We've just walked through the order of putting on your PPE.
The gown, mask or respirator, goggles or eye shield and gloves.
But the removal of PPE is a little different.
First, you're gonna take off your gloves, then, your goggles or eye shield, your gown, and finally, your mask or respirator.
But there's something I wanna talk about before we get into that.
You've got to be very self-aware when you're taking off your PPE.
So, I if could have sirens and flashing lights, I would have it on this slide
because you cannot become apathetic when you're doing this.
You have to be alert and aware.
Don't get distracted because you wanna make sure if you contaminate your hands at any point
while you're trying to remove your PPE,
you must immediately go and wash your hands or use an alcohol-based sanitizer.
So, danger, danger, Will Robinson, you wanna make sure you're self-aware,
pay attention when you're taking off your PPE so you don't contaminate your hands.
Now, we're gonna get a little more specific in each of these four steps of removal of your PPE.
First, we're gonna talk about removing your gloves because that's step one.
So, pull the first glove until it comes off inside out.
Remember, the outside of your gloves are contaminated,
so, as you're pulling it off, only touch the outside of your gloves and pull it off inside out.
Now, take that glove and put it in your remaining gloved hand. See our picture?
So, the glove that's inside out, now, holding it in the other hand.
So, gently insert your ungloved hand at the top of the wrist.
See how they're only touching underneath the glove
because you wanna make sure that that's the part that's not contaminated.
So, insert your ungloved hand, your fingers at the top of the wrist,
then, turn the second glove inside out while pulling it away from your body.
Now, the reason you pull it away from your body is
because if there's any germs coming off that, you want it to move away from you.
Now, when you're done, the first glove should be inside the second glove.
I had a good friend that always used to say, "party pack" every time she did that.
Don't ask me why but that's what still sticks in my head every time I take my gloves off.
So, you pull the first glove off until it comes off inside out.
You put that glove in your remaining hand, then, you slide your fingers
underneath to the uncontaminated part, pull that second glove off away from your body
and the first glove should be tucked inside there and you drop it in the appropriate trash.
Now, I would encourage if you haven't done this before to just get a pair of regular gloves and practice this.
It will make much more sense if you're doing it with a pair of gloves on your hands.
So, now, we've got our gloves off. Next step, right, removing goggles or face shield.
So, keep in mind, staying alert, that the front or outside of your goggles or shield are contaminated.
So, you don't want to touch that with your hands.
Remove the back by lifting the headband from the back of your head without touching the outside of your goggles.
If you make a mistake and you touch the front or outside of your goggles with your eye shield,
make sure you stop and wash your hands or use alcohol based sanitizer immediately.
I wanna show you two different options for how you remove your gown.
You've got two ways to do this. We're gonna call this option A.
Remember, you've already removed both of your gloves in this method.
So, the outside is considered dirty or contaminated.
We are talking about your mask, we're talking about your eye shield, and especially, when we're talking about your gown.
So, be careful when you're untying your gown.
Make sure your sleeves don't contact your body in any way because they're contaminated.
Pull the gown away from your neck and shoulders, turn it inside out
and then, fold or roll it into a bundle and discard it in the infectious waste container.
Now, this can take a little bit of practice, so, I would recommend that you do that.
Remember, you've gotta reach back and untie your gown and make sure your sleeves don't touch your body.
That would contaminate you.
You wanna pull the gown away from your neck and shoulders, turn it inside out
and then, fold or roll it into a bundle and discard it in the infectious waste.
So, that's option A. Let's look at option B.
I'm not very patient, so, I tend to do this way when I take a gown off.
Remember, the outside is still dirty but instead of untying your gown,
cuz I'm not really good at making great knots, you wanna touch only the outside of your gown with your gloves on
and then, you wanna just pull the front of the gown away from your body so the ties break.
It's pretty easy to do, it's not painful, but just pull that gown until the ties break.
Now, when you're removing the gown, peel off your gloves at the same time
and be really careful to only touch the inside of the gloves and gown with your bare hands.
So, do the same thing, kind of fold or roll it into a bundle and discard it in the infectious waste container.
Now, you remember how to remove your goggles and your face shield, it's the same method.
That front or outside is still contaminated.
You wanna make sure that you remove it by removing from the back,
by lifting the headband from the back without touching the outside of the goggles.
For a mask or a respirator, you wanna do this outside of the room with the patient's door closed.
Now, let's walk through the rationale of that.
Before I go into a patient's room with airborne precautions, I wanna put on the respirator to protect myself.
Now, when I remove it, I wanna be outside of the room with the door closed,
so, I'm not gonna expose the rest of the unit to those bacteria or viruses.
That's why I go out of the room, the door is closed, then, I'm gonna take off the respirator.
Remember, the front of that mask or respirator's contaminated, so, you don't wanna touch that area.
Just grasp the bottom of the ties or elastics of the mask or respirator,
then, the top ties and remove it without touching the front.
Now, this is harder than it sounds.
So, if you're new to this, you wanna make sure that you get a clean set
and just keep practicing so you don't feel like you're so fumbly.
Now, questions come up, can you reuse an N95 respirator?
Well, they're actually intended for single use but if we're in a time of severe shortage,
like possibly in a pandemic, they can be reused.
It's not ideal but it is acceptable as long as the mask is still structurally or functionally sound.
Their integrity of the structure or the function hasn't been broken and the filter isn't physically damaged or soiled.
That's what OSHA says in the United States.
So, while it's not our first choice, you can actually reuse an N95 respirator.
So, now, you're familiar with how to put on PPE safely,
how to take it off with extra caution to make sure you don't contaminate yourself.
Let's do a quick run-through of the three types of transmission precautions.
First, take a look at contact precautions. We've got it there in your graphic.
Remember, contact precautions are gonna make sure that you wear gloves and gown.
Handwashing goes without saying and yet, I'm doing it anyway,
is a part of universal precautions and all of the transmission precautions.
So, for contact precautions, it's gloves and gown.
For droplet precautions, you wanna protect your eyes, nose, and mouth.
So, that way, you've got an eye shield or goggles and an appropriate mask.
Make sure that you remove that face protection before you exit the room.
Different than what we do for airborne precautions.
Remember, airborne precautions require an N95 or higher respirator.
Now, that's a very special mask that has to be fit tested in order for it to be effective.
Make sure that you're outside of the room and close the door before you take this off and keep that door closed.
Now, it depends on the bug, or the virus, or the bacteria that we're trying to not transmit
to protect the healthcare provider and the patients from that will determine if you have contact, droplet, or airborne.
But I think you're aware, we've had some superbugs lately
that we've used all three of those types of precautions, contact, droplet, and airborne,
and that's when you put all the gear on head to toe, covering your eyes, nose, mouth, torso, arms, and hands.