(i.e., in a rush), the task (i.e., short visit versus more extended visit), inconvenient placement of hand sanitizer or gloves, and HCWs’ perceptions that hand hygiene prior to donning gloves Gowns Gowns, aprons, and other protective body clothing protect the HCW’s arms and clothing from contamination with blood, body fluids, and other potentially infectious material (OSHA, 1991), and from an MDRO when caring for a patient on TBP (CDC, 2022). The Association for the Advancement of Medical Instrumentation (AAMI) evaluates the effectiveness of surgical Masks Masks are used in healthcare for three primary purposes: (1) To protect the HCW from contact with infectious droplets, (2) to protect the patient from infectious exposure from the HCW during procedures, and (3) to place on a coughing patient or during transport if they are on droplet or airborne precautions (CDC, 2022). Masks are different from an N95 respirator. Leung and colleagues (2020) looked at viral shedding among individuals with COVID-19, influenza, and rhinoviruses. The authors measured droplet (large particles) and aerosol (small particles) transmission with and without wearing a mask. The results indicated that wearing a mask significantly reduced viral shedding from influenza droplets but not aerosols. For COVID-19, wearing a mask reduced droplets and aerosols; however, for rhinovirus, there was no significant difference in droplets or aerosol transmission with or without a mask. A limitation of this study was that all the viruses had an undetectable level of viral shedding during an exhaled breath. The authors suggested that future research include a longer Respirators Respirators (i.e., N95) protect HCWs against transmission of airborne pathogens (e.g., tuberculosis). Wearing respirators requires medical clearance and annual fit testing (CDC, 2022; OSHA, 2015). The COVID-19 pandemic increased the demand for N95 respirators in healthcare. Healthcare settings where respirators are not generally recommended provided “just-in- time” fit testing and training for their staff on how to wear a respirator. As COVID-19 cases were increasing, the supply chain for respirators was decreasing. The CDC published infection prevention guidelines related to optimizing PPE use based on Goggles and face shields Goggles and face shields (with solid side shields) protect the HCW’s eyes during specific situations. Personal eyeglasses are not considered PPE and do not provide adequate eye Sequence for donning and doffing PPE The CDC recommends a specific sequence for putting on (donning) PPE and removing (doffing) PPE, tailoring it to the specific PPE required for the task or procedure being performed (CDC, n.d.b). Donning PPE includes (in order): (1) gown, (2) mask or respirator, (3) goggles or face shield, and (4) gloves. If using a respirator, perform a user seal check (fit check) every time it is donned to ensure a good fit to the face and below the chin, thus minimizing air leakage. Doffing PPE includes (in order): (1) gloves, (2) goggles or face shield, (3) gown, and (d) mask or respirator. Wash hands or use an ABHR immediately after removing all PPE (CDC, n.d.b). Assume the outside of all the PPE is contaminated. Gloves are removed first, as they are the most contaminated. The gown should be removed by pulling it away from the neck and
is not necessary. Regular training on hand hygiene should be coupled with glove use to reduce the overuse of gloves when not necessary and the underuse with TBP (WHO, 2009c).
gowns, isolation gowns, and surgical drapes (CDC, 2022). There are four classifications based on the performance of the gown, with level 1 being the lowest level of protection and level 4 being the highest level of protection. Levels 1–3 gowns are not considered fluid impermeable; however, they are considered fluid resistant. sampling duration, beyond 30 minutes, to increase the levels of testing the efficacy of masks. A laboratory experiment tested PPE protection to compare wearing surgical masks and face shields (Salimnia et al., 2021). The investigation had subjects A (sick person) and B (healthy person) wearing different PPE in 17 different scenarios. The scenarios included subject A wearing a mask, subject B not wearing mask; subject A not wearing a mask, subject B wearing a mask; subject A wearing a mask and face shield, subject B wearing a mask and face shield. In each scenario, aerosolized droplets were measured onto an open petri dish (subject B). The lowest colony counts were found when both subjects were wearing masks at 6 feet apart (1+ colony count on a petri dish); however, the colony count was still low (1+) when subject A was wearing no mask or face shield, and subject B was wearing a mask at 6 feet apart. The authors reinforced findings by Chu et al. (2020) that wearing masks is an effective tool to prevent the transmission of aerosols. the supply levels (conventional, contingency, and crisis; CDC, 2020). Infection prevention strategies were unconventional as healthcare settings put plans in place to reuse and otherwise extend the use of masks. Powered air-purifying respirators (PAPRs) are also used as respirators. A PAPR is a respirator that uses a blower, forcing air through a hood that the HCW wears (CDC, 2020). When used correctly, a PAPR provides better protection than an N95 respirator.
protection. Certain styles of goggles can fit over eyeglasses (OSHA, 1991).
shoulders and rolling it inside out. Always grab the mask or respirator by the ties or elastics without touching the front. If hands get contaminated during the removal of any PPE, use an ABHR immediately after removing that item. Another example of doffing PPE (in order) is: (1) gown and gloves, (2) goggles or face shield, and (3) mask or respirator. Wash hands or use an ABHR immediately after removing all PPE (CDC, n.d.b). In addition to donning and doffing PPE correctly, safe work practices to protect the HCW and limit transmission include the following. ● Keep hands away from the face. ● Limit surfaces touched. ● Change gloves when torn or contaminated. ● Perform hand hygiene.
RESPIRATORY HYGIENE/COUGH ETIQUETTE
After working in a pandemic, the concept of respiratory hygiene is well known today. This infection prevention strategy targets patients experiencing signs or symptoms of respiratory illness: Cough, congestion, runny nose, or increased respiratory secretions. The critical elements to respiratory hygiene are (1)
provide education to HCWs, patients, and visitors; (2) post signs in languages appropriate to the region and population served; (3) implement source control (i.e., cover your cough with a tissue or sneeze into your sleeve, wear a surgical mask); (4) perform hand hygiene after contact with respiratory secretions; and (e)
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Book Code: RPTTX2024
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