your gloves and extend them
to cover the wrists of the isolation gown.
The skin of your wrist between your gloves
and gowns should not be showing.
It's also important to note that if you are reusing
or extending the use of any PPE, you will still need
to adjust your donning -- you may need to adjust your donning
and doffing procedures.
In addition, if you're reusing eye protection, it will need
to be cleaned and disinfected.
And at a minimum, you should use gloves while cleaning
and disinfecting these items.
For doffing, or taking off PPE, first remove your gloves,
using caution as the outside of the gloves is considered
to be contaminated or have germs on it.
One way to do this, as shown in the picture, is to use one
of your gloved hands to grasp the palm area
of the other gloved hand and peel off that first glove.
Then while you're holding the glove in your other gloved hand,
slide the fingers of your hand that no longer has a glove on it
under your remaining glove at the wrist
and peel the second glove over the first glove.
This may take practice.
And videos in the resource section at the end
of the presentation can help further demonstrate this.
You next remove your gown, rolling the gown
down and dispose of it.
At this point, you may be able to exit that area
and perform hand hygiene.
Then carefully remove your face shield or goggles,
avoiding touching the front of the face shield or the goggles.
These should then be reprocessed before reuse.
Next remove the respirator or facemask,
unless you are practicing extended use,
in which case you can continue
to wear unless dampened or soiled.
You would remove that respirator or facemask
by grasping the straps behind your head
and carefully pulling them over your head or over your ears.
And avoid touching your face or the front of the respirator
or mask, which is considered to have germs on it.
And perform hand hygiene again.
Donning and doffing PPE correctly is important in order
to make sure that you are protecting yourself
and avoiding contaminating yourself.
There are links to videos on this slide of the process
of donning, or putting on PPE, and doffing, or taking off PPE,
including if you are using an N95 respirator
or if you're using a facemask.
And the process of how you would reuse face and eye PPE.
The CDC website also includes additional materials and posters
that you can print and hang in your facility as a reminder.
Using PPE correctly is how you can keep yourself safe
from COVID-19.
Thank you.