The trained observer must complete this document for EVERY instance of a staff member entering and exiting rooms where persons are suspected or confirmed of having EVD. The trained observer must receive specific training to fulfill this role. A donning/doffing assistant is promoted; however it is understood procedures must be adjusted for local resource. The same or different individuals may fulfill each of the roles of PPE donning or doffing assistant. Only individuals who have received donning and doffing training may fulfill these roles. NAME OF TRAINED OBSERVER (Print) SDFGFGFF HCW INFORMATION (Print) Site: Staff Name: Date: Department: Employee ID: NAME OF DONNING ASSISTANT (Print) NAME OF DOFFING ASSISTANT (Print) SDFGFGFF If different from above PATIENT INFORMATION Affix Label Comments: Last Updated: 17/04/2015 Page 1 of 7
DONNING (Health Care Worker entering patient room) VCH Ebola Virus Disease Health Care Worker C = Complete N = Not Applicable Confirm the Health Care Worker (HCW) has done the following prior to starting donning procedure. Check off the appropriate box for every step below. No further action should be taken until the previous step is complete. C N Step 1. Remove personal clothing, all personal items, and jewellery. Change into hospital scrubs. Empty pockets. VCH approved footwear should be worn. Eyeglasses may be worn. 2. Securely tie hair back, if required. 3. Partner with a trained observer. Trained Observer must ensure the HCW visually inspects all items of PPE for defects prior to donning. HCW is to repeat back PPE instruction. C N Step 4. Perform hand hygiene with alcohol based hand rub or soap and water. 5. Put on fluid-impervious knee-high leg and foot coverings. 6. Perform hand hygiene with alcohol based hand rub. Allow 7. Put on fluid-impervious long sleeved disposable gown of sufficient length to reach mid-calf, and width to allow sufficient overlap over backside. 8. Perform range of motion lift arms above head, forward and low (similar to actions which may be performed during patient care). Look for significant gaps and/or loss of overlap with the booties. 9. Remove eyeglasses, if worn. C N Step 10. Put on bouffant cap, ensuring ears and all hair are covered. Last Updated: 17/04/2015 Page 2 of 7
VCH Ebola Virus Disease Health Care Worker 11. Put on N95 respirator (staff must be clean shaven at the point of seal and have been fit tested within the past year to the make and model being donned). 12. If eyeglasses required, put on overtop of bouffant cap and N95 respirator straps. 13. Put on fluid-impervious head covering, ensuring it covers all of the hair and the ears, and that it extends past the neck to the shoulders. 14. Perform N95 respirator seal check. 15. Put on full-face shield. 16. Perform hand hygiene with alcohol based hand rub. Allow 17. Put on a pair of long inner-gloves. Ensure that inner gloves are under cuff of the gown sleeve. Donning assistant may assist. 18. Put on a pair of long outer gloves. Pull the glove completely over the cuff of the gown sleeve. 19. Perform range of motion lift arms above head, forward and low (similar to actions which may be performed during patient care). Look for significant gaps and/or loss of overlap with the booties. 20. Trained observer and HCW must agree that the PPE is on correctly. Time Entered Patient Room: DOFFING (Health Care Worker exiting patient room) C = Complete N = Not Applicable B=Breach Check off the appropriate box for every step below. Trained Observer and HCW may adjust, based on a visual risk assessment, the ordering of doffing from most to least contaminated. HCW is to repeat back PPE instruction. Last Updated: 17/04/2015 Page 3 of 7
In Patient Room 1. Engage trained observer. Trained observer to notify PPE doffing assistant. 2. Ensure trained observer and doffing assistant have completed predoffing preparation and are ready for HCW doffing process to begin. 3. Before entering the PPE removal area, inspect PPE for damage or gross contamination. Remove gross contamination with disinfectant wipe such as Oxivir Tb wipes. 4. Disinfect outer gloves with disinfectant wipe. 5. Wipe door handle/mechanism with a new disinfectant wipe and discard into EVD waste container. 6. Exit the patient room into the PPE removal area, onto a hospital grade disinfectant saturated absorbent mat. Time Exited Patient Room: In PPE Removal Area 7. Further inspect PPE for visible contamination, turns around (while staying on the hospital grade disinfectant saturated mat) to allow the trained observer and doffing assistant to inspect your back. Further disinfect with disinfectant wipes or bottled hospital grade disinfectant, as needed. The Doffing Assistant may assist if bottled hospital grade disinfectant is being used. 8. Inspect the outer gloves for visible contamination, cuts or tears. 9. Disinfect outer gloves with disinfectant wipe or alcohol based hand rub. Allow 10. Using glove-to-glove technique, remove and discard outer gloves in EVD waste container. Last Updated: 17/04/2015 Page 4 of 7
VCH Ebola Virus Disease Health Care Worker 11. Inspect inner gloves for visible contamination, cuts or tears 12. Disinfect gloves with a disinfectant wipe or alcohol based hand rub. Allow 13. Remove the face shield by tilting your head slightly forward, keeping your chin up, and pulling the shield over the head using the rear strap. Allow the face shield to fall forward and discard in EVD waste container. 14. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 15. Carefully grasp outer surface of hood behind head and gently roll-up hood. Tilt head forward, close eyes and remove hood by pulling towards front of face. Discard in EVD waste container. 16. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 17. Untie side strap of gown. Loosen Velcro fastener by gently pulling on front of gown, near shoulders. Remove gown by pulling away from the body, rolling inside out. Discard in EVD waste container. 18. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 19. Remove knee-high leg and foot coverings, by alternating gently pulling on covering s exterior by the heel and toe sections. Discard leg and foot coverings in EVD waste container. 20. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 21. Using glove-to-glove technique, remove and discard gloves in EVD waste container. 22. Carefully perform hand hygiene with alcohol based hand rub or soap and water. 23. Put on a pair of new gloves. Last Updated: 17/04/2015 Page 5 of 7
24. If eyeglasses worn, remove and place in disposable tray or on disinfectant wipe then disinfect gloves with alcohol based hand rub or disinfectant wipe. 25. Remove N95 respirator by straps (lower strap first, then upper strap) allowing respirator to fall away from face then discard in the EVD waste container. Do not touch the front of the N95 respirator. 26. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 27. Remove bouffant cap by leaning backward, pinching top of cap pulling backward and away from face. Discard into EVD waste container. 28. Disinfect designated stool or grab bar with disinfectant wipes. 29. Step forward off mat. Roll absorbent mat and discard in EVD waste container. 30. Disinfect gloves with disinfectant wipe or alcohol based hand rub. Allow 31. Using glove-to-glove technique, remove and discard gloves in EVD waste container. 32. Carefully perform hand hygiene, using alcohol based hand rub or soap and water. If eyeglasses were worn into room, complete steps 33-37, if they were not, mark these steps as Not Applicable. 33. Don a new pair of gloves. 34. Disinfect eyeglasses with a disinfectant wipe. 35. Disinfect gloves with alcohol based hand rub or disinfectant wipe and allow 36. Remove gloves using glove-to-glove technique. 37. Perform hand hygiene using soap and water, rinse eyeglasses while washing hands. Last Updated: 17/04/2015 Page 6 of 7
38. Perform a final inspection for any indication of contamination of the hospital scrubs or otherwise on the body. 39. Trained Observer and HCW to agree process followed correctly. Exit doffing area. Post- Doffing 40. Remove shoes and wipe with disinfectant wipe. 41. Remove and discard scrubs into an EVD waste container. 42. Don new pair of scrubs and put shoes back on. 43. Proceed to shower area, shower and discard scrubs. Put on new scrubs. Steps to Follow if a Breach Occurs 1. If a breach in PPE is suspected go to designated doffing area immediately. Remain calm and work slowly through each step outlined in this document. 2. Work with trained observer to remove PPE as per the step-by-step instructions for doffing. 3. If exposed area is intact skin, wash the affected area well with soap and water. 4. If exposed area is a damaged skin, mucous membrane or eye flush the area with generous amounts of water. 5. If a percutaneous injury occurs, do not promote bleeding by squeezing the wound and do not soak the wound in bleach or disinfectant. Wash the area with soap and water. 6. Immediately follow health authority protocol for reporting a breach. Notify the Medical Health Officer (604-675-3900; after hours reporting are via pager at 604-527-4893). Notify the Workplace Health Call Centre (1-866-922-9464). Note: If the HCW is medically unable or in quarantine, the immediate supervisor will make the call. Last Updated: 17/04/2015 Page 7 of 7