JOHNS HOPKINS MEDICAL INSTITUTIONS Competency Validation Tool BIOLOGICAL PPE ENHANCED CONTACT AND DROPLET PRECAUTIONS (POWERED AIR PURIFYING RESPIRATOR (PAPR) OPTION) Employee Name: Role: Unit: Date: DESIRED OUTCOME: Demonstrates and understands procedures for donning and doffing personal protective equipment while taking care of patients with highly infectious diseases. Instructions: Fill in each box as performance criteria is observed and passed. Refer to Instruction and Evaluation Outcome Codes in the boxes to the left. Method of Instruction Codes O = Observation S = Simulation P = Protocol iew VT = Verbal Test OT = Online Training NA = Not Applicable RDN = Repeat Demonstration Needed Method of Instruction Donning OF HEALTHCARE WORKER: (in the clean donning room) Employee Assessment/Performance Competency Yes / No / RDN 1. Hydrate and use the restroom. 2. Change into disposable surgical scrubs. Cut scrub pants so they do not touch the floor. 3. Engage Trained Observer and Assistant Initials Validation of Competency Date Comments 4. Remove jewelry, cell phone, ID, pager, and other items. Secure hair. Secure eyeglasses. 5. Don bouffant 6. Gather, open and inspect PPE prior to donning, test PAPR airflow. 7. Don washable shoes AND boot covers*. 8. Perform hand hygiene. 9. Don inner gloves with extended cuffs. 10. Don fluid impermeable surgical gown. Secure at neck and tie at side with a SIMPLE BOW. Ensure that the gown cuff is over the gloves. Ensure that there is no gap between boot covers and surgical gown. 11. Secure PAPR belt at waist, with battery at the back. Fasten belt around waist securely and secure any loose straps. 12. Connect PAPR tubing to PAPR hood. Ensure that the PAPR is turned on. 13. Don PAPR hood with protective layers over top of gown. All hair, ears, and neck should be fully covered. 14. Don outer gloves with extended cuffs, ensuring cuffs are pulled over sleeves of gown. 15. Secure outer gloves with duct tape at the juncture of the gown. Leave a tab on the end of the tape for easy removal. 16. Don apron over gown and secure in the back with a SIMPLE BOW over PAPR hose. 17. Verify integrity and coverage of PPE ensemble by Trained Observer. Ensure healthcare worker has sufficient range of motion to perform patient care duties while still keeping all areas of body covered. ised 10/30/14 I:\HEIC NEW\Organisms and Diseases\Ebola\Competencies\EBOLA PPE Competency PAPR 10_30_14.docx Page 1 of 6
JOHNS HOPKINS MEDICAL INSTITUTIONS Employee Name: Competency Validation Tool BIOLOGICAL PPE ENHANCED CONTACT PRECAUTIONS (N95 RESPIRATOR OPTION) Role: Unit: Date: DESIRED OUTCOME: Demonstrates and understands procedures for donning and doffing personal protective equipment while taking care of patients with highly infectious diseases. Instructions: Fill in each box as performance criteria is observed and passed. Refer to Instruction and Evaluation Outcome Codes in the boxes to the left. Validation of Method of Instruction Codes Employee Assessment/Performance Competency O = Observation OT = Online Training S = Simulation NA = Not Applicable Method of Competency Initials Date P = Protocol iew RDN = Repeat Demonstration Instruction Yes / No / RDN VT = Verbal Test Needed Donning of the Assistant (to help remove Healthcare workers PPE): (in the clean donning room) 18. Assistant: Perform hand hygiene with ABHR Comments 19. Assistant: Change into disposable surgical scrubs. Cut scrub pants so they do not touch the floor. 20. Remove jewelry, cell phone, ID, pager, and other items. Secure hair. Secure eyeglasses. 21. Assistant: Don a bouffant 22. Gather, open and inspect PPE prior to donning, test PAPR airflow. 23. Assistant: Don washable shoes AND boot covers*. 24. Assistant: Perform hand hygiene using with ABHR 25. Assistant: Don inner gloves with extended cuffs. 26. Assistant: Don fluid impermeable surgical gown. Tie the gown securely in a manner that the tie can be easily untied when you are ready to doff. Leave some length of tie so that it can be pulled and untied without much effort. Ensure that the gown cuff is over the gloves. Ensure that there is no gap between boot covers and surgical gown. 27. Assistant: Don outer gloves with extended cuffs, ensuring cuffs are pulled over sleeves of gown. 28. Assistant: Don mask with faceshield 29. Verify integrity and coverage of PPE ensemble by Trained Observer. Ensure assistant has sufficient range of motion to perform duties while still keeping all areas of body covered. DOFFING OF HEALTHCARE WORKER: (in the Patient room) 30. In the Doffing room: Assistant: Ensure that there is a disinfected chair, bleach wipes, ABHR, red bag trash bags, bleach soaked pad taped to floor available for the doffing process, and clean dry pad taped to floor in doffing room ised 10/30/14 I:\HEIC NEW\Organisms and Diseases\Ebola\Competencies\EBOLA PPE Competency PAPR 10_30_14.docx Page 2 of 6
31. In the Doffing room: Assistant: Perform hand hygiene with bleach wipes or ABHR in Doffing room. 32. In the patient s room: Healthcare worker disinfects outer gloves and tape with bleach wipes or ABHR in patient s room. 33. In the patient s room: Healthcare worker removes apron by gently pulling out and away to break neck closure, rolling inwards to avoid contamination in patient s room. 34. While still in patient s room: Healthcare worker disinfects outer gloves and tape 35. While still in patient s room: Healthcare worker disinfects any areas of visible contamination with bleach wipes utilizing the mirror in the patient room. 36. While still in patient s room: Healthcare worker disinfects outer gloves and tape. ised 10/30/14 Page 3 of 6 37. Healthcare worker engages Trained Observer and Assistant. 38. Healthcare worker exits patients room, utilizing a bleach wipe to grab the door handle and open the door DOFFING OF HEALTHCARE WORKER: (in the Doffing room) 39. Healthcare workers enters the Doffing room 40. In Doffing room, Assistant inspects Healthcare worker s PPE for visible contamination, cuts, tears, etc. before starting to remove. If cut or tear in PPE then bleach wipe area, proceed with removal and notify HEIC of potential exposure. If visible contamination present, healthcare workers wipes him/herself off using bleach wipes. Bleach wipes are handed to the Healthcare worker by the Assistant. In the future steps, All PPE should be placed in leak-proof infectious waste container. 41. Healthcare worker disinfects outer gloves and tape with bleach wipes or ABHR. 42. Healthcare worker removes tape on outer gloves. 43. Healthcare worker removes outer gloves. Hold one of your wrists so that your thumb points toward the ceiling. Pinch that glove and lift at the wrist, then roll it down until the glove is completely off your hand in a ball in the palm of the other hand. Then, slide a finger down and inside the outer glove on the other hand and pull it off until it s balled around the first glove. Dispose of the gloves. BE CAREFUL NOT TO SNAP GLOVES. 44. Healthcare worker disinfects inner gloves with bleach wipes or ABHR. 45. Assistant disconnects PAPR tubing from hood, holding tubing away from healthcare worker. 46. Healthcare worker removes PAPR battery belt with assistant holding battery at back. Assistant places PAPR tubing, belt and battery into bin for decontamination 47. Healthcare worker removes PAPR hood by bending forward at 90 degrees, grasping hood over ears and pulling out and away from face. 48. Healthcare worker disinfects inner gloves with bleach wipes or ABHR. 49. Assistant disinfects outer gloves with bleach wipes or ABHR.
50. Assistant loosens back of healthcare worker s gown. Side tie is untied and Velcro is loosened. Assistant makes six inch fold on the right side of the gown by grasping the light blue outer portion of the gown at shoulders and waist areas, folding gown outwards towards healthcare worker. Repeat on left side. 51. Healthcare worker removes impermeable gown. grasps gown at one shoulder with opposite hand pull and slide it downward completely off the arm and folding inside and over that hand hand. Ultilizing other hand grasp at shoulder and slide gown down arm and downward in folding inside. Rolling gown inside itself, not to contaminate oneself. Placing gown in red bag trash. Don t let gown touch your body. 52. Healthcare worker disinfects inner gloves with bleach wipes or ABHR. ** 53. Healthcare worker removes inner gloves Hold one of your wrists so that your thumb points toward the ceiling. Pinch that glove and lift at the wrist, then roll it down until the glove is completely off your hand in a ball in the palm of the other hand. Then, slide a finger down and inside the outer glove on the other hand and pull it off until it s balled around the first glove. Dispose of the gloves. Then performs hand hygiene. 54. Healthcare worker performs hand hygiene with ABHR 55. Assistant disinfects outer gloves with bleach wipes or ABHR 56. Healthcare worker sits in clean chair. 57. Holding one leg up, the Assistant gently removes the healthcare worker s boot cover holding toe and heel areas and pulling out and away. Repeat for other leg. 58. Assistant disinfects outer gloves with bleach wipes or ABHR 59. Healthcare worker removes Bouffant 60. Healthcare worker steps onto pad containing Oxivir then onto dry pad prior to exiting doffing area. 61. Healthcare worker performs hand hygiene upon exiting the doffing area 62. Healthcare worker changes into personal scrubs and shoes at end of shift. Showering is optional for comfort. 63. Assistant: Disinfects PAPR tubing, battery, belt and floor utilizing an EPA approved disinfectant, 64. Assistant: Cleans and Disinfects Doffing room 65. Assistant: Doffs own PPE (see below) then performs hand hygiene ASSISTANT DOFFING 66. Assistant disinfects outer gloves with bleach wipes or ABHR 67. Assistant removes outer gloves Hold one of your wrists so that your thumb points toward the ceiling. Grasp that glove and lift at the wrist, then roll it down until the glove is completely off your hand in a ball in the palm of the other hand. Then, slide a finger down and ised 10/30/14 Page 4 of 6
inside the outer glove on the other hand and pull it off until it s balled around the first glove. Dispose of the gloves. 68. Assistant disinfects inner gloves with bleach wipes or ABHR. 69. Assistant removes impervious gown. Assistant unties gown then pulls gown at waist to release Velcro at neck. Assistant grasps gown at one shoulder with opposite hand pull and slide it downward completely off the arm and folding inside and over that hand. Ultilizing other hand grasp at shoulder and slide gown down arm and downward while folding inside. Rolling gown inside itself, not to contaminate oneself. Placing gown in red bag trash.** 70. Assistant disinfects inner gloves with bleach wipes or ABHR. 71. Assistant removes boot covers while sitting in clean chair. Grab boot covers from the outside and pull down to the ankle and slide off foot. Don t contaminate yourself and let boot covers touch legs. 72. Assistant disinfects inner gloves with bleach wipes or ABHR. 73. Assistant removes inner gloves. Hold one of your wrists so that your thumb points toward the ceiling. Grasp that glove and lift at the wrist, then roll it down until the glove is completely off your hand in a ball in the palm of the other hand. Then, slide a finger down and inside the outer glove on the other hand and pull it off until it s balled around the first glove. Dispose of the gloves. 74. Assistant performs Hand hygiene with ABHR. 75. Assistant dons purple exam gloves 76. Assistant walk toward door 77. Assistant removes faceshield with mask, and bouffant 78. Assistant performs Hand hygiene with ABHR. 79. Assistant remove gloves. Hold one of your wrists so that your thumb points toward the ceiling. Grasp that glove and lift at the wrist, then roll it down until the glove is completely off your hand in a ball in the palm of the other hand. Then, slide a finger down and inside the outer glove on the other hand and pull it off until it s balled around the first glove. Dispose of the gloves. 80. Assistant performs Hand hygiene with ABHR. 81. Assistant steps onto pad containing Oxivir then onto dry pad prior to exiting doffing area. 82. Assistant performs hand hygiene with ABHR upon exiting the doffing area 83. Assistant changes into personal scrubs and shoes at end of shift. Showering is optional for comfort. JOHNS HOPKINS MEDICAL INSTITUTIONS ised 10/30/14 Page 5 of 6
* If using thigh high boot covers, secure thigh high boot covers with single piece of tabbed duct tape. Tape will be placed in vertical direction in front of leg with the tab at the top. **If using thigh high boot covers: removes tape at the thigh from disposable scrubs and disinfect inner gloves with bleach wipes or ABHR. Definitions: Trained Observer = Person who is responsible for watch in process of Assistant and healthcare worker to identify breaches in protocol and providing exposure management Assistant = Person who directly assists healthcare worker with doffing and ensuring supplies are ready ABHR = Alcohol-based hand rub Evaluator Name: Employee Name: Evaluator Signature: Date: Employee Signature: Date: ised 10/30/14 Page 6 of 6