MASKED AND GOWNED

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Donning and doffing PPE the mnemonic way | OSHA Healthcare Advisor

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MASKED AND GOWNED

You must be logged in to access this feature. Leonard Corning and its subsequent application in humans by Augustus Bier in , close scrutiny has been paid to possible complications related to this technique. Although neurologic complications after spinal anesthesia, including aseptic meningitis, were described as early as , it was not until the Woolley and Roe cases in that these complications were highly publicized. In these cases, two relatively young healthy males became paraplegic after spinal anesthesia secondary to contamination of the syringes and spinal needles by an acidic descaler.

In another report in this issue of the journal, Ruppen et al. A statement on regional anesthesia approved by the House of Delegates of the American Society of Anesthesiologists 1 states that regional techniques are best performed by an anesthesiologist who possesses competence and skills necessary for safe and effective performance. Although the statement mentions that recognition of complications and provision of appropriate postprocedure care is the duty of the physician, there is no reference to sterile technique.

More importantly, a physician booklet drafted by the American Society of Anesthesiologists Task Force on Infection Control 2 recommends the use of maximal sterile barrier precautions during central venous catheter infection but does not address neuraxial techniques. Sterile precautions including cap, mask, sterile gown, sterile gloves, and large sterile drape have been demonstrated to reduce the incidence of intravascular catheter—related bloodstream infections when compared with standard precautions, including sterile gloves and small drapes.

This begs the question of whether the same precautions ought to be used for the placement of neuraxial anesthesia. Central venous catheter—related infections are more common than neuraxial-related infections, and the use of maximum sterile barriers while placing central lines was targeted by the Agency for Healthcare Research Quality as a practice that needs more widespread implementation.

Donning and doffing PPE the mnemonic way

Even in the presence of laminar airflow in operating rooms, bacterial counts measured on settle plates at head and waist height were higher when either hat or mask was not worn. Medications are frequently drawn up without a filter needle, although microparticles are often found in local anesthetics or other sterile solutions after the syringe has been filled.

Some have expressed skepticism that true sterile technique is actually practiced. Pointing to the many possible breeches leading to potential contamination, they have emphasized the need for a consensus conference to clarify the meaning of good aseptic practice for neuraxial techniques. It has been strongly supported by well-designed studies that the use of sterile gloves does not replace the need for hand hygiene. However, an alcohol-based chlorhexidine antiseptic solution is not approved by the Food and Drug Administration for spinal technique 3 because of controversial data on its neurotoxicity.

Although the data on facemasks is not as strong, there is evidence that upper mouth commensals have been implicated in cases of PDPM. Besides recognizing and accepting this complication, anesthesiologists should be aware of the changes needed to achieve safety in medicine. These include the need to limit discretion and autonomy, the need to standardize practices, the need for senior leadership arbitration, and the need for simplification. Even our colleagues in obstetrics have recognized that regional anesthetic—related complications are low. Other complications such as failed regional, spinal headache, and blood patch were more common.

Of note, there were no cases of epidural abscess or hematoma, or meningitis. In this issue of Anesthesiology, Ruppen et al. The results are not surprising in view of the results of a recent European report demonstrating that parturients have a lower incidence of major or severe complications related to neuraxial techniques when compared with the general population.

Unfortunately, we are unable to extract from the analysis of Ruppen et al. It is also difficult to determine whether combined spinal—epidural techniques were included in the analysis. One of the largest studies included does mention that combined spinal—extradural was not quantified and indeed was treated as epidural blockade in some cases. Use the mnemonic tip suggested by Susan E. You can see a sample of the PPE dispenser posters and quick-recall wallet cards, which Sammons sells through RapidRecalling.

Do you have a favorite safety tip that you would like to share with your colleagues? Tell us about it through the Contact Us feature. I cannot imagine doffing your gloves brfore the gown!!

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4. Donning and doffing PPE the mnemonic way!

In the OR we take off the gown first and then the gloves. This prevents the stuff on the gowns from contacting your ungloved hands. Someone was not thinking. If the patient was in airborne precautions the mask would be the last PPE to doff. Otherwise, I would doff gloves last, to protect my hands from potential contamination of blood, etc. Then, always hand hygiene after removal of gloves. I was a Surgical Tech instructor and I agree with the comment above. For Doff PPE 1. Of course this all depends on if any gross contamination is on the goggles then you would need to remove surgical gloves and put on utility ones to remove mask and goggles.

Kudos to Mr LaHoda for standing behind the standard. After researching this process I must admit that I found student nurses have prepared for the NCLEX using the alphabetical removal of soiled gowns and gloves. I too am a Surgical RN and agree with removing the gloves after the gown.



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I have researched alot of web sites and for the most part they talk about the sleeves being contaminated so when you take off the gloves first the contaminated gown is being pulled over your hands or when you reach up to remove your eye protection the dirty sleeves are near your face. Removing gloves first is absurd.