Which order should the nurse follow when removing personal protective equipment following a surgical procedure?

Hello. I'll be talking to you about how you correctly and safely put on, or don, and take off, or doff, personal protective equipment, also known as PPE, in a primary care setting. Primary health care workers are at increased risk of COVID-19 exposure due to the settings and activities they undertake. All health care workers must follow standard and transmission based precautions, as described in the Australian Guidelines for the Prevention and Control of Infection in Healthcare. A risk assessment should also inform the use of PPE and the likely risk of transmission of COVID-19. 

PPE is a critical part of infection prevention control. However, only one part of the defense within a broader hierarchy of controls necessary to minimise the transmission of COVID-19. Important controls include vaccination, hand hygiene, ventilation, the use of dedicated spaces, cleaning and training. When delivering care or services to someone who is confirmed or suspected of having COVID-19, the risk of transmission of COVID is high and full PPE should be worn. 

It's quite likely the person you're caring for at this time will have some concerns, so please take the time to explain the use of PPE to them and their families, reassuring them that you are well and that the using of PPE protects them, their families and yourself. Prior to wearing PPE, staff should have short, clean fingernails, not wearing artificial fingernails or nail polish and remove any jewellery and watches. 

PPE does come in different shapes and sizes, but it all does the same job. Before using PPE, you should check for any defects or damage, such as tires or broken loops. I will now talk you through the putting on or donning of PPE. All PPE should be donned in the following order and before entering the designated area, persons room or home, and before any direct interaction with the person. First, you need to perform hand hygiene. Wash your hands or use alcohol based hand rub. If using soap and water, wash for 20 seconds and then dry your hands thoroughly. When using hand rub, Use enough for both hands and continue to rub, covering all surfaces until your hands are dry. Next, put on your gown. It should be long sleeved, fastened at the back of the neck and around the waist. Next, put on a surgical mask or a P2/N95 respirator. If there's a metallic strip at the top of the mask, position this against the bridge of your nose and secure the mask by its ties, bands or loops. Mold the bendable metallic upper strip to the shape of your nose by pinching it and pressing it down with your fingers. Pull the bottom of the mask over your mouth and chin, ensuring it fits snugly on your face. Do not touch the mask once it's in position. If the mask gets soiled or damp while you're wearing it, then discarded in an appropriate waste bin and put on a new mask. You should not wear the same mask for more than four hours. Remember to perform hand hygiene after you remove a mask and before you put on a new one Particle filter respirators such as P2/N95 should be worn instead of a surgical mask If a risk assessment suggests there is a greater likelihood of COVID transmission. If this is the first time you are wearing a P2/N95 you should complete fit testing to select the most suitable mask for you. This is to achieve a good seal and comfort. Put the mask on your face. Place the headbands over your head. Place one band at the top of your head and the other at the base of your neck. A fit check is then performed. Breathe in and out to check that air is not escaping and the mask fits you well. A fit check will be done from now on each time you wear this type of mask. 

Next, you need to protect your eyes. Eye protection includes closely fitted wraparound goggles, safety glasses or a face shield. If you wear prescription glasses, eye protection is designed to be worn over your prescription glasses. And finally, you need to put on disposable, non-sterile gloves. Before doing so remember to perform hand hygiene. When putting on your gloves, extend them to cover the cuffs of the gown. While undertaking care, ensure you change or remove your gloves and perform hand hygiene in between dirty and clean tasks and between different procedures. 

And now for taking off or doffing PPE. The proper removal, or doffing, and disposal of PPE is the most crucial step in the preventing or inadvertent exposure to COVID-19. When removing PPE, ensure you do not touch the front of the gown, eye protection or mask and perform hand hygiene between each step. PPE must be discarded in the appropriate designed waste container. First, take off your gloves. Remove by grasping the outside of the glove with the opposite gloved hands and rolling outwards. Hold removed glove in gloved hand and then slide your fingers under the remaining glove and carefully discard. Perform hand hygiene. Remove your gown in a way that prevents contamination of clothing or skin. Unfasten the ties then pull the gown away from your neck and shoulders, only touching the inside of the gown. Turn it inwards and downwards on itself and roll into a bundle. Discard and perform hand hygiene. Now it's time to remove your eye protection and mask. These should only be removed and disposed of outside a person's room or in a designated space. Remove eye protection from the sides. Avoid touching your face or eyes. If eye protection is only to be used once, dispose of it. If it's reusable, clean thoroughly and perform hand hygiene. Finally, remove your mask by only untying the straps or removing the loops. Do not touch the front of your mask. Remove the mask away from your face and clothes, avoiding contamination. And again, discard appropriately. And finally, perform hand hygiene. If removing a P2/N95 mask, do so by holding the straps at the back of your head, lean forward and pull the straps up and over. Again, discard and perform hand hygiene. Follow by cleaning any shared equipment, and perform hand hygiene. 

If you have any questions about when or how to use PPE, go to Health.gov.au. By following the steps outlined in this video, you are minimising the impact of COVID-19 and preventing its spread. If we continue to work together, we can reduce the spread of COVID-19 and save lives. I'm extremely proud of your commitment and dedication to providing quality care to our communities in what has been a tremendously challenging time. Thank you.