>> 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
and 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've partnered with the CDC to do that.
We pulled together our infectious disease experts, human factors and systems engineers,
psychologist, 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 that 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 can safely care for those 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 trend observer will help you with the process.
Before you move from 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.
[ Silence ]
You and your trained observer are a team throughout the doffing process
>> I'm here to help you through the doffing process.
You'll hear me give directions that are not part of standard practice.
But are designed to keep you safe.
>> The trained observer will read each step aloud.
Giving you the time to take the required action.
>> We need to check for any rips, tears, or contaminants on your clothes.
>> Remember, don't rush through the doffing process.
Take your time and be careful.
[ Silence ]
>> Now I'd like you to disinfect your outer gloves.
[ Silence ]
>> 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, disinfect it with an EPA registered disinfectant wipe.
[ Silence ]
>> Now I'd like you to disinfect your outer gloves.
[ Silence ]
>> In your doffing area, you will have 2 chairs.
One will be where you sit to take off your boot covers only.
This chair will be marked clearly as dirty.
Once you sit down, be careful not to touch 1 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.
[ Silence ]
>> Okay, great.
Now it's time to disinfect your outer gloves again.
[ Silence ]
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 glovers.
You're doing great.
>> There are 2 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.
[ Silence ]
>> Good job.
Now inspect both sides of your inner gloves for visible 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 a new set of gloves up to the edge of the sleeve.
[ Silence ]
>> Okay, great.
Now disinfect your gloves.
[ Silence ]
>> In this step, you will take off your face shield.
To do this, 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.
[ Silence ]
>> Okay, great.
Now disinfect your gloves.
[ Silence ]
Next, slowly remove the hood.
>> To do this, tilt your head slightly.
Grasp at the crown of the head, and use 1 hand
to pull the hood forward away from the body and off the head.
Dispose of it.
[ Silence ]
>> Okay, great.
Now disinfect your gloves.
[ Silence ]
Okay. Go ahead and remove your gown.
>> First, release the tie.
Then grasp the gown at the hip area.
And pull the gown down and away from the sides of your body.
Once the gown is off your shoulders, pull one arm at a time from the sleeves of the gown.
[ Silence ]
Arms are bunched at your wrists.
Then roll the exposed side of the gown inward until it's a tight ball.
Dispose of it.
[ Silence ]
Now it's time to remove the inner gloves.
Like with the outer gloves, there are 2 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.
In this step, you'll need to first disinfect your gloves using the same product
as in previous stages.
[ Silence ]
The process to remove the inner gloves is the same as it was with the outer gloves.
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.
It's important that you don't touch your face or any other exposed skin with your bare hands now.
Perform hand hygiene using alcohol based hand rub only.
[ Silence ]
Then put on a fresh pair of gloves, and you're ready for the next step.
[ Silence ]
>> Now you're going it remove your respirator.
>> It's important that you not touch the front of the respirator.
First, tilt your head forward.
Then use 2 hands to grab the bottom strap.
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 it.
[ Silence ]
>> We're getting near the end.
You're doing great.
Now disinfect your gloves.
[ Silence ]
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.
This will be designated as 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.
[ Silence ]
>> Now disinfect your gloves.
[ Silence ]
>> Now we're going to remove your inner gloves.
Be careful to do this slowly to avoid tearing the gloves or contaminating your hands.
>> 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.
[ Silence ]
>> Go ahead and perform hand hygiene.
[ Silence ]
Okay. One more important step.
We need to check for any rips, tears, or contaminants on your clothes.
[ Silence ]
>> 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 for the comfort of the healthcare worker.
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