UNCONTROLLED WHEN PRINTED
Donning / Doffing Quick Reference Guide (Click to expand)
Donning
1.Hand hygiene
2.Gown / coverall
3.Facemask
4.Eye protection / Face shield (face shield recommended if high risk of splashes and sprays of blood and body fluids e.g. trauma, haemorrhage)
5.Gloves

 

Doffing
1.Gloves
2.Hand hygiene
3.Gown / coverall
4.Hand hygiene
5.Eye protection / Face shield
6.Hand hygiene
7.Facemask
8.Hand hygiene

 

Donning Sterile Gloves (CCP Only) (Click to expand)

Sterile or surgical gloves are worn when performing a surgical intervention (e.g. finger thoracostomy). They are manufactured to be free of microorganisms, and help to prevent surgical site infections to patients.

1. Perform hand hygiene (hand sanitiser in field settings OR soap and water with hand sanitiser in clinic or hospital settings)


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2. Select appropriate size gloves for wearer. Check package for integrity and use by date. If in doubt discard and get a new pair.


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3. Open outer wrapper and place glove package on clean dry surface, ensure you fully open outer package so that it does not fold back and contaminate gloves.

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4. Open inner package so that glove cuffs are nearest to you.

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6. The inside of the package is your sterile field.

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7. Whilst taking care not to touch anything else in the sterile field with your non-dominant hand grasp inner surface of glove for dominant hand lifting up and away from the table/surface used.

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8. Slide dominant hand into the glove, taking care to keep hand and fingers above your waist and away from your body.

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9. Slide gloved fingers under the cuff of the glove for the non-dominant hand.

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10. Lift glove up and away from the surface/table used and away from the body.

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11. Slide non-dominant hand into the glove using the same technique as for the dominant hand, avoid contact with gloved dominant hand.

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12. Adjust both gloves to properly fit fingers ensuring no dead space at tip of fingers.

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14. Pull cuffs up onto forearms, taking care not to touch ungloved skin with gloved hands.
Appropriate PPE protects clinical staff and patients from exposure to blood and body fluids, potentially infectious agents; and reduces the occurrence of healthcare associated infections.

Non-clinical PPE (e.g. high-visibility jackets, helmets etc…) are not included in this document. Please refer to relevant Workplace Instructions and Safety information.

PPE includes:

  • Nitrile gloves
  • Surgical facemask
  • P2/N95 respirator
  • Protective eyewear or face shield
  • Coveralls or Gowns

Nitrile Gloves

Gloves are worn as a barrier to protect the hands from contamination or to prevent the transfer of microorganisms already on the hands. They are single use items to be worn when performing invasive procedures, when in contact with non-intact skin or mucous membranes, and any activity where there is high risk of exposure to blood and body fluids, including cleaning of equipment and vehicles.

Gloves do not need to be routinely worn for all patient contact when the risk of exposure to blood and body fluids is minimal.

Prolonged glove use can lead to lack of hand hygiene and increase risk of contact dermatitis.

Hand hygiene must always be performed prior to donning gloves and immediately after removal (Refer to CPG 12.2. Hand Hygiene).

KEY POINT:
Gloves should not be worn as a personal safety strategy as contaminated gloves may be a significant cause of cross-contamination both to self and to the environment (i.e. door and drawer handles, equipment and environmental surfaces).

Surgical Mask

Surgical masks should be worn by the patient on droplet and airborne precautions to contain respiratory secretions of the wearer.

 

    P2/N95 Respirator 

    P2/N95 respirator provides protection from diseases transmitted through the droplet and airborne route. P2/N95 respirators must be fit checked before patient contact.

    Fitting a flat style respirator

    Fitting a cup style respirator

    Indications for use of a P2/N95 respirator:

    • Sprays of blood and body fluids likely (risk assessed as part of standard precautions)
    • Droplet and airborne precautions
    • During an AGP
    • Patient with aerosol generating behaviours
    • When cleaning large amounts of effluvia, blood or body fluid
    • When required by a SJWA directive.

    Indications for removal of P2/N95 respirator:

    • P2/N95 respirator should be changed between patients and when they become damaged soiled or wet
    • International guidance states that P2/N95 respirator can be continuously worn for up to 8 hours. Once they are removed they must be discarded and a new respirator used, if needed.
    • P2/N95 respirator should never be reapplied after they have been removed. 
    • P2/N95 respirator should not be left dangling around the neck. 
    • The front of the respirator is likely to be contaminated therefore touching this area while wearing it should be avoided.
    • Hand hygiene should be performed upon touching or discarding a used respirator.
    KEY POINT:
    Persons who have facial hair (including a 1-2 day beard growth) should be aware that an adequate seal cannot be guaranteed between the P2/N95 respirator and the wearer’s face. 

    Protective Eyewear

    Protective eyewear protects the conjunctiva from exposure to blood, body fluids, and secretions propelled into the air by coughing or sneezing. 

    Reusable protective eyewear should be cleaned and disinfected following use. 

    Disposable full face shields and are recommended when there is a high risk of splashes and sprays of blood and body fluids (e.g. trauma, haemorrhage) and are to be discarded after use. 

    Prescription eyewear is not considered protective as it allows contaminants to travel between the lens and the face. 

    Indications for the use of protective eyewear:

    • Sprays of blood and body fluids likely (risk assessed as part of standard precautions)
    • Droplet and airborne precautions
    • During an AGP
    • Patient with aerosol generating behaviours
    • When cleaning large amounts of effluvia, blood or body fluid
    • When required by a SJWA directive.

    Disposable Coveralls or Gowns

    Disposable fluid-resistant coveralls or gowns are used to prevent skin and uniforms being contaminated with blood/ bodily fluids. The need for a gown/coverall will depend on the degree of risk, including the anticipated degree of contact with infectious material and the potential for blood and body substances to penetrate through to clothes or skin.

    Indications for the use of coveralls/gowns:

    • Sprays of blood and body fluids likely (risk assessed as part of standard precautions)
    • Droplet and airborne precautions
    • During an AGP
    • Patient with aerosol generating behaviours
    • When cleaning large amounts of effluvia, blood or body fluid
    • When required by a SJWA directive
    KEY POINT:
    The risk of self-contamination during the doffing of coveralls is significant.

    PPE not routinely recommended

    The following items are not routinely recommended as part of contact, droplet or airborne precautions, however for specific situations may be introduced as a SJWA directive.

    Head coverings 

    • Generally do not prevent the wearer from contamination.
    • Add in an additional step in PPE doffing process therefore increase the risk of contamination of the wearer.

    Boot covers

    Use of boots covers is not recommended unless gross contamination is anticipated, as:

    • Boot covers can pose safety risk due to the risk of slipping and self-contamination at removal. 
    • Boots should be made of material that can be cleaned and disinfected. 
    • Boots should be wiped over at the end of each shift with a cleaning and disinfectant agent.
    • Boots should be left at the workplace, where practical or left outside the home.

    Powered air-purifying respirators (PAPRs) are an alternative to P2/N95 respirators in selected circumstances:

    • PAPRs require specific training and must only be used by personnel trained in their use, including safe removal with other PPE.
    • Currently only the Special Operations Paramedics and selected staff who have been trained for the Specialised Isolations Ambulances, are able to use PAPRs.

    Donning and Removal of Personal Protective Equipment (PPE)

    To reduce the risk of transmission of infectious agents, PPE must be used appropriately. Ideally PPE should be applied before patient contact. In the pre-hospital setting it is not always possible to identify times when PPE is required and this will need to be assessed on the individual basis. 

    If it is suspected or confirmed the patient has an infection that can be spread by the droplet or airborne route (such as influenza, measles) place a surgical facemask on the patient to help minimise the spread of respiratory droplets. However not all patients will be able to tolerate this. In these cases, encourage the patient to use a tissue to cover their nose and mouth when coughing/sneezing.

    Sequence for donning PPE

    Perform hand hygiene

    Gown/Coveralls

    Gown:

    • Slide arms through the armholes and through the cuffs.
    • Secure the top of the gown at the back of the neck with the ties, tape or Velcro
    • Secure the waist ties

    Coveralls:

    • Select the correct size of coveralls.
    • Unfold and unzip the coveralls.
    • Place each leg into the suit. Take care not touch footwear.
    • Fit coveralls over the body and shoulders, and allow the hood to hang free at the back. 
    • Zip up the coveralls

    P2/N95 respirator

    • Open the P2/N95 respirator by separating the edges
    • Slightly bend nose wire and make sure it is at the tops of the mask
    • Cup mask under chin and pull the bands over your head
    • Adjust the headbands so the lower band is at the base of the head and the top band is at the crown of the head (the bands should sit above and below your ears
    • Gently press the nose wire across the bridge of the nose adjust the edges until the respirator sits snugly on the face
    • A fit check must be performed prior to undertaking any clinical activity in which a P2/N95 respirator is required. Fit checks ensure that the respirator is sealed over the bridge of the nose and mouth and that there are no gaps in the seal between the respirator and the face:
    • Gently inhale. When you breathe in the respirator should draw in slightly toward the face and collapse.
    • When exhaling the respirator should fill up with air. It is important at this stage to check there is no air leakage around the edges of the respirator. Continue adjusting the seal of the respirator if needed.

    Eye protection/face shield

    • If you wear prescription glasses, place the protective eyewear over your glasses.
    • If eye protection fogs up, you do not have a good seal of your P2/N95 respirator – readjust.

    Gloves

    • Select the correct sized gloves. Ensure the gloves are pulled over the sleeve cuffs.

    Sequence for removal (doffing) of PPE

    Gloves

    • Grasp outside of glove with opposite gloved hand and peel off.
    • Hold removed glove in gloved hand.
    • Slide fingers of ungloved hand under the remaining glove at wrist.
    • Peel glove off over the first glove and discard in waste bag.

    Perform hand hygiene

    Gown/Coveralls

    • Gowns - Unfasten ties. Pull away from neck and shoulders, touching the inside of the gown only. Gown front and sleeves are likely to be contaminated. Carefully fold or roll into a bundle and place in waste bag
    • Coveralls - Unzip suit and carefully remove. Roll outwards leaving non-contaminated inside exposed – assistance may be required from a colleague. Carefully fold up suit, and place in waste bag. 

    Perform hand hygiene

    Protective Eyewear/face shield
    • Remove protective eyewear or face shield by handling the ear pieces or headband – avoid touching the front of the eyewear/face shield as this is likely to be contaminated.
    • Reusable eye protection can be cleaned and disinfected. Single use face shields to be disposed in waste bag.

    Perform hand hygiene

    P2/N95 respirator

    • Remove respirator –do not touch the front of the respirator. Handle by the head straps and dispose in waste bag.

    Perform Hand hygiene

    KEY POINT:
    When driving, PPE must be removed EXCEPT when transporting a patient with a suspected/confirmed airborne infection (e.g. measles) or as per a St John WA directive (e.g. COVID-19), when the driver should wear a P2/N95 respirator.

    References

    References

    Government of Western Australia Department of Health. (2013). IC: 0142/13 Fit testing and fit checking of particulate filter respirators (masks) in Western Australian healthcare facilities. Perth, Australia.

    National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2010). Australian guidelines for the prevention and control of infection in healthcare. Canberra, Australia: Commonwealth of Australia.

    Ontario Emergency Services Branch Ministry of Health and Long-Term Care. (2007). Infection Prevention and Control Best Practices Manual for Land Ambulance Paramedics.

    South Western Ambulance Service NHS Trust. (2010). Guidance and procedures for infection prevention and control. Managing healthcare associated infection and control of serious communicable diseases. United Kingdom: South Western Ambulance Service NHS Trust.

    Standards Australia/Standards New Zealand. AS/NZS 4011:1997/Amdt 1:1998. Single-use examination gloves - Specification. Sydney, Australia: Standards Australia International Limited.

    Standards Australia. AS 4381:2002. Single-use face masks for use in healthcare. Sydney, Australia: Standards Australia International Limited.

    Standards Australia/Standards New Zealand. AS/NZS 1716:2003/Amdt 1:2005. Respiratory protective devices. Sydney, Australia: Standards Australia International Limited.

    Standards Australia/Standards New Zealand. AS/NZS 1715:1994. Selection, use and maintenance of respiratory protective devices. Sydney, Australia: Standards Australia International Limited.

    Standards Australia/Standards New Zealand. AS/NZS 1336:1997/Amdt 1:1997. Recommended practices for occupational eye protection. Sydney, Australia: Standards Australia International Limited.

    Standards Australia/Standards New Zealand. AS/NZS 1337:1992/Amdt 1:1994/Amdt 2:1997. Eye protectors for industrial application. Sydney, Australia: Standards Australia International Limited.

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