美国CDC医疗机构内个人防护用品(PPE)选择和课件.ppt

1、Guidance for the Selection and Use of Personal Protective Equipment(PPE)in Healthcare SettingsPPE Use in Healthcare Settings:Program GoalImprove personnel safety in the healthcare environment through appropriate use of PPE.PPE Use in Healthcare SettingsPPE Use in Healthcare Settings:Program Objectiv

2、es Provide information on the selection and use of PPE in healthcare settings Practice how to safely don and remove PPEPPE Use in Healthcare SettingsPersonal Protective Equipment Definition“specialized clothing or equipment worn by an employee for protection against infectious materials”(OSHA)PPE Us

3、e in Healthcare SettingsRegulations and Recommendations for PPE OSHA issues workplace health and safety regulations.Regarding PPE,employers must:Provide appropriate PPE for employees Ensure that PPE is disposed or reusable PPE is cleaned,laundered,repaired and stored after use OSHA also specifies ci

4、rcumstances for which PPE is indicated CDC recommends when,what and how to use PPEPPE Use in Healthcare SettingsHierarchy of Safety and Health Controls Training and administrative controls Engineering controls Work practice controls Personal protective equipmentPPE Use in Healthcare SettingsTypes of

5、 PPE Used in Healthcare Settings Gloves protect hands Gowns/aprons protect skin and/or clothing Masks and respirators protect mouth/nose Respirators protect respiratory tract from airborne infectious agents Goggles protect eyes Face shields protect face,mouth,nose,and eyesPPE Use in Healthcare Setti

6、ngsFactors Influencing PPE Selection Type of exposure anticipated Splash/spray versus touch Category of isolation precautions Durability and appropriateness for the task FitPPE Use in Healthcare SettingsGloves Purpose patient care,environmental services,other Glove material vinyl,latex,nitrile,other

7、 Sterile or nonsterile One or two pair Single use or reusablePPE Use in Healthcare SettingsGloves Purpose patient care,environmental services,other Glove material vinyl,latex,nitrile,other Sterile or non-sterile One or two pair Single use or reusablePPE Use in Healthcare SettingsDos and Donts of Glo

8、ve Use Work from“clean to dirty”Limit opportunities for“touch contamination”-protect yourself,others,and the environment Dont touch your face or adjust PPE with contaminated gloves Dont touch environmental surfaces except as necessary during patient carePPE Use in Healthcare SettingsDos and Donts of

9、 Glove Use(contd)Change gloves During use if torn and when heavily soiled(even during use on the same patient)After use on each patient Discard in appropriate receptacle Never wash or reuse disposable glovesPPE Use in Healthcare SettingsGowns or Aprons Purpose of use Material Natural or man-made Reu

10、sable or disposable Resistance to fluid penetration Clean or sterilePPE Use in Healthcare SettingsFace Protection Masks protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration Goggles protect eyes Should fit snuggly over and around eyes Personal glasses not a substitut

11、e for goggles Antifog feature improves clarityPPE Use in Healthcare SettingsFace Protection Face shields protect face,nose,mouth,and eyes Should cover forehead,extend below chin and wrap around side of facePPE Use in Healthcare SettingsRespiratory Protection Purpose protect from inhalation of infect

12、ious aerosols(e.g.,Mycobacterium tuberculosis)PPE types for respiratory protection Particulate respirators Half-or full-face elastomeric respirators Powered air purifying respirators(PAPR)PPE Use in Healthcare SettingsElements of a Respiratory Protection Program Medical evaluation Fit testing Traini

13、ng Fit checking before usePPE Use in Healthcare SettingsFor additional information on respirators.http:/www.cdc.gov/niosh/npptl/respirators/respsars.html http:/www.cdc.gov/niosh/99-143.html http:/www.cdc.gov/niosh/topics/respiratorsPPE Use in Healthcare SettingsPPE Use in Healthcare Settings:How to

14、Safely Don,Use,and Remove PPEKey Points About PPE Don before contact with the patient,generally before entering the room Use carefully dont spread contamination Remove and discard carefully,either at the doorway or immediately outside patient room;remove respirator outside room Immediately perform h

15、and hygienePPE Use in Healthcare SettingsSequence*for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves*Combination of PPE will affect sequence be practicalPPE Use in Healthcare SettingsHow to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and

16、 waist If gown is too small,use two gowns Gown#1 ties in front Gown#2 ties in backPPE Use in Healthcare SettingsHow to Don a Mask Place over nose,mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fitPPE Use in Healthcare SettingsHow to Don a Partic

17、ulate Respirator Select a fit tested respirator Place over nose,mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check Inhale respirator should collapse Exhale check for leakage around facePPE Use in Healthcare SettingsHow to Don Eye and

18、 Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortablyPPE Use in Healthcare SettingsHow to Don Gloves Don gloves last Select correct type and size Insert hands into

19、gloves Extend gloves over isolation gown cuffsPPE Use in Healthcare SettingsHow to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn;perform hand hygiene before donning new gloves Limit surfaces and items touchedPPE Use in Healthc

20、are SettingsPPE Use in Healthcare Settings:How to Safely Remove PPE“Contaminated”and“Clean”Areas of PPE Contaminated outside front Areas of PPE that have or are likely to have been in contact with body sites,materials,or environmental surfaces where the infectious organism may reside Clean inside,ou

21、tside back,ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organismPPE Use in Healthcare SettingsSequence for Removing PPE Gloves Face shield or goggles Gown Mask or respiratorPPE Use in Healthcare SettingsWhere to Remove PPE At doorway,before leavi

22、ng patient room or in anteroom*Remove respirator outside room,after door has been closed*Ensure that hand hygiene facilities are available at the point needed,e.g.,sink or alcohol-based hand rubPPE Use in Healthcare SettingsHow to Remove Gloves(1)Grasp outside edge near wrist Peel away from hand,tur

23、ning glove inside-out Hold in opposite gloved handPPE Use in Healthcare SettingsHow to Remove Gloves(2)Slide ungloved finger under the wrist of the remaining glove Peel off from inside,creating a bag for both gloves DiscardPPE Use in Healthcare SettingsRemove Goggles or Face Shield Grasp ear or head

24、 pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposalPPE Use in Healthcare SettingsRemoving Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle DiscardPPE Use i

25、n Healthcare SettingsRemoving a Mask Untie the bottom,then top,tie Remove from face DiscardPPE Use in Healthcare SettingsRemoving a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic DiscardPPE Use in Healthcare SettingsHand Hygiene Perform hand hygiene

26、 immediately after removing PPE.If hands become visibly contaminated during PPE removal,wash hands before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rubPPE Use in Healthcare Settings*Ensure that hand hygiene facilities are available at the point needed,e.g.,

27、sink or alcohol-based hand rubPPE Use in Healthcare Settings:When to Use PPEStandard and Expanded Isolation PrecautionsStandard Precautions Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious Recommends PPE and other infection control practices to

28、prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patientPPE Use in Healthcare SettingsPPE for Standard Precautions(1)Gloves Use when touching blood,body fluids,secretions,excretions,contaminated items;for touching mucus membranes

29、and nonintact skin Gowns Use during procedures and patient care activities when contact of clothing/exposed skin with blood/body fluids,secretions,or excretions is anticipatedPPE Use in Healthcare SettingsPPE for Standard Precautions(2)Mask and goggles or a face shield Use during patient care activi

30、ties likely to generate splashes or sprays of blood,body fluids,secretions,or excretionsPPE Use in Healthcare SettingsWhat Type of PPE Would You Wear?Giving a bed bath?Suctioning oral secretions?Transporting a patient in a wheel chair?Responding to an emergency where blood is spurting?Drawing blood

31、from a vein?Cleaning an incontinent patient with diarrhea?Irrigating a wound?Taking vital signs?PPE Use in Healthcare SettingsWhat Type of PPE Would You Wear?Giving a bed bath?Generally none Suctioning oral secretions?Gloves and mask/goggles or a face shield sometimes gown Transporting a patient in

32、a wheel chair?Generally none required Responding to an emergency where blood is spurting?Gloves,fluid-resistant gown,mask/goggles or a face shield Drawing blood from a vein?Gloves Cleaning an incontinent patient with diarrhea?Gloves w/wo gown Irrigating a wound?Gloves,gown,mask/goggles or a face shi

33、eld Taking vital signs?Generally nonePPE Use in Healthcare SettingsPPE for Expanded Precautions Expanded Precautions include Contact Precautions Droplet Precautions Airborne Infection IsolationPPE Use in Healthcare SettingsUse of PPE for Expanded Precautions Contact Precautions Gown and gloves for c

34、ontact with patient or environment of care(e.g.,medical equipment,environmental surfaces)In some instances these are required for entering patients environment Droplet Precautions Surgical masks within 3 feet of patient Airborne Infection Isolation Particulate respirator*Negative pressure isolation

35、room also requiredPPE Use in Healthcare SettingsHand Hygiene Required for Standard and Expanded Precautions Perform Immediately after removing PPE Between patient contacts Wash hands thoroughly with soap and water or use alcohol-based hand rubPPE Use in Healthcare SettingsPPE Use in Healthcare Settings:Final Thoughts PPE is available to protect you from exposure to infectious agents in the healthcare workplace Know what type of PPE is necessary for the duties you perform and use it correctly