CNA Skill: Donning and Doffing of Personal Protective Equipment

Personal Protective Equipment (PPE) is a vital component of infection control systems.  PPE will help to keep you, your patient, your coworkers, and visitors safe from disease.

In a medical setting, gloves are the most often used item of PPE.  Gloves are made of vinyl or nitrile rubber and are intended to be used only once.  Gloves should be worn anytime there is a danger of touching infectious material or bodily fluids.

Gowns are another common piece of PPE.  They are usually made of a thin, waterproof fabric, and are most often used only once.  Gowns are worn over the uniform when there is a danger that the medical professional may come into contact with excessive bodily fluids or if the patient is in isolation to prevent infection.

Protection for the face comes in two forms- goggles, worn over the eyes, and masks worn over the nose and mouth.  The eyes, mouth, and nose are the most common pathways for infectious agents, and this PPE protects you from many types of disease.  If you are likely to be exposed to excessive amounts of bodily secretions, you can wear a face shield to protect the entire facial area.

To put on PPE, follow these steps in this order:

• Unfold the gown and hold it so the opening is toward your back.  Place your arms through the sleeves.  Tie the gown snugly at the neck and waist.
• Put on facial protection.  The facemask should fit securely over the nose and mouth.  Goggles should cover the eyes but not interfere with vision.
• Put gloves on last, ensuring that the cuffs of the glove cover the wrists and go over the gown.

When removing PPE, remember that isolation gear should be removed before you leave the patient’s room.  To remove PPE, follow these steps in order:

• Remove gloves first.  Grasp the outside of the glove at the wrist with your other hand and pull to remove it.  Ball the glove up in the fist of your gloved hand.  Grasp the remaining glove inside the wrist, and slowly pull it downwards to remove.  Dispose of the gloves in a proper receptacle.
• Remove the gown by pulling it off from the neckline, so that the sleeves end up turned inside out.  Ball the gown and place it into an appropriate receptacle.
• Remove the face mask and place it into the correct trash container.  Remove the goggles and place them in an area to be decontaminated.
• Once all items have been removed and discarded, carefully wash your hands including your wrists.

Attention to PPE use and disposal will prevent the spread of infection and keep both you and your patient safer and healthier.

Examiners Checklist For This Skill:

1)  Performed beginning tasks.
2) Identified type of isolation required.
3) Applied appropriate personal protective equipment outside the isolation room.
• Mask: Placed mask over nose and mouth, secured appropriately.
• Gown: Applied gown and secured it at neck and waist.
• Gloves: Applied gloves appropriately.
4) Removed Personal Protective Equipment inside the isolation room.
• Gloves: Removed gloves appropriately. Washed hands.
• Gown: Removed gown appropriately. Washed hands.
• Mask: Removed mask appropriately. Washed hands.
5) Discarded Personal Protective Equipment appropriately.
6) Performed completion tasks

Expert Tip by Tanya Glover, CNA

For many CNA’s, PPE is simply gloves. This is a major problem in nursing homes and other health care facilities as more and more workers are being infected by illnesses simply because of their lack of PPE use. Though this may not seem like something that is a big deal while you are a student, in the real world of nursing, PPE can be the line between life and death for both you and your patients. The key is to treat each and every patient as if they are infected with something deadly. This way, you take the proper precautions to protect all involved. This is known as universal precautions.

It is especially important to make proper use of PPE when working with a patient who is in isolation. This is because you do not want what put them there in the first place and because you do not want to give your germs to someone who may already have a seriously compromised immune system. While using PPE is important, it is also important not to go overboard. Allow me to share this experience with you. The first year I was working as a hospice CNA in nursing home, I was assigned to a gentleman who was in the advanced stages of AIDS. This terrified me to no end. Logically I knew that if I took the proper precautions, I could not become infected. However, like many people, my logic was outweighed by my fear of getting AIDS. Because of this fear I put on two gowns, two pairs of gloves and a whole face mask. The patient never showed signs of being upset but I knew he must have been. It must be horrible to know people are afraid to touch you. I knew it could not continue that way so I went to counseling and got over it. Keep in mind that all of our patients are people just like us, even the ones with deadly illnesses. Make them feel comfortable and make sure their last days are full of happy memories.