Personal Protective Equipment (Home Health Care) - CE/NCPD

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

OVERVIEW

Standard precautions should be used for all patient care for preventing the spread of infection to health care team members or the family and caregivers.^{undefined#ref1">1,2} These precautions are based on risk assessment.^1,2

Personal protective equipment (PPE) is recommended as part of standard precautions whenever there is a chance of possible contact with infectious materials (i.e., contact with blood or body fluids).^1,2 Team members should assume that every patient is potentially infected or colonized with an organism that could be transmitted to a team member or the family and caregivers.^1,2 Standard precautions are recommended for specific topics by the Centers for Disease Control and Prevention (CDC), including:^1,2

• Hand hygiene
• PPE
• Respiratory hygiene and cough etiquette
• Appropriate placement of patients
• Handling and disinfecting patient care equipment and instruments or devices
• Cleaning and disinfecting the environment
• Handling of textiles and laundry
• Safe injection practices

Transmission-based precautions are the second tier of basic infection control and are to be used in addition to standard precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed (e.g., contact, droplet, airborne).^1,2

Other types of isolation precautions should be initiated for patients who are neutropenic, are receiving chemotherapy, or have contracted infectious diseases outside the scope of the second tier of precautions. In these situations, the organization’s practice should be followed.

SUPPLIES

See Supplies tab at the top of the page.

PROCEDURE

1. Determine the appropriate PPE that is needed for the patient care activities to be performed (e.g., handling body fluids, isolation precautions) (Box 1) (Table 1).

   Rationale: Putting on the appropriate type of PPE helps prevent the transmission of infection and provides protection to the team member.^1,2

Putting on PPE (Figure 1)

1. Clean hands and put on appropriate PPE based on the risk of exposure to body fluids or infection precautions.
2. Inspect PPE before putting it on. Ensure that the PPE is intact, that all required PPE and supplies are available, and that the correct size has been selected.
3. Put on a gown, as applicable.
   1. Be sure the gown covers the torso from neck to knees, arms to end of wrists, and that it wraps around the back.
   2. Close the gown securely at the neck and waist.

      Rationale: Putting on a gown correctly prevents the transmission of infection and provides protection if the patient has excessive drainage or discharge.

4. Put on a mask or respirator, as applicable.
   1. Secure the ties, loops, or straps at the middle of the head and neck or ears, as applicable.
   2. Adjust the flexible band over the nose.
   3. Ensure a snug fit to the face and below the chin.
   4. Fit-check the respirator, as applicable.
5. Put on protective eyewear (e.g., goggles, face shield), as applicable.

   Rationale: Putting on eye protection decreases the risk of exposure to pathogens from splashing.

6. Put on gloves, as applicable.
   1. Use nonsterile gloves for isolation.
   2. Select the gloves per hand size.
   3. Extend the gloves to cover the wrist or the cuff of the gown (if worn).
7. Provide the designated care to the patient while maintaining standard precautions.
   1. Keep hands away from the face.
   2. Work from clean to dirty.
   3. Limit touching surfaces in the patient care area.
   4. Replace gloves when torn or heavily contaminated.
   5. Clean hands when appropriate (e.g., before and after glove use).

Taking off PPE (Figure 2) (Figure 3)

1. Remove PPE at the doorway of the patient’s room or in the anteroom.

   If hands become contaminated during PPE removal, immediately clean hands with soap and water or use an alcohol-based hand rub (ABHR).

   Do not touch the outer surface of any of the PPE; it is considered contaminated.^1,2

2. Remove gloves.
   1. Grab the outside of the palm of the glove with the opposite gloved hand.
   2. Hold the removed glove in the gloved hand.
   3. Slide fingers of ungloved hand under the remaining glove at the wrist and peel off the second glove.
3. Remove gown.
   1. Undo ties or other neck closure, then undo the waist ties.

      Do not allow the gown sleeves to touch the rest of body.^1,2

   2. Pull the gown down from each shoulder, away from the body.
   3. Roll the gown inside out.
4. Clean hands if visibly soiled.
5. Remove protective eyewear (e.g., goggles or face shield), as applicable.
6. Remove the mask with face shield, as applicable.
   1. Grasp the ties, loops, or straps.
   2. Pull forward, away from the face.
7. Remove the respirator after leaving the patient’s room if the patient is on airborne isolation precautions, as applicable.
8. Dispose of PPE in the applicable waste container (or place reusable items in the designated container) and clean hands.

EXPECTED OUTCOMES

• Appropriate PPE is chosen, worn, taken off, and discarded correctly.

UNEXPECTED OUTCOMES

• Appropriate PPE is not worn correctly.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). (n.d.). PPE sequence. Retrieved December 12, 2024, from https://www.cdc.gov/healthcare-associated-infections/media/pdfs/ppe-sequence-p.pdf?CDC_AAref_Val=https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
2. Siegel, J.D. and others. (2007, updated 2024). 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Retrieved December 12, 2024, from https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)

Published: January 2025