INFECTION PREVENTION AND

CONTROL AND COVID-19: USE OF

PERSONAL PROTECTIVE
EQUIPMENT (PPE)

Division of Healthcare Management

and Occupational Health and Safety
05/2020

UNITED NATIONS
UNITED NATIONS
DEPARTMENT | DEPARTMENT
OF OPERATIONAL SUPPORT OF OPERATIONAL SUPPORT 1
1. Basic Infection Control Principles

2. Principles of Effective PPE Use for COVID-19

3. Demonstration of Donning and Doffing PPE

4. Additional Resources

5. Questions

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COVID-19 Transmission
• According to current evidence, COVID-19 is primary transmitted between people
through respiratory droplets and contact routes

• Droplet transmission occurs when a person is in close contact (within 1 meter) with
someone who has respiratory symptoms (e.g. coughing or sneezing)

• Contact transmission may also occur through fomites in the immediate environment
around the infected person (e.g., stethoscope, thermometer)

• Airborne transmission is different than droplet transmission and occurs when smaller
particles containing the virus remain in the air for long periods of time and can be
transmitted to others over distances greater than 1 meter

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COVID-19 Transmission (continued)
• In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which aerosol generating
procedures are performed
– Examples include: endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual
ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive
positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation

• WHO recommends that the addition of airborne precautions (i.e. use of an N-95 respirator) is warranted during aerosol-generating
procedures

• Due to the desire for a more conservative approach, the UN Medical Directors is recommending that an N-95 mask should be
used at all times when caring for a suspect/confirmed case

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Screening and Triage
• Effective screening and triage protocols can minimize the need for PPE, conserving resources

• Screening patients before they come to your health facility can help identify patients who
require additional infection control precautions
– This should be preferably done by phone before the patient presents in person to your
facility

• A 24/7 COVID-19 telephone hotline should be set up to refer patients to the appropriate
destination for clinical assessment and/or testing as per local protocol

• For individuals that physically come to the UN health facility, you should set up a triage station
at the entrance of your health facility (i.e. outside of your waiting area) to screen patients
– This enables you to immediately segregate patients with COVID-19 symptoms from the non-
symptomatic patients, and limits potential spreading infection throughout the health facility
– Signage should be displayed at this station instructing patients with symptoms to inform
reception staff immediately on their arrival

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Screening and Triage (continued)
• UN personnel involved in triage or screening at the points of entry should wear a medical mask when screening patients at the
triage station

• Ensure to have alcohol-based hand rub or soap and water hand washing stations readily available at this station

• Any individual that fits the WHO case definition of a suspect case should be immediately advised to wear a surgical mask, and then
triaged to a separate waiting and assessment area immediately
– The WHO case definition of a suspect case is living and dynamic, be sure to check
https://apps.who.int/iris/bitstream/handle/10665/331506/WHO-2019-nCoV-SurveillanceGuidance-2020.6-eng.pdf for the latest case
definitions

• No UN personnel should be allowed to enter the UN health facility without having first passed the triage area

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Waiting Area
• Within your waiting area, set up a well-defined and separate waiting area for COVID-
19 suspect cases

• This separate area should be designated at least 6 feet away from your regular
waiting area

• In your waiting area/s, post information like posters and flyers, reminding patients
and visitors to practice good respiratory and hand hygiene

• Patients should be instructed to stay in this waiting area and not visit other parts of
your facility

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Hand Hygiene
• Effective hand washing is essential to protecting you and your patients
– Hand hygiene supplies should be available before patients enter the clinic as well as in any area where patients or staff may be
present (e.g., triage area, waiting rooms, clinic rooms, designated PPE donning/doffing area)

• Washing hands with soap and water or an alcohol based hand rub (ABHR) is the best way to get rid of germs!

• Follow these five steps when washing your hands with soap and water:

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your
nails.

3. Scrub your hands for at least 20 seconds.

4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them.
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Hand Hygiene (continued)
• When using a alcohol-based hand rub, use a solution that contains at least 60% alcohol

• Hand sanitizers can quickly reduce the number of germs on hands, however may not be as
effective when hands are visibly dirty or greasy

• Follow these 3 steps when using hand sanitizer:

1. Apply the gel product to the palm of one hands

2. Rub your hands together
3. Rub gel over all surfaces of your hands and fingers until your hands are dry (this should
take around 20 seconds)

• Areas most commonly missed are thumbs, fingertips and between the fingers

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Hand Hygiene Where Soap and Running Water is Unavailable
• Hand hygiene with soap and water or ABHR is recommended by WHO

• In settings where bleach/chlorine solutions are currently used for hand hygiene, WHO recommends implementing
a strategy to change to ABHR or soap and water

• For areas where bleach/chlorine solutions are currently in use for hand hygiene, the WHO states this method can
be used in the interim period in emergency situations until ABHRs or soap and water become available

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1. Basic Infection Control Principles

2. Principles of Effective PPE Use for COVID-19

3. Demonstration of Donning and Doffing PPE

4. Additional Resources

5. Questions

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When to Wear PPE
• With regards to PPE for healthcare workers caring for a suspect/confirmed COVID-19 case, the WHO recommends standard, contact,
and droplet precautions (i.e. gown, gloves, and medical mask) with eye (e.g. goggles) or face protection
– Note that boots and coverall suits are not required

• WHO recommends that the addition of airborne precautions (i.e. using a particular respirator such as an N-95) is warranted during
aerosol-generating procedures

• Due to the desire for a more conservative approach, the UN Medical Directors is recommending that an N-95 mask should be used
at all times when caring for a suspect/confirmed case

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Preparation and Planning
• Prepare designated area to don and doff PPE

• Hand hygiene supplies

• PPE supplies
– Adequate supplies in appropriate sizes
– Adequate space
– Waste basket within reach for removal

• Step-by-step instructions displayed on the wall

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Key Points for Safe Practice Workflow
• Have a detailed plan for your duties

• Try to ensure cleanliness and orderliness of the worksite

• Coordinate breaks to avoid extended periods of time in PPE

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Prior to Donning PPE
• Visually inspect PPE ensemble

• Ensure it is in serviceable condition and the correct size for the healthcare worker

• PPE must remain in place and be worn correctly for the duration of work in potentially contaminated areas

• PPE should not be adjusted (e.g., retying gown, adjusting respirator/facemask) during patient care

• Ensure you remove all jewelry and personal items and that your hair is tied back

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Recommended PPE for COVID-19

• Gown

• Gloves

• N95 Respirator

• Face shield or goggles

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Donning PPE (Putting on the Gear)
1. Identify and gather the proper PPE to don. Ensure choice of gown size is correct (based on training).

2. Perform hand hygiene using hand sanitizer.

3. Put on isolation gown. Tie all of the ties on the gown. Assistance may be needed by another HCP.

4. Put on N95 filtering face piece respirator or higher (use a facemask if a respirator is not available). Perform seal check!

5. Put on face shield or goggles. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging
is common.

6. Gloves should cover the cuff (wrist) of gown.

7. HCP may now enter patient room.

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Wearing an N95 Respirator

• Should be a structured design that does not collapse against the mouth (e.g. duckbill, cup shape, flat fold)

• Fluid resistant (need “surgical” quality)

• Respirators must be worn correctly to be effective:

– A fit test evaluates the existence of leaks at the moment it is performed for the model being tested
– If more than one type/size of mask is available, a fit test can be used to determine the best fit for each
person

• A seal check is done EACH time the respirator is worn to be sure that the respirator is adjusted well to the
face

• At a minimum, each use should be trained on how to use the respirator, and should perform a seal-check
before each use (fit testing preferable)

• Always follow the manufacturer's instructions

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How to Perform a Seal Check
• Cover the front of the respirator with both hands

• Positive seal check:

– Exhale sharply
– A positive pressure inside the respirator = no leakage
– If leakage, adjust position and/or tension straps.
– Retest the seal and repeat the steps until the respirator is sealed properly

• Negative seal check:

– Inhale deeply
– If no leakage, negative pressure will make the respirator cling to your face

• Respirators should be discarded after every use

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How to Put On a Particulate Respirator
1. Position the respirator under your chin with the nosepiece up

2. Pull the top strap over your head resting it high at the back of your head

3. Pull the bottom strap over your head and position it around the neck below the ears

4. Perform a seal-check

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Considerations While Wearing PPE
• Avoid touching or adjusting the PPE once you are in the patient room

• Keep gloved hands away from face

• PPE should be changed between use and for each different patient

• Anything single-use should not be reused or sterilized

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Considerations for Doffing PPE
• Removal of PPE poses the highest risk of transmission to healthcare workers

• PPE must be removed slowly and deliberately in a sequence that prevents self-contamination

• Make sure to avoid any contact between potentially contaminated PPE and the clothes, skin, and especially your face

• Remove PPE in a separate area from where you put it on to prevent contamination

• Discard disposable items in a waste container

• Never touch face, mouth, nose, eyes, or any part of body before removal AND hand hygiene is complete

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Doffing PPE (Taking off the Gear)
1. Remove gloves. Ensure glove removal does not cause additional contamination of hands.

2. Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful
movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach.
Dispose in trash receptacle.

3. Perform hand hygiene.

4. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch
the front of face shield or goggles.

5. Remove and discard respirator (or facemask if used instead of respirator).

6. Do not touch the front of the respirator or facemask.

– Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over
the head, and then pull the respirator away from the face without touching the front of the respirator.
– Facemask: Carefully untie (or unhook from the ears) and pull away from face without touching the front.

7. Perform hand hygiene after removing the respirator/facemask.

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Commonly Observed Mistakes
• Pulling respirator off while in patient area to “take a breath”

• Touching face while wearing PPE and in patient area

• Taking off respirator while still wearing “dirty” gloves

• Taking off respirator during doffing by pulling the front of the mask off vs. the back straps

• Back strap of the face shield not being tight enough and slipping off or blowing off if windy (can tie a knot if needed)

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1. Basic Infection Control Principles

2. Principles of Effective PPE Use for COVID-19

3. Demonstration of Donning and Doffing PPE

4. Additional Resources

5. Questions

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WHO Video: How to Put On and Remove Personal Protective Equipment (PPE)

Link to video: https://openwho.org/courses/IPC-PPE-EN/items/6o69URMIg5sManZMkdaMQD

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1. Basic Infection Control Principles

2. Principles of Effective PPE Use for COVID-19

3. Demonstration of Donning and Doffing PPE

4. Additional Resources

5. Questions

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Additional Resources
• DHMOSH COVID-19 Pandemic planning resources:
https://www.un.org/en/coronavirus/reference-documents-administrators-and-managers

• WHO COVID-19: How to put on and remove personal protective equipment (PPE) [VIDEO]:
https://openwho.org/courses/IPC-PPE-EN/items/6o69URMIg5sManZMkdaMQD

• WHO Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19):
https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

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1. Basic Infection Control Principles

2. Principles of Effective PPE Use for COVID-19

3. Demonstration of Donning and Doffing PPE

4. Additional Resources

5. Questions

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