Mindfulness may not be a term usually associated with personal protective equipment (PPE), but it is a useful concept for the discussion of putting together, layer by layer, the protective barriers that allow the safe provision of care for patients with highly hazardous communicable diseases. Each piece of the full PPE ensemble will have limitations that must be understood by the wearer. Close and careful attention to behaviors in the patient care environment becomes good PPE etiquette. Donning, or putting on PPE, carefully and fully before attending to a patient’s needs is fundamental but not intuitive. Removing PPE is a high-risk procedure that can be performed safely with practice, coaching, and observation. Mitigating risk depends on awareness to all areas of potential contamination and a mindful approach to delivering safe patient care.
KeywordsPersonal protective equipment (PPE) Healthcare worker (HCW) Powered air-purifying respirators (PAPR) Alcohol-based hand rubs Trained observer Aerosol generating Proprioception Mindfulness Inoculation
Personal protective equipment, specifically that worn or used by healthcare providers during patient care
Healthcare worker, may be physician, nurse, therapist, or laboratorian
Resistant to penetration by liquids and small particles
Putting on, as in gloves or clothing
Removing gloves or clothing
Powered air-purifying respirators
Alcohol-based hand rubs
- Trained Observer
A person familiar with procedures and protocols, especially donning and doffing, whose role is to watch other staff for compliance while they perform those procedures
- Aerosol generating
Procedures or acts that may produce very small droplets of body fluids
Awareness of where our body is in space
Focusing one’s attention at the present, being aware of one’s situation and surroundings
The introduction of a microorganism into a person or organism
- 1.Garner, JS, Simmons BP. Guideline for isolation precautions in hospitals. [Online]. 1996 [cited 2016 Dec 27]; CDC Prevention Guidelines Database (Archive). Available from: URL:https://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp#head002003000000000.
- 2.Graves PB, Twomey CL. The changing face of hand protection. AORN J [Online from PubMed] 2002 Aug [2016 Dec 27]; 76(2):246–58.Google Scholar
- 3.Nutton V. The reception of Fracastoro’s theory of contagion: the seed that fell among thorns? [Online from The University of Chicago Press Journals]. 1990 [2016 Dec 27]; 6i:196–234. Available from: URL:www.journals.uchicago.edu/doi/abs/10.1086/368701.
- 4.Grady D. Questions rise on preparedness at hospitals to deal with Ebola. (Internet) New York Times. 2014 Oct 13 [cited 2016 Dec 29]; Available from: https://www.nytimes/2014/10/14/US/questions-rise-on-preparations-at-hospitals-to-deal-with-ebola.html.
- 5.Fuller TP. Personal protective equipment: patient and worker safety. In: Charney W, editor. Epidemic of medical errors and hospital-acquired infections: systemic and social causes [Internet]. Boca Raton: CRC Press; 2012 [cited 2016 Dec 29].Google Scholar
- 6.Casanova L, Alfano-Sobsey E, Rutala WA, Weber DJ, Sobsey M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerg Infect Dis 2008;14(8):1291–3. Available from: https://doi.org/10.3201/eid1408.080085.
- 7.Casanova LM, Rutala WA, Weber DJ, Sobsey MD. Effect of single-versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment. Am J Infect Control [Internet]. 2012 [cited 2016 Dec 29]; 40(4):369–74. Available from: PubMed.Google Scholar
- 8.US Department of Health, Education, and welfare. Isolation techniques for use in hospitals. Washington, DC: Public Health Service Publication 2054; US Government Printing Office; 1970.Google Scholar
- 9.CDC. Guidance on personal protective equipment (PPE) to be used by healthcare workers during management of patients with confirmed Ebola or persons under investigation (PUI’s) for Ebola who are clinically unstable or have bleeding, vomiting, or diarrhea in US hospitals, including procedures for donning and doffing PPE. [Online] 2015 Aug 27 [cited 2016 Dec 29]. Available from: https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html.
- 10.Larson EL, Liverman CT, Institute of Medicine (US) Committee on Personal Protective Equipment. Preventing transmission of pandemic influenza and other respiratory diseases [Internet]. Washington, DC: National Academies Press; 2014 [cited 2016 Dec 29]. Available from: PubMed.Google Scholar
- 11.Kilinc FS. A review of isolation gowns in healthcare: fabric and gown properties. J Eng Fiber Fabr. 2015 Jul [cited 2016 Dec 29]; 10(3):180–90. Available from: PubMed.Google Scholar
- 12.CDC. Considerations for selecting protective clothing used in healthcare for protection against microorganisms in blood and body fluids. 2015 Feb 10. [cited 2016 Dec 29]. Available from: https://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html.
- 13.Guo YP, Li Y, Wong PL. Environment and body contamination: a comparison of two different removal methods in three types of personal protective clothing. Am J Infect Control [Internet]. 2014 Apr [cited 2016 Dec 26];42(4):39–45. Available from: PubMed.Google Scholar
- 14.Casanova LM, Teal LJ, Sickbert-Bennett EE, Anderson DJ, Sexton DJ, Rutala WA, et al. Assessment of self-contamination during removal of personal protective equipment for Ebola patient care. Infect Control Hosp Epidemiol [Internet]. 2016 Oct [cited 2016 Dec 29];37(10):1156–61. Available from: PubMed.Google Scholar
- 15.Gao P, Horvatin M, Niezgoda G, Weible R, Shaffer R. Effect of multiple alcohol-based hand rub applications on the tensile properties of thirteen brands of medical exam nitrile and latex gloves. J Occup Environ Hyg [Internet]. 2016 Dec [cited 2016 Dec 29];13(12):905–14. Available from: PubMed.Google Scholar
- 16.Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control [Internet]. 2007 Dec [cited 2016 Dec 29];35(10) Suppl 2:s65–164, Available from: https://doi.org/10.1016/j.ajic.2007.10.007.
- 17.National Personal Protective Technology Laboratory. NIOSH- Approved N95 particulate filtering facepiece respirators. [Internet]. Updated 2014 Sep [cited 2016 Dec 27]. Available from: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/h95list1.html.
- 18.United States Department of Labor. Personal protective equipment standard # 1910.134 App. A. [Internet]. Occupational Safety and Health Administration Occupational Safety and Health Standards. [cited 2016 Dec 29]. Available from: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=9780.
- 19.Jinadatha C, Simmons S, Dale C, Ganachari-Mallapa N, Villamaria FC, Goulding N, Tanner B, et al. Disinfecting personal protective equipment with pulsed xenon ultraviolet as a risk mitigation strategy for health care workers. Am J Infect Control [Internet]. 2015 Apr [cited 2016 Dec 27];43(4):412–4. Available from: PubMed.Google Scholar