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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Determine whether the patient has a known or suspected airborne transmissible disease. Wear respiratory protection, such as an N95 respirator or disposable particulate respirator, when caring for a patient with a known or suspected airborne transmissible disease.2
Masks, caps (head covering), and eye protection are articles of PPE worn to prevent contact with infectious agents, vector agents (bedbugs, lice, fleas, ticks), or bodily fluids that may contain an infectious agent. PPE’s effectiveness is created by a barrier between health care team members, the patient or a visitor, and the infectious or vector agent.
The appropriate PPE is based on the type of exposure anticipated for patient care (e.g., touch, splashes, or sprays), type (if any) of isolation precautions, proper fit of the PPE, and compliance with the organization’s practice for use of PPE.
Although masks and caps are usually worn in surgical procedure areas, there are aseptic procedures performed in the patient’s home that also require these barriers. For example, a health care team member may be required to wear a mask while accessing an implanted venous access device or a peripherally inserted central catheter. Hair that is exposed or loose may be a source of bacteria, increasing the risk of infection. When performing bedside procedures, such as dressing changes for patients with burns, caps may be worn to contain hair. The health care team member should use good judgment and follow the organization’s practice.
A surgical mask is recommended when caring for immunosuppressed patients, patients with open wounds, or patients with a disease that is transmitted via the respiratory route. For diseases that are transmitted via the airborne route (e.g., tuberculosis, chicken pox), an N95 respirator mask is recommended. The organization’s practice should be followed to protect the patient, family, caregivers, visitors, and the health care team from the spread of disease. The immunosuppressed patient is at risk for acquiring an infection from the health care team member performing a central line dressing change if he or she does not wear a mask. A mask decreases the incidence of microorganisms escaping from the health care team member’s mouth and nose, and contaminating the field.
Eye protection, such as goggles or a face shield, protect the membranes of the eyes, nose, and mouth when performing tasks that could generate splashes or sprays of bodily fluids.2 Eye protection provides barrier protection for the eyes. Goggles should fit snugly over and around the eyes or over personal prescription lenses. When skin protection is also needed, a face shield should be donned. A face shield should cover the forehead, extend below the chin, and wrap around the sides of the face.
PPE should be donned before initiating contact with the patient. When all immediate tasks are completed, the PPE is removed carefully to prevent self-contamination. If hands become contaminated while removing any article of PPE, they should be washed or decontaminated with an alcohol-based agent if washing with soap and water is not possible in the home setting. Handwashing should occur before removing the next article of PPE. All articles of PPE should be discarded in the appropriate receptacles. Gloves should be removed first (if worn), followed by eye protection (goggles or face shield), and then the mask and cap. Hand hygiene must be performed after removal of PPE.
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Rationale: Airborne precautions should be used when caring for a patient who is known or suspected to be infected with microorganisms that can be transmitted by an airborne route.
Do not use personal prescription lenses in place of goggles. Personal prescription lenses do not provide adequate eye protection.
Remove articles of PPE carefully to prevent self-contamination. If hands become contaminated while removing the cap, mask, or eye protection, perform hand hygiene before removing the next article.
The clear faceplate may become contaminated with droplets. Avoid touching the faceplate.4
Do not touch the front of the mask.
Rationale: Untying the bottom strings first prevents the top part of the mask from falling and contaminating the uniform.
Rationale: Untying the mask strings and holding them securely away from the mask prevents hand contact with the contaminated mask.
Rationale: Lifting the cap by the outer surface minimizes hand contact with hair.
The N95 respirator should be removed and discarded without touching the front of the mask.
Valdez, A.M. (2015). Are you covered? Safe practices for the use of personal protective equipment. Journal of Emergency Nursing, 41(2), 154-157. doi:10.1016/j.jen.2014.11.011
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