2.3 TRUST POLICY FOR PERSONAL PROTECTIVE EQUIPMENT

Transcription

1 2.3 TRUST POLICY FOR PERSONAL PROTECTIVE EQUIPMENT Reference Number CL RM/2013/050 Version 2.1 Status Final Author: Forrest Helen Job Title Lead Nurse Infection Prevention and Control Version / Amendment History Version Date Author Reason 2 October June 2016 J. Toplass H. Forrest Review and Update Review and Update Intended Recipients: All medical and clinical staff, Associate Directors, Service Managers, Heads of Nursing, Clinical Governance Facilitators, Matrons. Training and Dissemination: Dissemination via the Trust Intranet. Forms part of Infection Control mandatory training To be read in conjunction with: Trust Policy and Procedure for Hand Hygiene; Trust Policy and Procedure for Standard Infection Control Precautions. Trust Policy for the Management of Influenza, Trust Policy and Procedure for Clostridium difficile, Trust Policy and Procedure for Diarrhoea and Vomiting (Norovirus) In consultation with and Date: Health and Safety (June 2016) Infection Control Operational Group ( ), Infection Control Committee ( ) EIRA stage one Completed Yes Stage two Completed N/A Procedural Documentation Review Group Assurance and Date Approving Body and Date Approved Infection Control Committee Management Executive Date of Issue July 2016 Review Date and Frequency May 2019 (then every 3 years)

2 Contact for Review Executive Lead Signature Approving Executive Signature Lead Nurse Infection Prevention and Control Chief Nurse Chief Nurse

3 Contents Section 1 Introduction 2 Purpose and Outcomes 3 Managing the Policy for Personal Protective Equipment 3.1 Storage 3.2 Risk Assessment 3.3 Gloves 3.4 Masks and Eye Protection 3.5 Aprons 3.6 Long sleeved gowns 3.7 Footwear 3.8 Levels of Personal Protective Equipment 3.9 Donning and Doffing of Personal Protective Equipment 3.10 Disposal of Personal Protective Equipment 4 Definitions Used 5 Key Responsibilities/Duties 6 Monitoring Compliance and Effectiveness 7 References

4 TRUST POLICY FOR PERSONAL PROTECTIVE EQUIPMENT (PPE) 1 Introduction Protective clothing, such as gloves, aprons, face protection and footwear is used in addition to normal clothing / uniform to protect both the patient and healthcare worker from the potential risk of crossinfection. Protective clothing must: Be readily available and easily accessible Be appropriate for the task / procedure being undertaken Take account of the worker s needs Fit appropriately Be compatible with any other item of protective equipment being worn simultaneously Be disposable where possible. If not disposable it must be cleaned and / or disinfected, maintained and replaced as necessary Be changed after each procedure or activity to prevent the transmission of infection to other patients, and between different tasks on the same patient to prevent transfer of infective organisms to susceptible sites. Not be worn in public areas, unless specifically required, for example when transporting a patient as directed by Infection Prevention and Control. 2 Purpose and Outcomes This policy will provide instruction for all staff in the safe and appropriate use of personal protective equipment. Adherence to this policy will reduce the risk of cross infection for patients and staff that may come into contact with blood or body fluids. 3 Managing the Policy for Personal Protective Equipment (PPE) 3.1 Storage Supplies of personal protective equipment should be stored in a clean, dry place, free from contamination e.g. not in a dirty area such as a sluice. Gloves and masks must not be decanted from the original box to ensure the expiry date is known and their integrity maintained. 3.2 Risk Assessment Selection of appropriate protective clothing should follow a risk assessment of the procedure. The following factors should be considered: The nature of the task

5 The risk of contamination The barrier efficacy of the protective clothing NB. If the patient is cared for under the Isolation policy or a specific Infection Prevention policy such as viral haemorrhagic fever or Norovirus policy, then the PPE specified in that policy takes priority 3.3 Gloves Gloves must be worn when in contact with blood or body fluids and for contact with non-intact skin or mucous membranes. In addition to these instances, gloves may be required to be worn when in contact with other biological and chemical agents. If no contact is likely to be made with blood, body fluids, sterile equipment or hazardous substances gloves are not worn. It is important for all healthcare staff to be made aware that sensitivities can also occur with gloves as there are many elements to the manufacturing process, e.g. chemical accelerators in nitrile gloves. Any sensitivity (e.g. redness, itching) should be reported to the Occupational Health Department. Disposable gloves are single-use items and must be changed between caring for different patients or between different care / treatment activities for the same patient. Gloves must not be washed or decontaminated as this may alter their efficacy. Following a risk assessment, an appropriate glove choice can be made for the specific task / procedure to be undertaken. The following factors should be borne in mind: The nature of the task The risk of contamination Barrier efficacy of gloves Sterile or non-sterile gloves required Patient / user latex sensitisation status

6 3.3.1 Choosing the correct glove type: TYPE OF GLOVE TASK / PROCEDURE UNDERTAKEN Sterile powder free latex/ Nitrile Surgery surgeons Sterile powder free nitrile examination / procedure All aseptic procedures with potential exposure to blood / blood stained body fluids Sterile pharmaceutical preparations Non sterile powder free Nitrile Non aseptic procedures with potential exposure to blood / blood stained body fluids. Handling disinfectants 3.4 Masks and Eye Protection Eye protection and a mask or full face visor must be worn for any activity where there is a risk of body fluid splashing into the face. They may also be advised when dealing with patients with specific infections (refer to Isolation Policy). Staff are vulnerable to infection by blood borne viruses and other pathogens if infected body fluid is splashed onto the mucous membranes of the eyes and mouth. Surgical masks should always fit comfortably, covering the mouth and nose. When not in use for protection, they must be discarded and not worn around the neck. Face shields / visors should be considered, in place of a surgical mask and / or goggles, where there is a higher risk of splattering / aerosolisation or blood / other body fluids. Face protection should not be touched when worn. Manufacturer s instructions should be adhered to while donning face protection to ensure the most appropriate fit / protection. Specialist respirator masks such as FFP3 respirators used for open pulmonary TB cases or aerosolising procedures on influenza patients must always be fit checked when donned. In accordance with the Health and Safety executive all staff should undergo a fit test with the Trust approved FFP3 respirators to ensure a good fit can be maintained. In the situation whereby a staff member has not undergone a fit test then a fit check must have been completed as a minimum prior to entering the patient s isolation room. Masks and eye protection must be readily available in any clinical area where such procedures are performed. A risk assessment to dictate the need for other types of masks e.g. respirator type masks should be carried out in conjunction with infection prevention and control and other staff, in line with specific policies on specific infections when these needs arise.

7 If surgical masks become wet or soiled or damaged they should be changed immediately (safety permitting) to ensure continued protection from splashes to the mouth and nose. 3.5 Aprons Disposable plastic aprons: Must be worn when there is a risk that clothing or uniform will, or may become, exposed to contamination from the environment, patients, blood, body fluids, secretions and excretions. Remove aprons promptly after use, avoiding contact with most likely contaminated areas e.g. the front surface, and avoiding contamination of clothing or uniform. The outer contaminated side of the apron / gown should be turned inward, rolled into a ball and the item discarded. Are single use items and must only be used for one procedure or episode of patient care and then disposed into clinical waste Should be worn for bed making, handling used or soiled linen and any waste or contaminated items. Apron Colour Duty Yellow Isolation Nursing Red Dirty procedures / patient toileting Blue Clean procedures / aseptic techniques Green Catering departments / ward kitchen areas and patient food service at ward level ITU, A&E and the Renal Unit may keep colour coded aprons as bed specific as agreed with Infection Prevention and Control. 3.6 Long sleeved disposable gowns These must be worn when as directed by specific infection prevention polices, such as Norovirus, Norwegian scabies, Viral Haemorrhagic Fever, or as directed by the Infection Prevention and Control Team. 3.7 Footwear Refer to Derby Teaching Hospitals Dress Code Policy When providing care, closed toed shoes must be worn to prevent contamination of blood or other body fluids, or potential injury from sharps.

8 Where designated footwear is assigned e.g. operating theatres, local procedures must be available for the use and care of these, including clear cleaning schedules with assigned responsibilities. 3.9 Donning and Doffing Personal Protective Equipment The level of PPE used will vary based on the procedures being carried out and not all items of PPE will always be required. Standard infection control precautions apply at all times. The order given here for putting on PPE is practical, but the order for putting on is less critical than the order of removal, see appendix One Order for Donning (putting on) 1. Apron or gown 2. FFP3 respirator or surgical masks 3. Goggles or face shield 4. Disposable gloves Order for Doffing (removal) 1. Gloves 2. Apron or gown 3. Goggles or face shield 4. FFP3 respirator of surgical masks 5. Perform hand hygiene immediately after removing PPE. To minimise cross-contamination the order outlined above should be applied even if not all items of PPE have been used Disposal of Personal Protective Equipment PPE should be disposed of in the offensive waste stream unless the patient is known or suspected to have an infection, then the PPE is to be disposed of in the infectious waste stream. 4. Definitions Used Body Fluids Cross Infection Any fluid found in, or excreted from the human body which includes blood, urine, faeces, breast milk, CSF, pleural fluid, wound / tissue fluid, drain fluid, sputum, vomit. The transfer of infectious agents between people, either directly or indirectly via instruments, appliances of surfaces. Donning Doffing PPE and of The putting on (donning) and taking off (doffing) of personal protective equipment

9 5 Key Responsibilities/Duties 5.1 Infection Prevention and Control Team Will provide guidance on the use, type and appropriateness of protective clothing available. Will review and update the policy as appropriate 5.2 Matrons/Clinical Leads / Sister / Charge Nurses Will ensure all staff are aware of and adhere to this policy. Are responsible for ensuring adequate stock levels of appropriate personal protective equipment are available in clinical areas. 5.3 Individual Employees Are responsible for ensuring their own practice complies with this policy and for encouraging others to do so. Are responsible for identifying and escalating if there are issues with stock availability of personal protective equipment to their clinical lead / senior sister. 6. Monitoring Compliance and Effectiveness Monitoring Requirement : The IPCT will monitor compliance with Personal Protective Equipment Any non-compliance issues will be reported to the Business unit Matron / Divisional Nurse Director. Monitoring Method: The Infection Prevention and Control Team will undertake annual infection control audits, including assessment of the use of personal protective equipment. Report Prepared by: Monitoring presented to: Report Lead Nurse Infection Prevention and Control These findings will be reported in the first instance to the departmental Sister / Charge Nurse, Matron and Facilities Management who will produce an Action Plan in order to rectify areas of concern. A summary of Divisional audit results will be reviewed by the Infection Control Committee. Frequency of Report As required

10 7 References Loveday et al epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection. Available online at Public Health England Infection Control Advice. Middle Eastern respiratory syndrome coronavirus (MERS-CoV) Public Health England Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae Department of Health Management of Hazard Group 4 viral haemorrhagic fevers and similar infectious diseases of high consequence

11 Prepare & Protect Guidance for healthcare staff on personal protective equipment PUTTING ON personal protective equipment (PPE) The type of PPE used will vary based on the type of exposure anticipated, and not all items of PPE will be required. The order for putting on PPE is: APRON, SURGICAL MASK, EYE PROTECTION and GLOVES. APRON (OR GOWN) Pull over head and fasten at back of waist SURGICAL MASK (OR RESPIRATOR) Secure ties or elastic bands at middle of head and neck Fit flexible band to nose bridge Fit snug to face and below chin Fit check respirator REMOVING personal protective equipment (PPE) PPE should be removed in an order that minimises the potential for cross-contamination. The order for removing PPE is GLOVES, APRON, EYE PROTECTION and SURGICAL MASK. GLOVES Grasp the outside of the glove with the opposite gloved hand; peel off Hold the removed glove in the gloved hand Slide the fingers of the ungloved hand under the remaining glove at the wrist Peel the second glove off over the first glove Discard in a lined waste bin APRON (OR GOWN) Unfasten or break ties Pull apron away from neck and shoulders, touching inside only Fold or roll into a bundle Discard in a lined waste bin EYE PROTECTION (GOGGLES/FACE SHIELD) Place over face and eyes and adjust to fit EYE PROTECTION (GOGGLES/FACE SHIELD) Handle only by the headband or the sides Discard in a lined waste bin GLOVES Extend to cover wrist SURGICAL MASK (OR RESPIRATOR) Unfasten the ties first the bottom, then the top Pull away from the face without touching front of mask/respirator Discard in a lined waste bin USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF INFECTION Keep hands away from face Limit surfaces touched in the patient environment Change gloves if they became torn or heavily contaminated Regularly perform hand hygiene Always clean hands after removing gloves PERFORM HAND HYGIENE IMMEDIATELY AFTER REMOVING ALL PPE All PPE should be removed before leaving the area and disposed of as healthcare waste. FOR MORE INFORMATION CONTACT: These images are for illustrative purposes only. Always follow the manufacturer s instructions.