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Donning and removing PPE: Directions are included (CDC and OSHA)

May 11, 2015
Personal protective equipment (PPE) keeps you and your patients safe, but not if you don't know how to use it. Know and follow guidance from the CDC and OSHA.

Editor's note: Looking for information about PPE related to the coronavirus pandemic? Please visit our COVID-19 channel for the most up-to-date information for dental health-care professionals.

My daughter bought me a Roku for Christmas. It is a device that was developed to end the outrageous cost of cable services. It has not helped me much. In March, it still sat beside my TV. Roku won the war; I could not manage to figure out how to use this device. Personal protective equipment is just like Roku. Many do not know how to use it.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC), however, have developed directions.

OSHA defines personal protective equipment (PPE) as "specialized clothing or equipment, worn by an employee for protection against infectious materials." It is a vital tool in the dental setting. These tools are the barrier between the clinician and pathogens that may be present during patient care and contact.

OSHA requires that employers provide their employees with appropriate PPE and that they make sure that it is either disposed of, if it is single use, or cleaned or laundered if multiple use. Employers must make sure it is repaired if necessary and stored after use.

The CDC has developed recommendations to keep staff and patients safe. They have simple directions for donning and removing personal protective equipment. One of the most important things in infection control that is often overlooked is that donning and removing PPE can itself be a source of contamination. The CDC has given guidelines to help prevent the possibility of such contamination.

Putting it on: the sequence

1. Gown: Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back. Fasten in back of the neck and waist.

Tip: Do not wear the gown outside of patient care areas of the office and the lab such as the front desk. You could cross-contaminate those areas.

2. Mask or respirator: Secure ties or elastic bands at middle of head and neck. Fit flexible band around nose bridge. Fit snug to face and below chin.

Tip: Do not twist the flexible band as this will create a gap.

3. Goggles or face shield: Place over face and eyes and adjust to fit.

Tip: Get properly fitted glasses that do not have to be adjusted during patient care. Touching the glasses during patient care can lead to cross-contamination.

4. Gloves: Extend to cover wrist of gown. Covering the wrist of the gown will create a "seal."

Tip: Never store gloves in your gown pocket. Keep them in an easily accessed area in their original box or covered container.

Taking it off: the sequence

According to the CDC, PPE should be removed before you go into any area that is not involved in patient care. This includes removal before going into the lunchroom, lobby, etc. When a respirator is necessary, remove respirator after leaving patient room and closing door.

Removal of personal protective equipment can be one of the most risky areas in infection control if it is not done properly. Overspray from patient care, debris from processes, saliva, and bloodborne pathogens can cross-contaminate during the process of removal. You may be taking home those pathogens if you are not following the protocols.

1. Gloves: Grasp outside of glove with opposite hand; peel off. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at wrist. Peel glove off over first glove. Discard gloves in waste container.

Tip: It is important to keep watches and jewelry off to make this process easy with removal.

2. Goggles or face shield: Handle by headband or ear pieces. Place in designated receptacle for reprocessing or in waste container.

Tip: Clean and disinfect eye protection according to manufacturer's directions if they are not disposable.

3. Gown: Unfasten ties. Pull away from neck and shoulders, touching inside of gown only. Turn gown inside out. Fold or roll into a bundle and discard.

Tip: It is important to make sure that the gown does not contaminate environmental surfaces. Have a specific place for hanging the gown that is not used for hanging anything else such as patients' coats. Do not use the lunchroom or restroom for this purpose.

4. Mask or respirator: Grasp bottom, then top ties or elastics and remove. Discard in waste container.

Tip: Never reuse a mask. It is a single-use item. Do not place it on the counter or in your pocket after use because of cross-contamination. Do not lower it on your chin or allow it to hang off your ear. It is contaminated after patient care.

When delivering care, the CDC gives some great recommendations to keep everyone safe!

• Keep hands away from face

• Limit surfaces touched

• Change gloves when torn or heavily contaminated

• After removing gloves and PPE, perform hand hygiene before leaving the patient's environment.

I final broke down and called my daughter and confessed my inability to master Roku. She asked if I read the directions. What directions? As soon as I fumbled through the simple directions, I won the war. I now use the Roku every day.

The information in this article contains the directions to keep you safe. Read them. Use them. The resources listed in the sidebar are great for training staff and keeping everyone safe.

Resources for personal protective equipment

NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.

About the Author

Noel Kelsch, MS, RDHAP

Noel Kelsch, MS, RDHAP, is a syndicated columnist, researcher, writer, speaker, and cartoonist. She is the director of Cabrillo College dental hygiene program, past president of the California Dental Hygienists ‘Association, and immediate past president of the Dental Hygiene Board of California. She owns her own dental hygiene practice that facilitates care for those dealing with homelessness and hospice care. She has received many national awards and may be reached at [email protected].