{"id":67,"date":"2018-06-05T11:34:02","date_gmt":"2018-06-05T15:34:02","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/"},"modified":"2020-03-23T18:21:29","modified_gmt":"2020-03-23T22:21:29","slug":"1-4-additional-precautions-and-personal-protective-equipment-ppe","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/","title":{"raw":"1.4 Additional Precautions and Personal Protective Equipment (PPE)","rendered":"1.4 Additional Precautions and Personal Protective Equipment (PPE)"},"content":{"raw":"Certain pathogens and communicable diseases are easily transmitted\u00a0and require additional precautions to interrupt the spread of suspected or identified agents to healthcare providers, other patients, and visitors (PIDAC, 2012). Additional precautions are used in addition to routine precautions and are defined by how a microorganism is transmitted (Perry et al., 2014).\r\n\r\n<strong>Point of Care Risk Assessment<\/strong> <strong>(PCRA)<\/strong> is the first step in routine practices. As such healthcare workers should be doing this with all patients for all care at all times. It involves assessing the infection risk posed to themselves and others by the\u00a0patient, a procedure or a situation. Personal protective equipment (PPE)\u00a0is chosen based on that risk (Vancouver Coastal Health, 2017).\r\n<h2>Types of Additional Precautions<\/h2>\r\nThere are three categories of additional precautions: contact precautions, droplet precautions, and airborne precautions (CDC, 2007).\r\n\r\n<strong>Contact precautions<\/strong> are are the most common type of additional precautions. They are used in addition to routine practice for patients who are known or suspected to be infected with microorganisms that can be transferred by direct (touching) or indirect (shared equipment) contact. Types of organisms in this category are <strong>antibiotic-resistant organisms (AROs)<\/strong> such as methicillin-resistant <em>Staphylococcus\u00a0aureus<\/em> (MRSA), extended spectrum beta-lactamase (ESBL), <em>Clostridium difficile<\/em> (CDI), carbapenemase-producing organisms (CPO),\u00a0diarrhea, and scabies. AROs are also known as multi-drug-resistant organisms (MDROs).\r\n\r\n<strong>Droplet precautions<\/strong> are used in addition to routine practices for patients who are known or suspected to be infected with microorganisms that are spread through the air by large droplets. Types of organisms and unconfirmed conditions in this category include mumps, influenza, vomiting of unknown cause, norovirus, and unconfirmed cough.\r\n\r\n<strong>Airborne precautions<\/strong> are used in addition to routine practices for patients who are known to have or are suspected of having an illness that is transmitted by small droplet nuclei that may stay suspended in the air and be inhaled by others.\u00a0These particles can remain infectious for a long period of time when spread through the air. Types of organisms in this category include tuberculosis (TB), measles, chicken pox (varicella), disseminated zoster, and severe acute respiratory syndrome (SARS).\r\n<h4>Special considerations:<\/h4>\r\n<ul>\r\n \t<li>Signage and accommodation: Signs\u00a0must state the type of precaution required for the patient and be displayed on the door or at the foot of the bed. Accommodation in a private room, or cohorting patients with the same type of infection, is acceptable. Private bathrooms are preferred.<\/li>\r\n \t<li>Personal protective equipment (PPE): PPE is clothing or equipment worn to protect staff from catching or transmitting an infection. Depending on the type of additional precaution,\u00a0PPEs are required when performing patient care tasks and may consist of a mask, gown, gloves, face shield, and\/or eyewear.<\/li>\r\n \t<li>Consistent communication: Patients on additional precautions must be clearly identified on their patient chart or requisitions to ensure all hospital personnel, departments, or other healthcare settings know what additional precautions to use.<\/li>\r\n \t<li>Visitor information: Visitors must be informed of the precautions and must wear the appropriate PPEs and follow the routine practices for healthcare settings. Visitors also must wear the same PPEs as the healthcare provider if providing direct care for the patient.<\/li>\r\n \t<li>Multiple additional precautions: Some microorganisms may be transmitted by more than one mode and, therefore, more than one additional precaution is needed.\u00a0For example, a patient with suspected or confirmed Ebola virus disease (EVD) would be on contact and droplet precautions.<\/li>\r\n \t<li>Aerosol procedures: Aerosol-generating medical procedures (such as tracheostomy care, CPR, nebulized therapy) may increase risk of transmitting infectious agents. Airborne precautions should be initiated during specific procedures when a patient is suspected of having or confirmed to have TB.<\/li>\r\n \t<li>Equipment is patient specific (i.e., BP cuffs, stethoscopes, BGMs) and not used on others unless thoroughly cleaned. Ideally all patient equipment stays in the room with that patient.<\/li>\r\n<\/ul>\r\nTables 1.1, 1.2, and 1.3. summarize the three categories of additional precautions.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\r\n<h3 style=\"text-align: center\">Table 1.1 Contact Precaution Guidelines<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">PPE<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Private Room<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Visitors<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Cleaning<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Gown, gloves<\/td>\r\n<td style=\"border: 1px solid #000000\">Private room preferred or cohort\u00a0patients.\r\n\r\nMust have own dedicated equipment.<\/td>\r\n<td style=\"border: 1px solid #000000\">Gown and gloves must be worn if providing direct care.\r\n\r\nMust perform hand hygiene before and after care.\r\n\r\nMust not go into other patient rooms.<\/td>\r\n<td style=\"border: 1px solid #000000\">Patient: none required\r\n\r\nStaff: gown and gloves<\/td>\r\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.\r\n\r\n&nbsp;<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012;\u00a0PHAC, 2013;\u00a0Siegal, Rhinehart, Jackson, &amp; HICPAC, 2007<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><\/h3>\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\r\n<h3 style=\"text-align: center\">Table 1.2 Droplet Precautions<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">PPE<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Private Room<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Visitors<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Cleaning<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Gloves, gown, and a surgical mask if within two metres of the patient<\/td>\r\n<td style=\"border: 1px solid #000000\">Private room preferred or cohort.\r\n\r\nMust have own dedicated equipment.\r\n\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000\">Gown, gloves, surgical masks, and eye protection are worn for all activities within two metres of the patient.\r\n\r\nThe patient must wear a surgical mask when leaving the room.\r\n\r\nThe door may remain open.\r\n\r\nStrict adherence to hand hygiene must be observed.\r\n\r\nGloves, gown, and surgical mask must be worn \u00a0if providing direct care.\u00a0Must perform hand hygiene before and after care.\r\n\r\nVisitors may not go into other patient rooms.<\/td>\r\n<td style=\"border: 1px solid #000000\">Patient: gown, surgical mask<\/td>\r\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012; PHAC, 2013; Siegal et al., 2007<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><\/h3>\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\r\n<h3 style=\"text-align: center\">Table 1.3 Airborne Precautions<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">PPE<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Private Room<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Visitors<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\r\n<\/td>\r\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Cleaning<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Must wear N95 respirator prior to entering room.\r\n\r\nStrict adherence to hand hygiene.\r\n\r\nMust remove N95 respirator after exiting the room.\r\n\r\nNo immune-compromised persons to enter room. Care providers should have current vaccines.<\/td>\r\n<td style=\"border: 1px solid #000000\">Yes.\r\n\r\nMust have a negative pressure room.\r\n\r\nMust have own dedicated equipment.\r\n\r\nKeep the door closed whether or not the patient is in the room.\r\n\r\nThe room should have bathroom facilities.\r\n\r\nThe room must be a single room, preferably one that is under negative pressure. When a negative pressure room is unavailable, refer to your health authority policy to determine whether a transfer to another facility is mandated.<\/td>\r\n<td style=\"border: 1px solid #000000\">Gloves, gown, and surgical mask required if providing direct care.Must perform hand hygiene before and after care.\r\n\r\nMust not go into other patient rooms.<\/td>\r\n<td style=\"border: 1px solid #000000\">Patient: must wear surgical mask\r\n\r\nStaff: N95 mask<\/td>\r\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012; PHAC, 2013; Siegal et al., 2007<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Personal Protective Equipment (PPE)<\/h2>\r\nAdditional precautions require the use of <strong>personal protective equipment (PPE)<\/strong>,\u00a0which is equipment or clothing worn by staff to prevent the transmission of infection from patient to staff or to family member (PIDAC, 2012). All PPE must be applied and removed in a specific order to ensure the skin, nose, mouth, and eyes are covered to prevent transmission of infection to healthcare providers. Depending on the type of additional precaution or risk assessment, a\u00a0gown, goggles, face shield, and mask (surgical or N95) may be used during patient care. Refer to Checklist 6 for steps to take when donning (putting on) PPE.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\r\n<h3 style=\"text-align: center\"><span style=\"color: #333333\">\u00a0 \u00a0 <a id=\"checklist6\"><\/a>Checklist 6: Donning PPE<\/span><\/h3>\r\n<h5 style=\"text-align: center\"><span style=\"color: #333333\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\r\n<h5 style=\"text-align: left\"><span style=\"color: #333333\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">The selection of PPE is based on the nature of the interaction with the patient and the likelihood of transmission of infectious agents. <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">PPE should be put on just prior to the interaction with the patient and should be removed immediately after the interaction, followed by hand hygiene. <\/span><\/li>\r\n \t<li style=\"text-align: left\">Donning of PPE is usually done outside the patient's room.<\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Patients may feel depressed or lonely when isolated in a room or experiencing decreased contact with healthcare providers. Support for individuals on isolation must be provided. Conversely, some patients may appreciate the privacy of an individual room.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">1. Remove rings, bracelets, and watches. Perform hand hygiene.<\/td>\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">This prepares hands for direct patient care.\r\n\r\n[caption id=\"attachment_112\" align=\"aligncenter\" width=\"218\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"218\" height=\"145\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">2. Apply waterproof long-sleeved gown. Tie the neck and waist strings.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Waterproof gown prevents any potential cross-contamination from blood or body fluids onto forearms and body.\r\n\r\n[caption id=\"attachment_113\" align=\"aligncenter\" width=\"213\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00004.jpg\"><img class=\"wp-image-61\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-300x200.jpg\" alt=\"Apply water proof gown\" width=\"213\" height=\"142\" \/><\/a> Apply waterproof gown[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3.\u00a0Apply mask. Remember different masks are required for different situations. Ensure the fit is secure with no air leaks. Secure the metal band around the nose and pull mask over chin as required.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Wearing a poor-fitting mask is the number one reason for exposure to pathogens for healthcare providers.\r\n\r\nMasks should be worn if provider is within two metres of a coughing or sneezing patient or if there is a potential for spray of secretions or excretions.\r\n\r\n[caption id=\"attachment_117\" align=\"aligncenter\" width=\"213\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00007.jpg\"><img class=\"wp-image-62\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00007-300x200.jpg\" alt=\"Surgical mask (L) and N95 mask (R)\" width=\"213\" height=\"142\" \/><\/a> Surgical mask (left) and N95 mask (right)[\/caption]\r\n\r\nReplace mask if it becomes wet or soiled.\r\n\r\n[caption id=\"attachment_118\" align=\"aligncenter\" width=\"207\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00008.jpg\"><img class=\"wp-image-63\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-300x200.jpg\" alt=\"Apply mask\" width=\"207\" height=\"138\" \/><\/a> Apply mask[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4.\u00a0Apply goggles or face shield.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Goggles or a face shield prevents accidental exposure to eyes, nose, and mouth. Goggles can be placed on top of eyeglasses.\r\n\r\nPrescription glasses are not an alternative to goggles as they do not protect the entire eye.\r\n\r\n[caption id=\"attachment_119\" align=\"aligncenter\" width=\"200\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00009.jpg\"><img class=\"wp-image-64\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-300x200.jpg\" alt=\"Applying goggles\" width=\"200\" height=\"133\" \/><\/a> Apply goggles[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">5.\u00a0Apply non-sterile gloves over top of the cuff of the gown.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Non-sterile gloves ensure complete coverage of skin on arms for direct patient care.\r\n\r\n[caption id=\"attachment_121\" align=\"aligncenter\" width=\"207\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00011.jpg\"><img class=\"wp-image-65\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00011-300x200.jpg\" alt=\"apply non-sterile gloves over top of sleeves\" width=\"207\" height=\"138\" \/><\/a> Apply non-sterile gloves over top of sleeves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source:\u00a0Barratt, Shaban, &amp; Moyle, 2011; PIDAC, 2012;\u00a0PHAC, 2012b<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nSee Checklist 7 for steps on how to doff (or remove) PPE.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist7\"><\/a>Checklist 7: Doffing PPE<\/h3>\r\n<h5 style=\"text-align: center\"><span style=\"color: #333333\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">1. Remove gloves.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Grasp outer edge of glove by wrist and peel away from hand, rolling the glove inside out. Roll it into a ball in gloved hand.\r\n\r\nWith the bare hand, reach under the second glove and gently peel down off the fingers.\r\n\r\n[caption id=\"attachment_5943\" align=\"aligncenter\" width=\"271\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-191.jpg\"><img class=\"wp-image-66\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-300x125.jpg\" alt=\"Place bare finger under gloved hand to avoid contamination from glove\" width=\"271\" height=\"113\" \/><\/a> Place bare finger under glove to avoid contamination from glove[\/caption]\r\n\r\nDrop glove into garbage bin.\r\n\r\nAlways perform hand hygiene after removing gloves. Gloves are not tear- or leak-proof. Hands may have been contaminated upon removal of the gloves.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">2. <a href=\"http:\/\/opentextbc.ca\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">Use soap and water if hands are visibly\u00a0dirty.\r\n\r\n[caption id=\"attachment_112\" align=\"aligncenter\" width=\"224\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"224\" height=\"149\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3. Remove gown.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Remove gown in a manner that does not contaminate clothing. Starting at the neck ties, pull the outer (contaminated) part forward and, turned inward, roll into a ball. Discard in appropriate receptacle bin.\r\n\r\n[caption id=\"attachment_113\" align=\"aligncenter\" width=\"233\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00004.jpg\"><img class=\"wp-image-61\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-300x200.jpg\" alt=\"Remove gown\" width=\"233\" height=\"155\" \/><\/a> Remove gown[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4. <a href=\"http:\/\/opentextbc.ca\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Always perform hand hygiene after removing gown. Hands may have been contaminated upon removal of the gown.\r\n\r\n[caption id=\"attachment_112\" align=\"aligncenter\" width=\"251\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"251\" height=\"167\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">5. Remove eye protection or face shield.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Arms of goggles and the headband on the face shield are considered clean. Handle these only by the sides. The front of the face shield or goggles is considered contaminated. Dispose them according to agency policy.\r\n\r\n[caption id=\"attachment_119\" align=\"aligncenter\" width=\"212\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00009.jpg\"><img class=\"wp-image-64\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-300x200.jpg\" alt=\"Remove goggles\" width=\"212\" height=\"141\" \/><\/a> Remove goggles[\/caption]\r\n\r\nEnsure you are at least two meters from the patient when removing eyewear.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">6. Remove mask or N95 respirator.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Ties, earlobe loops, or straps are considered clean and may be touched. If tied, remove bottom tie first, then top tie. Remove ear loops or straps by leaning forward to allow the mask to slip off your face.\r\n\r\nMasks are removed outside the patient room\r\n\r\nDispose of the mask in the garbage bin.\r\n\r\n[caption id=\"attachment_118\" align=\"aligncenter\" width=\"210\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00008.jpg\"><img class=\"wp-image-63\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-300x200.jpg\" alt=\"Remove mask\" width=\"210\" height=\"140\" \/><\/a> Remove mask[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">7.\u00a0 Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_112\" align=\"aligncenter\" width=\"210\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"210\" height=\"140\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Barratt et al., 2011; Perry et al., 2014;\u00a0PHAC, 2012b; Siegal et al., 2007<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox shaded\" style=\"text-align: center\"><span style=\"font-size: 1em\">Watch the video <\/span><a href=\"https:\/\/barabus.tru.ca\/nursing\/donning_and_doffing.html\"><em style=\"font-size: 1em\">Donning and Doffing PPE<\/em><\/a><span style=\"font-size: 1em\">\u00a0by Ren\u00e9e Anderson &amp; Wendy McKenzie Thompson Rivers University<\/span><\/div>\r\n<div class=\"textbox shaded\" style=\"text-align: center\"><span style=\"font-size: 1em\">Please note the CDC offers another option for doffing PPE. See <em>How to Remove PPE Example 2 on page 3\u00a0<\/em> \u00a0<\/span><a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\"><span style=\"font-size: 1em\">https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf<\/span><\/a><\/div>\r\n<div><\/div>\r\n<h2>Blood or Body Fluid (BBF) Exposure<\/h2>\r\nA <strong>blood and body fluid (BBF) <\/strong><strong>exposure<\/strong>\u00a0is defined as an exposure to potentially infectious body fluids or blood through the following methods: a puncture wound by a sharp object or needle (percutaneous exposure), from a body fluid\/blood splash onto your mucous membranes (permucosal exposure) or exposure through eczema, an open wound\/skin or scratch (non-intact skin exposure) (BCCDC, 2015).\r\n\r\nPost-exposure management is only required when (1) percutaneous, permucosal, or non-intact skin is exposed to a BBF; (2) the exposure is to blood or potentially infectious body tissue or fluid; (3) the source is considered potentially infectious (e.g., patient is part of a high-risk group, exposure occurred in a high-risk setting, or patient has a positive test); and (4) the exposed person is considered susceptible to HIV, hepatitis B, or hepatitis C. Checklist 8 explains what to do if exposed.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist8\"><\/a>Checklist 8: BBF Exposure<\/h3>\r\n<h5 style=\"text-align: center\"><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">\r\n<h5>Safety considerations:<\/h5>\r\n<ul>\r\n \t<li>Evidence shows that antiretroviral therapy can reduce the transmission of HIV by 86%.<\/li>\r\n \t<li>The risks and benefits of the post-exposure immunoprophylaxis should be discussed and appropriate recommendations made by the physician to the exposed person.<\/li>\r\n \t<li>Despite the relatively low risk of infection from an exposure, the event is associated with stress and anxiety for the exposed person.<\/li>\r\n \t<li>Seek advice from a physician at a hospital, walk-in clinic, or community clinic within two hours of any BBF exposure.<\/li>\r\n \t<li>Not all body fluids are implicated in transmission of viruses.\u00a0Search the <a href=\"http:\/\/www.bccdc.ca\/search?k=cps_cdmanual_bbfexpmangt_20150715.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">CDC guidelines<\/a>\u00a0to understand which body fluids are implicated in transmitting HIV and hepatitis B and C.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">1. Wash the exposed skin, mucous membrane, or eye.<\/p>\r\n<\/td>\r\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">Skin: Wash the area thoroughly with soap and water.\r\n\r\nMucous membranes or eye: Rinse area with water or normal saline.\r\n\r\nAllow injury\/wound site to bleed freely and then cover lightly.\r\n\r\nDo not promote bleeding of percutaneous injuries by cutting, scratching, or squeezing or puncturing the skin. This may damage the skin and increase uptake of any pathogens.\r\n\r\nDo not apply bleach or soak wound\/injury in bleach.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">2. Contact first aid for assistance and obtain proper forms. These forms are also available in emergency departments.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">If unable to contact first aid, proceed to the emergency room.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">3. Advise your supervisor or charge nurse of the incident. Ask them to complete the required form and return it to you. If available take the patient name &amp; date of birth with you to the emergency department to allow for cross referencing and necessary follow up.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step allows for follow-up by the manager, in relation to a BBF exposure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">4. A risk assessment should be completed within two hours. Go to the emergency room or urgent care centre and be assessed by a physician\/NP.<\/p>\r\n<p style=\"text-align: left\">Inform the department personnel that an occupational BBF exposure has occurred. You will be assessed and blood work will be drawn.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Emergency rooms or other health agencies are supplied with antiretroviral kits from the BC Centre for Excellence in HIV\/AIDS.\r\n\r\nPhysicians will assess your risk of exposure and the risk of transmission from source.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"text-align: left\">5.\u00a0Following treatment, return to your department and report the incident according to agency policy.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This ensures that the proper procedure is followed and the incident form is filled out to prevent or minimize further exposure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">\r\n<p style=\"text-align: left\">Data source: BCCDC, 2015<\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>What is a point of care risk assessment?<\/li>\r\n \t<li>What resources are available to the nurse when making decisions about implementing additional precautions?<\/li>\r\n \t<li>A family member has come into the healthcare setting to visit his mother, who has been admitted with chicken pox. List four infection preventive measures to discuss with the family member.<\/li>\r\n<\/ol>\r\n<\/div>","rendered":"<p>Certain pathogens and communicable diseases are easily transmitted\u00a0and require additional precautions to interrupt the spread of suspected or identified agents to healthcare providers, other patients, and visitors (PIDAC, 2012). Additional precautions are used in addition to routine precautions and are defined by how a microorganism is transmitted (Perry et al., 2014).<\/p>\n<p><strong>Point of Care Risk Assessment<\/strong> <strong>(PCRA)<\/strong> is the first step in routine practices. As such healthcare workers should be doing this with all patients for all care at all times. It involves assessing the infection risk posed to themselves and others by the\u00a0patient, a procedure or a situation. Personal protective equipment (PPE)\u00a0is chosen based on that risk (Vancouver Coastal Health, 2017).<\/p>\n<h2>Types of Additional Precautions<\/h2>\n<p>There are three categories of additional precautions: contact precautions, droplet precautions, and airborne precautions (CDC, 2007).<\/p>\n<p><strong>Contact precautions<\/strong> are are the most common type of additional precautions. They are used in addition to routine practice for patients who are known or suspected to be infected with microorganisms that can be transferred by direct (touching) or indirect (shared equipment) contact. Types of organisms in this category are <strong>antibiotic-resistant organisms (AROs)<\/strong> such as methicillin-resistant <em>Staphylococcus\u00a0aureus<\/em> (MRSA), extended spectrum beta-lactamase (ESBL), <em>Clostridium difficile<\/em> (CDI), carbapenemase-producing organisms (CPO),\u00a0diarrhea, and scabies. AROs are also known as multi-drug-resistant organisms (MDROs).<\/p>\n<p><strong>Droplet precautions<\/strong> are used in addition to routine practices for patients who are known or suspected to be infected with microorganisms that are spread through the air by large droplets. Types of organisms and unconfirmed conditions in this category include mumps, influenza, vomiting of unknown cause, norovirus, and unconfirmed cough.<\/p>\n<p><strong>Airborne precautions<\/strong> are used in addition to routine practices for patients who are known to have or are suspected of having an illness that is transmitted by small droplet nuclei that may stay suspended in the air and be inhaled by others.\u00a0These particles can remain infectious for a long period of time when spread through the air. Types of organisms in this category include tuberculosis (TB), measles, chicken pox (varicella), disseminated zoster, and severe acute respiratory syndrome (SARS).<\/p>\n<h4>Special considerations:<\/h4>\n<ul>\n<li>Signage and accommodation: Signs\u00a0must state the type of precaution required for the patient and be displayed on the door or at the foot of the bed. Accommodation in a private room, or cohorting patients with the same type of infection, is acceptable. Private bathrooms are preferred.<\/li>\n<li>Personal protective equipment (PPE): PPE is clothing or equipment worn to protect staff from catching or transmitting an infection. Depending on the type of additional precaution,\u00a0PPEs are required when performing patient care tasks and may consist of a mask, gown, gloves, face shield, and\/or eyewear.<\/li>\n<li>Consistent communication: Patients on additional precautions must be clearly identified on their patient chart or requisitions to ensure all hospital personnel, departments, or other healthcare settings know what additional precautions to use.<\/li>\n<li>Visitor information: Visitors must be informed of the precautions and must wear the appropriate PPEs and follow the routine practices for healthcare settings. Visitors also must wear the same PPEs as the healthcare provider if providing direct care for the patient.<\/li>\n<li>Multiple additional precautions: Some microorganisms may be transmitted by more than one mode and, therefore, more than one additional precaution is needed.\u00a0For example, a patient with suspected or confirmed Ebola virus disease (EVD) would be on contact and droplet precautions.<\/li>\n<li>Aerosol procedures: Aerosol-generating medical procedures (such as tracheostomy care, CPR, nebulized therapy) may increase risk of transmitting infectious agents. Airborne precautions should be initiated during specific procedures when a patient is suspected of having or confirmed to have TB.<\/li>\n<li>Equipment is patient specific (i.e., BP cuffs, stethoscopes, BGMs) and not used on others unless thoroughly cleaned. Ideally all patient equipment stays in the room with that patient.<\/li>\n<\/ul>\n<p>Tables 1.1, 1.2, and 1.3. summarize the three categories of additional precautions.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\n<h3 style=\"text-align: center\">Table 1.1 Contact Precaution Guidelines<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">PPE<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Private Room<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Visitors<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Cleaning<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Gown, gloves<\/td>\n<td style=\"border: 1px solid #000000\">Private room preferred or cohort\u00a0patients.<\/p>\n<p>Must have own dedicated equipment.<\/td>\n<td style=\"border: 1px solid #000000\">Gown and gloves must be worn if providing direct care.<\/p>\n<p>Must perform hand hygiene before and after care.<\/p>\n<p>Must not go into other patient rooms.<\/td>\n<td style=\"border: 1px solid #000000\">Patient: none required<\/p>\n<p>Staff: gown and gloves<\/td>\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012;\u00a0PHAC, 2013;\u00a0Siegal, Rhinehart, Jackson, &amp; HICPAC, 2007<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><\/h3>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\n<h3 style=\"text-align: center\">Table 1.2 Droplet Precautions<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">PPE<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Private Room<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Visitors<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Cleaning<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Gloves, gown, and a surgical mask if within two metres of the patient<\/td>\n<td style=\"border: 1px solid #000000\">Private room preferred or cohort.<\/p>\n<p>Must have own dedicated equipment.<\/p>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000\">Gown, gloves, surgical masks, and eye protection are worn for all activities within two metres of the patient.<\/p>\n<p>The patient must wear a surgical mask when leaving the room.<\/p>\n<p>The door may remain open.<\/p>\n<p>Strict adherence to hand hygiene must be observed.<\/p>\n<p>Gloves, gown, and surgical mask must be worn \u00a0if providing direct care.\u00a0Must perform hand hygiene before and after care.<\/p>\n<p>Visitors may not go into other patient rooms.<\/td>\n<td style=\"border: 1px solid #000000\">Patient: gown, surgical mask<\/td>\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012; PHAC, 2013; Siegal et al., 2007<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><\/h3>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\n<h3 style=\"text-align: center\">Table 1.3 Airborne Precautions<\/h3>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">PPE<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Private Room<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Visitors<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Patient Transport<\/h4>\n<\/td>\n<td style=\"width: 20%;border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Cleaning<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Must wear N95 respirator prior to entering room.<\/p>\n<p>Strict adherence to hand hygiene.<\/p>\n<p>Must remove N95 respirator after exiting the room.<\/p>\n<p>No immune-compromised persons to enter room. Care providers should have current vaccines.<\/td>\n<td style=\"border: 1px solid #000000\">Yes.<\/p>\n<p>Must have a negative pressure room.<\/p>\n<p>Must have own dedicated equipment.<\/p>\n<p>Keep the door closed whether or not the patient is in the room.<\/p>\n<p>The room should have bathroom facilities.<\/p>\n<p>The room must be a single room, preferably one that is under negative pressure. When a negative pressure room is unavailable, refer to your health authority policy to determine whether a transfer to another facility is mandated.<\/td>\n<td style=\"border: 1px solid #000000\">Gloves, gown, and surgical mask required if providing direct care.Must perform hand hygiene before and after care.<\/p>\n<p>Must not go into other patient rooms.<\/td>\n<td style=\"border: 1px solid #000000\">Patient: must wear surgical mask<\/p>\n<p>Staff: N95 mask<\/td>\n<td style=\"border: 1px solid #000000\">Additional daily room cleaning may be required.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: PIDAC, 2012; PHAC, 2013; Siegal et al., 2007<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Personal Protective Equipment (PPE)<\/h2>\n<p>Additional precautions require the use of <strong>personal protective equipment (PPE)<\/strong>,\u00a0which is equipment or clothing worn by staff to prevent the transmission of infection from patient to staff or to family member (PIDAC, 2012). All PPE must be applied and removed in a specific order to ensure the skin, nose, mouth, and eyes are covered to prevent transmission of infection to healthcare providers. Depending on the type of additional precaution or risk assessment, a\u00a0gown, goggles, face shield, and mask (surgical or N95) may be used during patient care. Refer to Checklist 6 for steps to take when donning (putting on) PPE.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\n<h3 style=\"text-align: center\"><span style=\"color: #333333\">\u00a0 \u00a0 <a id=\"checklist6\"><\/a>Checklist 6: Donning PPE<\/span><\/h3>\n<h5 style=\"text-align: center\"><span style=\"color: #333333\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\n<h5 style=\"text-align: left\"><span style=\"color: #333333\">Safety considerations:<\/span><\/h5>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #333333\">The selection of PPE is based on the nature of the interaction with the patient and the likelihood of transmission of infectious agents. <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">PPE should be put on just prior to the interaction with the patient and should be removed immediately after the interaction, followed by hand hygiene. <\/span><\/li>\n<li style=\"text-align: left\">Donning of PPE is usually done outside the patient&#8217;s room.<\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Patients may feel depressed or lonely when isolated in a room or experiencing decreased contact with healthcare providers. Support for individuals on isolation must be provided. Conversely, some patients may appreciate the privacy of an individual room.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">1. Remove rings, bracelets, and watches. Perform hand hygiene.<\/td>\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">This prepares hands for direct patient care.<\/p>\n<figure id=\"attachment_112\" aria-describedby=\"caption-attachment-112\" style=\"width: 218px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"218\" height=\"145\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-225x150.jpg 225w\" sizes=\"auto, (max-width: 218px) 100vw, 218px\" \/><\/a><figcaption id=\"caption-attachment-112\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">2. Apply waterproof long-sleeved gown. Tie the neck and waist strings.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Waterproof gown prevents any potential cross-contamination from blood or body fluids onto forearms and body.<\/p>\n<figure id=\"attachment_113\" aria-describedby=\"caption-attachment-113\" style=\"width: 213px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00004.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-61\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-300x200.jpg\" alt=\"Apply water proof gown\" width=\"213\" height=\"142\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-225x150.jpg 225w\" sizes=\"auto, (max-width: 213px) 100vw, 213px\" \/><\/a><figcaption id=\"caption-attachment-113\" class=\"wp-caption-text\">Apply waterproof gown<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3.\u00a0Apply mask. Remember different masks are required for different situations. Ensure the fit is secure with no air leaks. Secure the metal band around the nose and pull mask over chin as required.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Wearing a poor-fitting mask is the number one reason for exposure to pathogens for healthcare providers.<\/p>\n<p>Masks should be worn if provider is within two metres of a coughing or sneezing patient or if there is a potential for spray of secretions or excretions.<\/p>\n<figure id=\"attachment_117\" aria-describedby=\"caption-attachment-117\" style=\"width: 213px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00007.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-62\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00007-300x200.jpg\" alt=\"Surgical mask (L) and N95 mask (R)\" width=\"213\" height=\"142\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00007.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00007-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00007-225x150.jpg 225w\" sizes=\"auto, (max-width: 213px) 100vw, 213px\" \/><\/a><figcaption id=\"caption-attachment-117\" class=\"wp-caption-text\">Surgical mask (left) and N95 mask (right)<\/figcaption><\/figure>\n<p>Replace mask if it becomes wet or soiled.<\/p>\n<figure id=\"attachment_118\" aria-describedby=\"caption-attachment-118\" style=\"width: 207px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00008.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-63\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-300x200.jpg\" alt=\"Apply mask\" width=\"207\" height=\"138\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-225x150.jpg 225w\" sizes=\"auto, (max-width: 207px) 100vw, 207px\" \/><\/a><figcaption id=\"caption-attachment-118\" class=\"wp-caption-text\">Apply mask<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4.\u00a0Apply goggles or face shield.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Goggles or a face shield prevents accidental exposure to eyes, nose, and mouth. Goggles can be placed on top of eyeglasses.<\/p>\n<p>Prescription glasses are not an alternative to goggles as they do not protect the entire eye.<\/p>\n<figure id=\"attachment_119\" aria-describedby=\"caption-attachment-119\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00009.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-64\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-300x200.jpg\" alt=\"Applying goggles\" width=\"200\" height=\"133\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-225x150.jpg 225w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><figcaption id=\"caption-attachment-119\" class=\"wp-caption-text\">Apply goggles<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">5.\u00a0Apply non-sterile gloves over top of the cuff of the gown.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Non-sterile gloves ensure complete coverage of skin on arms for direct patient care.<\/p>\n<figure id=\"attachment_121\" aria-describedby=\"caption-attachment-121\" style=\"width: 207px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00011.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-65\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00011-300x200.jpg\" alt=\"apply non-sterile gloves over top of sleeves\" width=\"207\" height=\"138\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00011.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00011-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00011-225x150.jpg 225w\" sizes=\"auto, (max-width: 207px) 100vw, 207px\" \/><\/a><figcaption id=\"caption-attachment-121\" class=\"wp-caption-text\">Apply non-sterile gloves over top of sleeves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source:\u00a0Barratt, Shaban, &amp; Moyle, 2011; PIDAC, 2012;\u00a0PHAC, 2012b<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>See Checklist 7 for steps on how to doff (or remove) PPE.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist7\"><\/a>Checklist 7: Doffing PPE<\/h3>\n<h5 style=\"text-align: center\"><span style=\"color: #333333\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">1. Remove gloves.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Grasp outer edge of glove by wrist and peel away from hand, rolling the glove inside out. Roll it into a ball in gloved hand.<\/p>\n<p>With the bare hand, reach under the second glove and gently peel down off the fingers.<\/p>\n<figure id=\"attachment_5943\" aria-describedby=\"caption-attachment-5943\" style=\"width: 271px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-191.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-66\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-300x125.jpg\" alt=\"Place bare finger under gloved hand to avoid contamination from glove\" width=\"271\" height=\"113\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-300x125.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-768x321.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-65x27.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-225x94.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191-350x146.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Book-pictures-2015-191.jpg 800w\" sizes=\"auto, (max-width: 271px) 100vw, 271px\" \/><\/a><figcaption id=\"caption-attachment-5943\" class=\"wp-caption-text\">Place bare finger under glove to avoid contamination from glove<\/figcaption><\/figure>\n<p>Drop glove into garbage bin.<\/p>\n<p>Always perform hand hygiene after removing gloves. Gloves are not tear- or leak-proof. Hands may have been contaminated upon removal of the gloves.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">2. <a href=\"http:\/\/opentextbc.ca\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">Use soap and water if hands are visibly\u00a0dirty.<\/p>\n<figure id=\"attachment_112\" aria-describedby=\"caption-attachment-112\" style=\"width: 224px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"224\" height=\"149\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-225x150.jpg 225w\" sizes=\"auto, (max-width: 224px) 100vw, 224px\" \/><\/a><figcaption id=\"caption-attachment-112\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3. Remove gown.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Remove gown in a manner that does not contaminate clothing. Starting at the neck ties, pull the outer (contaminated) part forward and, turned inward, roll into a ball. Discard in appropriate receptacle bin.<\/p>\n<figure id=\"attachment_113\" aria-describedby=\"caption-attachment-113\" style=\"width: 233px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00004.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-61\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-300x200.jpg\" alt=\"Remove gown\" width=\"233\" height=\"155\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00004-225x150.jpg 225w\" sizes=\"auto, (max-width: 233px) 100vw, 233px\" \/><\/a><figcaption id=\"caption-attachment-113\" class=\"wp-caption-text\">Remove gown<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4. <a href=\"http:\/\/opentextbc.ca\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Always perform hand hygiene after removing gown. Hands may have been contaminated upon removal of the gown.<\/p>\n<figure id=\"attachment_112\" aria-describedby=\"caption-attachment-112\" style=\"width: 251px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"251\" height=\"167\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-225x150.jpg 225w\" sizes=\"auto, (max-width: 251px) 100vw, 251px\" \/><\/a><figcaption id=\"caption-attachment-112\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">5. Remove eye protection or face shield.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Arms of goggles and the headband on the face shield are considered clean. Handle these only by the sides. The front of the face shield or goggles is considered contaminated. Dispose them according to agency policy.<\/p>\n<figure id=\"attachment_119\" aria-describedby=\"caption-attachment-119\" style=\"width: 212px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00009.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-64\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-300x200.jpg\" alt=\"Remove goggles\" width=\"212\" height=\"141\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00009-225x150.jpg 225w\" sizes=\"auto, (max-width: 212px) 100vw, 212px\" \/><\/a><figcaption id=\"caption-attachment-119\" class=\"wp-caption-text\">Remove goggles<\/figcaption><\/figure>\n<p>Ensure you are at least two meters from the patient when removing eyewear.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">6. Remove mask or N95 respirator.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Ties, earlobe loops, or straps are considered clean and may be touched. If tied, remove bottom tie first, then top tie. Remove ear loops or straps by leaning forward to allow the mask to slip off your face.<\/p>\n<p>Masks are removed outside the patient room<\/p>\n<p>Dispose of the mask in the garbage bin.<\/p>\n<figure id=\"attachment_118\" aria-describedby=\"caption-attachment-118\" style=\"width: 210px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00008.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-63\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-300x200.jpg\" alt=\"Remove mask\" width=\"210\" height=\"140\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00008-225x150.jpg 225w\" sizes=\"auto, (max-width: 210px) 100vw, 210px\" \/><\/a><figcaption id=\"caption-attachment-118\" class=\"wp-caption-text\">Remove mask<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">7.\u00a0 Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_112\" aria-describedby=\"caption-attachment-112\" style=\"width: 210px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/01\/Image00002.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-60\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-300x200.jpg\" alt=\"Perform hand hygiene\" width=\"210\" height=\"140\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Image00002-225x150.jpg 225w\" sizes=\"auto, (max-width: 210px) 100vw, 210px\" \/><\/a><figcaption id=\"caption-attachment-112\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Barratt et al., 2011; Perry et al., 2014;\u00a0PHAC, 2012b; Siegal et al., 2007<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox shaded\" style=\"text-align: center\"><span style=\"font-size: 1em\">Watch the video <\/span><a href=\"https:\/\/barabus.tru.ca\/nursing\/donning_and_doffing.html\"><em style=\"font-size: 1em\">Donning and Doffing PPE<\/em><\/a><span style=\"font-size: 1em\">\u00a0by Ren\u00e9e Anderson &amp; Wendy McKenzie Thompson Rivers University<\/span><\/div>\n<div class=\"textbox shaded\" style=\"text-align: center\"><span style=\"font-size: 1em\">Please note the CDC offers another option for doffing PPE. See <em>How to Remove PPE Example 2 on page 3\u00a0<\/em> \u00a0<\/span><a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\"><span style=\"font-size: 1em\">https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf<\/span><\/a><\/div>\n<div><\/div>\n<h2>Blood or Body Fluid (BBF) Exposure<\/h2>\n<p>A <strong>blood and body fluid (BBF) <\/strong><strong>exposure<\/strong>\u00a0is defined as an exposure to potentially infectious body fluids or blood through the following methods: a puncture wound by a sharp object or needle (percutaneous exposure), from a body fluid\/blood splash onto your mucous membranes (permucosal exposure) or exposure through eczema, an open wound\/skin or scratch (non-intact skin exposure) (BCCDC, 2015).<\/p>\n<p>Post-exposure management is only required when (1) percutaneous, permucosal, or non-intact skin is exposed to a BBF; (2) the exposure is to blood or potentially infectious body tissue or fluid; (3) the source is considered potentially infectious (e.g., patient is part of a high-risk group, exposure occurred in a high-risk setting, or patient has a positive test); and (4) the exposed person is considered susceptible to HIV, hepatitis B, or hepatitis C. Checklist 8 explains what to do if exposed.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist8\"><\/a>Checklist 8: BBF Exposure<\/h3>\n<h5 style=\"text-align: center\"><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">\n<h5>Safety considerations:<\/h5>\n<ul>\n<li>Evidence shows that antiretroviral therapy can reduce the transmission of HIV by 86%.<\/li>\n<li>The risks and benefits of the post-exposure immunoprophylaxis should be discussed and appropriate recommendations made by the physician to the exposed person.<\/li>\n<li>Despite the relatively low risk of infection from an exposure, the event is associated with stress and anxiety for the exposed person.<\/li>\n<li>Seek advice from a physician at a hospital, walk-in clinic, or community clinic within two hours of any BBF exposure.<\/li>\n<li>Not all body fluids are implicated in transmission of viruses.\u00a0Search the <a href=\"http:\/\/www.bccdc.ca\/search?k=cps_cdmanual_bbfexpmangt_20150715.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">CDC guidelines<\/a>\u00a0to understand which body fluids are implicated in transmitting HIV and hepatitis B and C.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">1. Wash the exposed skin, mucous membrane, or eye.<\/p>\n<\/td>\n<td style=\"width: 50%;border: 1px solid #000000\" colspan=\"2\">Skin: Wash the area thoroughly with soap and water.<\/p>\n<p>Mucous membranes or eye: Rinse area with water or normal saline.<\/p>\n<p>Allow injury\/wound site to bleed freely and then cover lightly.<\/p>\n<p>Do not promote bleeding of percutaneous injuries by cutting, scratching, or squeezing or puncturing the skin. This may damage the skin and increase uptake of any pathogens.<\/p>\n<p>Do not apply bleach or soak wound\/injury in bleach.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">2. Contact first aid for assistance and obtain proper forms. These forms are also available in emergency departments.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">If unable to contact first aid, proceed to the emergency room.<\/p>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">3. Advise your supervisor or charge nurse of the incident. Ask them to complete the required form and return it to you. If available take the patient name &amp; date of birth with you to the emergency department to allow for cross referencing and necessary follow up.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step allows for follow-up by the manager, in relation to a BBF exposure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">4. A risk assessment should be completed within two hours. Go to the emergency room or urgent care centre and be assessed by a physician\/NP.<\/p>\n<p style=\"text-align: left\">Inform the department personnel that an occupational BBF exposure has occurred. You will be assessed and blood work will be drawn.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Emergency rooms or other health agencies are supplied with antiretroviral kits from the BC Centre for Excellence in HIV\/AIDS.<\/p>\n<p>Physicians will assess your risk of exposure and the risk of transmission from source.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"text-align: left\">5.\u00a0Following treatment, return to your department and report the incident according to agency policy.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This ensures that the proper procedure is followed and the incident form is filled out to prevent or minimize further exposure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">\n<p style=\"text-align: left\">Data source: BCCDC, 2015<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>What is a point of care risk assessment?<\/li>\n<li>What resources are available to the nurse when making decisions about implementing additional precautions?<\/li>\n<li>A family member has come into the healthcare setting to visit his mother, who has been admitted with chicken pox. List four infection preventive measures to discuss with the family member.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"author":397,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-67","chapter","type-chapter","status-publish","hentry"],"part":24,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/67","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":26,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/67\/revisions"}],"predecessor-version":[{"id":5198,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/67\/revisions\/5198"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/24"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/67\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=67"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=67"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=67"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=67"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}