>> 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 system engineers,
psychologists, and 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 3 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 gown.
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 worker 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 procedure.
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 to 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.
Ensure your nails are no longer than a quarter-inch so they do not puncture the gloves.
>> The first thing I need you to do is remove any jewelry, earrings, 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 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 observer reviews the donning sequence
with the healthcare provider before the healthcare provider begins the donning process
and reads it to the healthcare worker in a step-by-step fashion.
>> Do you see any problems with your equipment?
No? Great.
[ Silence ]
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.
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 we're going to put on our gown, go ahead inspect it
and make sure there are no holes or tears.
Make sure the inside of the gown if facing you and that the holes and the ties are in the back.
We're going to tie the gown on the side carefully.
>> Ensure the gown is sized properly and large enough
to allow unrestricted freedom of movement.
If available, a gown with thumb hooks helps to secure the cuffs of the gown
over the inner glove to help ensure there's not a gap between the glove and cuff.
Tie the gown securely, but in a manner that it can be easily untied
when you begin the doffing process.
Leave some length of the tie so that it can be pulled and untied without much effort.
Ensure cuffs of inner gloves are tucked under the sleeve of the gown,
if your gown does not have thumb hooks, some facilities may consider taping the sleeve
of the gown 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 ]
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 ]
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 gown.
It may be necessary to ask the 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.
Put on the single-use PAPR hood that fully covers the neck and extends over the shoulders.
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.
Depending on the type of PAPR unit, the outer apron may need to put on first.
[ Silence ]
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 the outer apron has been placed over the hood,
the trained observer will attach the PAPR tube to the PAPR hood making sure the tube is snapped
and fits and then turn on the PAPR battery pack and filter unit.
If a PAPR unit should stop during patient care, you must leave the patient area immediately.
After completing the donning process,
the integrity of the ensemble is verified by the trained observer.
>> Can you please hold your arms out to your side and turn around for me?
I'm going to check to make sure that all of your skin is covered
and you're able to move comfortably.
>> 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.
>> Can you please bend at your waist and lean over a bit, I want to make sure
that you have full range of motion.
Okay, everything looks great.