COVID-19 guidance: donning and doffing PPE

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Guidance for nurses

03/04/2020 By Sarah

We know lots of you have questions around donning and doffing PPE. We have sourced the following guidance from Public Health England. Please familiarise yourself with this guide and take time to watch the PHE YouTube videos below.

Pre-donning requirements:

  • This is undertaken outside the patient’s room
  • Ensure you are hydrated and have emptied your bladder
  • Tie hair back
  • Remove jewellery
  • Check PPE in the correct size is available
  • Perform hand hygiene before putting on PPE – hand gel or rub
  • Should be supervised by a buddy – 2 metres distance if possible

Donning PPE

The following guide is from Public Health England. You can find a copy of the guide here.

– Ensure that it is the correct size for you
– Do not use the inside tie
– Fasten the necktie/velcro and waist ties
– Make sure the gown is securely fitted at the neck and waist ties

– If you wear glasses remove these before donning the respirator, clean them with an alcohol wipe and replace them before donning the visor
– Put on the respirator and check for fit
– This MUST be the respiratory type that you have been fit-tested to use
– The respiratory must be compatible with other facial protection
– If you have not been fit-tested for the particular mask you must not enter the patient’s room
– Position the upper straps on the crown of your head above the ears
– Position the lower strap at the nape of the neck
– Ensure that the respirator is flat against your cheeks
– With both hands, mould the nose piece from the bridge of the nose, firmly pressing down on both sides of the nose with your fingers until you have a good facial fit
– Always perform a fit check before entering the work area – no air leaking from the edges of the respirator
– If you are wearing a non-valve respirator, exhale sharply to test
– For a valved product, inhale sharply
– For either of the above if air leaks around the nose or edges re-adjust the mask and try again – if you are unable to obtain a successful fit check DO NOT enter the work area
– If you wear glasses, put them back on now before going onto the next stage

– This could be a full-face visor or goggles
– If you using a visor ensure that it covers your entire face including your chin – adjust the headband if necessary
– Get your buddy to check, if a buddy is not available, check yourself in a mirror to ensure that it is fitted

– Put on a pair of gloves that are the correct size for your hands
– Ensure the gloves cover the cuff of the gown

Complete a final PPE check:

  • Check that the gown ties at the neck and waist are secure
  • The respirator is correctly fitted
  • The visor is in position
  • The gloves cover the cuffs

You can watch a video demonstration from Public Health England here.

Doffing PPE

Key facts

  • PPE should be removed in an order that minimises the potential for cross-contamination
  • PPE must be removed before leaving the patient’s room (apart from your mask)
  • Your mask must always be removed when you are outside the patient’s room
  • If you need to leave the room for example to visit the toilet – make sure you leave yourself enough time to appropriately doff the PPE – this should not be rushed
  • Where possible the process should be supervised by a buddy at a distance of two metres
  • If you are aware of any PPE breach or high-exposure contamination to PPE, inform your buddy before removing PPE

The following guide is from Public Health England. You can view a full copy of the guide here.

1. Gloves: always remember the outside of the gloves are likely to be contaminated.

To safely remove gloves you need to:
– Grasp the outside of the glove with the opposite gloved hand and peel off
– Hold the removed glove in the gloved hand

– Slide your fingers under the other glove
– Peel the remaining glove off over the other glove
– Dispose of the gloves into the clinical waste bin

Clean your hands, wrists and forearms with alcohol hand gel or rub

2. Gloves: always remember that the front of the gown and sleeves are likely to be contaminated

– Always remove the gown slowly and carefully
– Undo the necktie
– Undo the waist tie

Pull the gown away from the neck and shoulders touching the INSIDE of the gown ONLY using a peeling motion

– Turn the gown inside out
– Fold or roll into a bundle and discard into the clinical waste bin

3. Eye Protection: always remember the outside of the eye protection is likely to be contaminated

– To remove the visor, stand straight and do not bend forwards as this brings the bottom of the visor into contact with the (clean) upper body
– Find the elastic strap at the back of the head, close your eyes and lift the strap upwards then over your head using both hands
– Place the visor into the clinical waste bin
– Now leave the patients room still wearing your respirator
– Clean hands, wrists and forearms again with alcohol hand gel/rub

– To remove goggles, find the elastic strap at the back of your head, close your eyes and lift strap upwards then over your head using both hands
– Discard into a clinical waste bin or into a receptacle for reprocessing/decontamination

4. Mask: always remember DO NOT touch the front of the respirator as it will be contaminated.

– If you wear glasses, remove them before doffing the respirator
– Clean them with an alcohol wipe and do not put them back on until you have completed doffing and washed your hands
– Carefully and slowly remove the respirator without touching the front
– Reach to the back of the head with both hands to find the bottom strap and bring it up to the top strap
– Lift both straps over the top of the head
– Let the respirator fall away from your face and drop into the clinical waste bin

5. Wash your hands, wrists and forearms with soap and water

You can watch a video demonstration from Public Health England here.

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