When caring for patients with Ebola, PPE with full-body coverage is recommended. There should be NO exposed skin. Properly putting on (donning) and removing (doffing) PPE is just as critical to the protection of laboratory workers as selecting the correct PPE to wear upon entering the room of a hospitalized Ebola patient. The CDC emphasizes the importance of the following principles with regard to the correct donning and doffing of PPE:
- Training: Repeated and rigorous training must occur for all healthcare workers before entering the room to care for an Ebola patient.
- Practice: Once trained, healthcare workers should practice donning/doffing procedures for all PPE recommended in the facility's protocols.
- Competence: All healthcare workers involved in the care of Ebola patients must have demonstrated competency (through testing and assessment) in all areas of Ebola-related infection control practices, most notably in using proper procedures to put on and remove the appropriate PPE.
- Observation: At least one onsite manager must oversee the overall safe care of Ebola patients within a facility. A trained observer must supervise and monitor each step of every PPE donning/doffing procedure to ensure proper completion of established PPE protocols.
It is very important to use a controlled and DELIBERATE
pace to ensure that all PPE is both put on properly and removed slowly to be sure that you do not contaminate yourself. The basic rules used to ensure safe and effective PPE use include:
- Donning (putting PPE on): Putting on PPE must be directly observed by a trained observer and each item must be put on in a specific order. Once the PPE items are on, no manipulation of those items can occur inside the patient care area.
- PPE worn during patient care: PPE must be worn correctly, remain in place, and be worn the entire time the healthcare worker is exposed to potentially contaminated areas. Worker should frequently use an alcohol-based hand rub (ABHR) to disinfect their gloved hands, particularly after exposure to body fluids. If a partial or total breach in PPE should occur (eg, a tear in a glove, skin becomes exposed, or a needle stick), move immediately to the doffing area and assess the exposure. If indicated, implement the facility exposure plan.
- Doffing (taking off PPE): Removing PPE is a high-risk process that again requires direct observation by a trained observer. Doffing must be performed in a designated area, using an organized procedure that contains removal steps that must be followed in a very specific order to ensure protection and prevent cross-contamination. A step-by-step process should be used, including hand hygiene with an ABHR after the completion of each doffing step.