What is PPE in strict isolation?
Pulmonary and Critical Care Division, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Rabold and DuMont); and Internal Medicine Residency, Medicine Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania (Dr Rovnan). Show PPE used in healthcare includes gloves, aprons, long sleeved gowns, goggles, fluid-repellant surgical masks, face visors and respirator masks. The initial risk assessment of whether or not PPE is required is based on the level of risk of transmission to and from the patient. Standard IPC precautions are required to be implemented by all healthcare workers for the care of all patients and their environment’s. When these measures alone are insufficient to interrupt transmission, additional transmission based precautions appropriate to the mode of spread are indicated. GlovesGloves should be worn when there may be exposure to blood, bodily fluids, secretions or excretions and when handling contaminated equipment. Gloves should also be worn when patients require transmission based precautions (insert link to TBP). Increased awareness among healthcare workers of the potential for gloves to provide protection against various pathogenic microorganisms, has led to the increased use of gloves in health care. However, gloves cans sometimes be used inappropriately and failure to remove them at the correct time and complete hand hygiene effectively can increase the risk of transmitting infections to vulnerable patients. Each healthcare worker should understand the rationale for glove use and assess the potential risk that each task carries. N.B. Gloves do not replace the requirement for good hand hygiene (link to Hand Hygiene section). Gloves should be changed when they have become contaminated i.e. between patients and between different procedures on the same patient. Hands should always be decontaminated following the removal of gloves. Gloves are single-use items and should not be washed or reused. Types of Glove Polythene: Thin and have a tendency to tear. They are not an appropriate choice for healthcare settings. Vinyl: Have been shown to be less effective than latex gloves in providing an impermeable barrier against microorganisms. They are also loose fitting and unsuitable for procedures that require manual dexterity. The use of vinyl gloves in healthcare is limited.
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Limit the potential for “touch contamination” by unnecessary contact of e.g. your face/environmental surfaces when wearing gloves that may have been contaminated. Further information on glove usage can be found here Aprons/GownsDisposable Plastic Aprons / Gowns are designed to protect uniforms / clothing from moisture / soiling during direct patient care. In the majority of cases, plastic aprons will be appropriate for standard precautions. In some cases, where extensive contamination of blood / body fluids is anticipated e.g. maternity units, ED units or when the patient requires a significant amount of direct care with close skin-to-skin contact, a long sleeved fluid repellent gowns may be more appropriate. Gowns do not need to be sterile unless used for an aseptic procedure such as central line insertion or in an operating theatre.
Eye protection, visors or full face protection Eye and face protection must be worn when there is risk of splashing body fluids onto mucous membranes e.g. eyes/nose. Eyes can be protected by wearing either goggles or a visor. Personal glasses are not a suitable substitute. If reusable eye/face protection is used, it should be decontaminated in accordance with the manufacturer’s guidelines. Hands should always be decontaminated after removing the equipment. Suitable protective eye/face equipment should:
MasksSurgical masks (Fluid Repellent)
FFP3 respirator masks
ReferencesCoia, J.E. Ritchie, L. Adisesh, A. Makison-Booth, C.Bradley, C. Bunyan, D. Carson, G. Fry, C. Hoffman, P. Jenkins, D. Phin, N. Taylor, B. Nguyen-Van-Tam, Zuckerman, M. (2013) Guidance on the use of respiratory and facial protection equipment Journal of Hospital Infection 85: 170-182 FRAISE, A . and BRADLEY, C. (2009) Ayliffe’s Control of Healthcare-Associated Infection: A Practical Handbook Fifth Ed. CRC Press, Croydon Guidance for the selection of PPE https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf Health Protection Scotland (2015) Standard Infection Control Precautions Literature Review available at http://www.hps.scot.nhs.uk/haiic/ic/index.aspx HSE (2005) Personal Protective Equipment at work 2nd ed. HSE Books, Norwich HSENI: Health & Safety at Work (Amendment) (Northern Ireland) Regulations 2006. [Available at http://www.hseni.gov.uk/index/information_and_guidance/general_health_an... NICE TB Guidelines https://www.nice.org.uk/guidance/cg117 RCN (2012) Essential practice for infection prevention and control: Guidance for nursing staff 2nd ed. RCN, London What PPE is used for protective isolation?A particulate respirator must be worn by anyone entering the patient's room that is on airborne precautions. This may be an N95 respirator or powered air purifying respirator or PAPR. Respirators are specifically designed to provide respiratory protection by efficiently filtering out airborne particles.
What are 3 types of isolation precautions?There are three categories of Transmission-Based Precautions: Contact Precautions, Droplet Precautions, and Airborne Precautions.
What PPE is required for wound care?Personal protective equipment (PPE)
Wear gloves during all stages of wound care including when applying new dressings. Don gloves after preforming hand hygiene. During an individual resident's wound care, doff gloves every time when going from dirty to clean surfaces or supplies.
What is the purpose of protective isolation?Protective isolation is used for severely immunocompromised patients in order to prevent contamination and/or infection with microorganisms (bacteria and viruses). For example, protective isolation is used for patients with burns or leukemia.
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