PPE: Clinically Stable Patients Suspected to have VHF

Recommended PPE

All PPE should be used in the context of a comprehensive infection control program that follows CDC recommendations and must follow applicable Occupational Safety and Health Act of 1970 (OSHA) requirements, including the Bloodborne Pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132) standards, and other requirements under OSHA (e.g., the General Duty Clause, section 5(a)(1); and prohibitions against discrimination or retaliation against workers, section 11(c)).

While evaluating and managing patients suspected to have VHF who are clinically stable and do not have bleeding, vomiting, or diarrhea, healthcare providers should at a minimum wear:

• Single-use (disposable) fluid-resistant gown that extends to at least mid-calf or single-use (disposable) fluid-resistant coveralls without integrated hood
• Single-use (disposable) full face shield
• Single-use (disposable) facemask
• Single-use (disposable) gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.

In this guidance, fluid-resistant means a gown that has demonstrated resistance to water or a coverall that has demonstrated resistance to water or synthetic blood. The specific test methods that assess resistance are listed in Table 1. When purchasing gowns and coveralls, facilities should follow specifications in this table to ensure they select recommended gowns and coveralls.

Table 1. Specifications for fluid-resistant gowns and coveralls

Donning PPE

Donning PPE – This donning procedure applies to PPE recommended for evaluating and managing patients suspected to have VHF who are clinically stable and do not have bleeding, vomiting, or diarrhea. There is a lower risk of splashes and contamination in these situations. An established protocol, combined with proper training of the healthcare worker (HCW), helps to facilitate compliance with PPE guidance.

1. Remove Personal Clothing and Items: The HCW should wear surgical scrubs. No personal items (e.g., jewelry [including rings], watches, cell phones, pagers, pens) should be worn under PPE or brought into the patient room. Long hair should be tied back. Eye glasses should be secured with a tie.
2. Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to ensure that it is in serviceable condition (e.g., not torn or ripped), that all required PPE and supplies are available, and that the sizes selected are correct for the HCW.
3. Perform Hand Hygiene: Perform hand hygiene with alcohol-based hand rub (ABHR). When using ABHR, allow hands to dry before moving to next step.
4. Put on Inner Gloves: Put on first pair of gloves.
5. Put on Gown or Coverall: Put on gown or coverall. Ensure gown or coverall is large enough to allow unrestricted movement. Ensure cuffs of inner gloves are tucked under the sleeve of the gown or coverall.
6. Put on Facemask: Put on facemask.
7. Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall.
8. Put on Face Shield: Put on full face shield over the surgical facemask to protect the eyes, as well as the front and sides of the face.
9. Verify: After completing the donning process, the integrity of the ensemble should be verified by the HCW (e.g., there should be no cuts or tears in the PPE). The HCW should be comfortable and able to extend the arms, bend at the waist, and go through a range of motions to ensure there is sufficient range of movement while all areas of the body remain covered. A mirror in the room can be useful for the HCW while donning PPE.

Doffing PPE

Doffing PPE – PPE is doffed in the designated PPE removal area in the healthcare facility. As with all PPE doffing, meticulous care should be taken to avoid self-contamination. Place all PPE waste in a leak-proof infectious waste container.

1. Inspect: Inspect the PPE for visible contamination, cuts, or tears before starting to remove. If any PPE is visibly contaminated, disinfect by using an *EPA-registered disinfectant wipe. If the facility conditions permit and appropriate regulations are followed, an *EPA-registered disinfectant spray can be used, particularly on contaminated areas.
2. Disinfect and Remove Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard outer gloves, taking care not to contaminate inner gloves when removing the outer gloves. Dispose of outer gloves into the designated leak-proof infectious waste container.
3. Inspect and Disinfect Inner Gloves: Inspect the inner gloves' outer surfaces for visible contamination, cuts, or tears. If an inner glove is visibly soiled, then disinfect the glove with either an * EPA-registered disinfectant wipe or ABHR, remove the inner gloves, perform hand hygiene with ABHR on bare hands, and don a new pair of gloves. If a cut or tear is seen on an inner glove, immediately review occupational exposure risk per hospital protocol. If there is no visible contamination and no cuts or tears on the inner gloves, then disinfect the inner-gloved hands with either an * EPA-registered disinfectant wipe or ABHR.
4. Remove Face Shield: Remove the full face shield by tilting the head slightly forward, grabbing the rear strap and pulling it over the head, gently allowing the face shield to fall forward. Avoid touching the front surface of the face shield. Discard the face shield into the designated leak-proof infectious waste container.
5. Disinfect Inner Gloves: Disinfect inner gloves with either an * EPA-registered disinfectant wipe or ABHR.
6. Remove Gown or Coverall: Remove and discard.
   1. Depending on gown design and location of fasteners, the HCW can either untie fasteners or gently break fasteners. Avoid contact of scrubs or disposable garments with outer surface of gown during removal. Pull gown away from body, rolling inside out and touching only the inside of the gown.
   2. To remove coverall, tilt head back to reach zipper or fasteners. Unzip or unfasten coverall completely before rolling down while turning inside out. Avoid contact of scrubs with outer surface of coverall during removal, touching only the inside of the coverall. Dispose of gown or coverall into the designated leak-proof infectious waste container.
7. Disinfect and Change Inner Gloves: Disinfect inner gloves with either an * EPA-registered disinfectant wipe or ABHR.
   1. Remove and discard gloves, taking care not to contaminate bare hands during removal process.
   2. Perform hand hygiene with ABHR.
   3. Don a new pair of inner gloves.
8. Remove Surgical Facemask: Remove the surgical facemask by tilting the head slightly forward, grasping first the bottom tie or elastic strap, then the top tie or elastic strap, and remove the front of the surgical facemask without touching it. Discard the surgical face mask into the designated leak-proof infectious waste container.
9. Disinfect and Remove Inner Gloves: Disinfect inner-gloved hands with either an * EPA-registered disinfectant wipe or ABHR. Remove and discard gloves, taking care not to contaminate bare hands during removal process. Dispose of inner gloves into the designated leak-proof infectious waste container.
10. Perform Hand Hygiene: Perform hand hygiene with ABHR.
11. Inspect: The HCW should inspect for any contamination of the surgical scrubs or disposable garments. If there is contamination, shower immediately, and then immediately inform the infection preventionist or occupational safety and health coordinator or their designee.

*EPA-registered disinfectant wipe: Use a disposable wipe impregnated with a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant from List Q; List L can also be used.