COVID-19 guidance: donning and doffing PPE (ROI)

We know lots of you have questions around donning and doffing PPE. We have sourced the following guidance from the HSE. Please familiarise yourself with this guide and take time to watch the HSE YouTube videos below.

Pre-donning requirements:

Donning PPE

To be worn by ALL persons entering the room where a suspected, or confirmed case is being cared for.

General Guidance

• PPE should be available outside the patient’s room
• A buddy system to observe donning and doffing of PPE is recommended
• In addition to standard precautions, the following PPE for contact and droplet precautions should be used by all HCW routinely.
• Long sleeved, fluid-repellent disposable gown over scrubs, standard work clothing is acceptable if changing to Scrubs is not practical.
• Non-sterile examination gloves
• Surgical Mask
• For Aerosol Generating Procedures a FFP2/FFP3 mask for airborne precautions instead of a surgical mask should be used. HCW with facial hair including beards and moustaches require further respirator support with a power air-purifying respirator (PAPR) option. Eye protection must be worn (prescription glasses do not provide adequate protection against droplets sprays and splashes)
• It is recommended that eye protection should be single-use and disposed as healthcare risk waste after use. This is due to the difficulties associated with cleaning to eliminate contamination

The following guide is from the HSE with supporting imagery from PHE.

Before you begin, decontaminate your hands:

• Ensure that you decontaminate your hands, wrists and forearms with soap and hot water
• Apply alcohol gel and rub

– Ensure that it is the correct size for you
– Do not use the inside tie
– Fasten the necktie/velcro and waist ties
– Make sure the gown is securely fitted at the neck and waist ties

– If you wear glasses remove these before donning the mask, clean them with an alcohol wipe and replace them before donning the visor
– Put on the mask and check for fit:
o Place mask over nose, mouth and chin
o Fit flexible nose piece over nose bridge
o Secure on head with elastic
o Adjust to fit
o Inhale – mask should collapse
o Exhale – check for leakage around face
– Ensure no folds around the seal and no twists or turns on the straps
– If you wear glasses put them back on now before going onto the next stage

–This could be a full-face visor or goggles
– If you using a visor ensure that it covers all of your face including your chin – adjust the head band if necessary
– Get your buddy to check, if a buddy is not available check in a mirror to ensure that it is fitted
– NB Googles go over glasses, glasses on their own do not provide protection against droplet or airborne infection

– Put on a pair of gloves that are the correct size for your hands
– Ensure the gloves cover the cuff of the gown

Complete a final PPE check:

• Check that the gown ties at the neck and waist are secure
• The respirator is correctly fitted
• The visor is in position
• The gloves cover the cuffs

You can watch a video demonstration from the HSE here.

Doffing PPE

Key facts

• PPE should be removed in an order that minimises the potential for cross-contamination
• PPE must be removed before leaving the patients room (apart from your mask)
• Your mask must always be removed when you are outside the patient’s room
• If you need to leave the room for example to visit the toilet – make sure you leave yourself enough time to appropriately doff the PPE – this should not be rushed
• Where possible the process should be supervised by a buddy at a distance of two metres
• If you are aware of any PPE breach or high-exposure contamination to PPE, inform your buddy before removing PPE
• Ensure the patient’s door is closed before taking off PPE

The following guide is from the HSE with supporting imagery from PHE.

1. Gloves: always remember the outside of the gloves are likely to be contaminated.

To safely remove gloves you need to:
– Grasp the outside of the glove with the opposite gloved hand and peel off
– Hold the removed glove in the gloved hand

– Slide your fingers under the other glove
– Peel the remaining glove off over the other glove
– Dispose of the gloves into the clinical waste bin

Clean your hands, wrists and forearms with alcohol hand gel or rub

2. Gloves: always remember that the front of the gown and sleeves are likely to be contaminated

– Always remove the gown slowly and carefully
– Undo the neck tie
– Undo the waist tie

Pull the gown away from the neck and shoulders touching the INSIDE of the gown ONLY, using a peeling motion

– Turn the gown inside out
– Fold or roll into a bundle and discard into the clinical waste bin

3. Eye Protection: always remember the outside of the eye protection is likely to be contaminated

– To remove the visor, stand straight and do not bend forwards as this brings the bottom of the visor into contact with the (clean) upper body
– Find the elastic strap at the back of the head, close your eyes and lift the strap upwards then over your head using both hands
– Place the visor into the clinical waste bin
– Leave the patient’s room still wearing your respirator
– Clean hands, wrists and forearms again with alcohol hand gel/rub

– To remove goggles, find the elastic strap at the back of your head, close your eyes and lift strap upwards then over your head using both hands
– Discard into a clinical waste bin or into a receptacle for reprocessing/decontamination

4. Mask: always remember DO NOT touch the front of the respirator as it will be contaminated.

– If you wear glasses, remove them before doffing the respirator
– Clean them with an alcohol wipe and do not put them back on until you have completed doffing and washed your hands
– Carefully and slowly remove the respirator without touching the front
– Reach to the back of the head with both hands to find the bottom strap and bring it up to the top strap
– Lift both straps over the top of the head
– Let the respirator fall away from your face and drop into the clinical waste bin

5. Wash your hands, wrists and forearms with soap and water

You can watch a video demonstration from the HSE here.