Use of Personal Protective Equipment when Caring for a
Person Under Investigation for Ebola Virus Disease in
a First Nations or other Community Health Facility.
This training video is based on advice from the Public Health
Agency of Canada's Infection Prevention and
Control Expert Working Group.
My colleague, Dr. David Butler-Jones,
and I would like to tell you about this very important
initiative to help keep our health care workers safe and
ensure they are prepared for infectious disease threats
including Ebola or other hemorrhagic fevers.
Health Canada is pleased to collaborate with the Royal
College of Physicians and Surgeons of Canada
and the Public Health Agency of Canada to bring
you these training videos.
They will show how to put on and take off the personal protective
equipment needed when caring for patients suspected or confirmed
to have Ebola Virus Disease, in a First Nations
community health setting.
Training and repeated practice is necessary to
ensure when personal protective equipment is used,
it is done so in a correct and safe way.
These videos are to be used along with
the in-person training.
These videos are an important part of infection prevention and
control training - both now and in the future - to help refresh
and maintain these essential skills on an ongoing basis.
We recommend watching these videos regularly as a reminder
of the important skills learned during in-person training.
Our goal is to ensure health care workers in First Nations
communities are prepared for any serious communicable disease
event, including the Ebola Virus Disease.
We hope you find these videos a valuable contribution towards
our efforts to protect and be protected when dealing
with potential risks.
Recommended personal protective equipment donning and doffing
processes where there is a higher risk of exposure
to blood or other bodily fluids.
Please note that the sequences for donning and doffing may vary
according to the type of personal protective equipment
in use at your health facility and based on the
point-of-care risk assessment.
A risk assessment approach should be used before,
and during, every interaction with a patient under
investigation for Ebola Virus Disease to support
the use of additional infection prevention and control
measures where indicated.
This video segment demonstrates the DONNING sequence of personal
protective equipment for higher risk of exposure to blood
or other bodily fluids.
The recommended personal protective equipment used in the
following higher-risk scenario, as per the point-of-care
risk assessment, includes:
fluid-resistant foot and leg coverings,
a fluid-resistant mask
(or respirator, if performing an
aerosol-generating medical procedure),
a fluid-resistant head and neck covering,
a fluid-impermeable gown, a fluid-impermeable apron,
a faceshield, and double gloves.
DONNING STEP 1: Prepare for donning enhanced personal
protective equipment in a designated clean area.
You, the health care worker,
together with the Trained Monitor:
- Perform self-care, such as hydrating
and going to the washroom.
- Remove all personal items such as stethoscope, cell phone,
jewellery, identification tag, pens, and other items.
- Pull hair back and away from your face and neck
and secure it in place.
- Ensure that your fingernails are trimmed
to prevent tearing of gloves.
- Perform hand hygiene, thoroughly and effectively,
using alcohol-based hand rub,
or soap and water if hands are visibly soiled.
(Note: The proper technique and complete hand hygiene
procedure is being demonstrated in this step.
Subsequent hand hygiene steps have been abbreviated.)
- Ensure that you have all the personal
protective equipment required.
- Inspect the personal protective equipment for
defects and appropriate size.
Most importantly, be attentive and careful,
and take your time in donning the personal
protective equipment.
Supporting you is a Trained Monitor whose role is to assist,
assess, and document your appropriate selection, use,
removal and disposal of personal protective equipment.
The Trained Monitor reads aloud all steps throughout the donning
procedure and ensures all steps are performed properly.
STEP 2: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DONNING STEP 1.
- Use alcohol-based hand rub.
STEP 3: Put on fluid-resistant foot
and leg coverings.
If needed, sit down (on a stool or other surface)
in the designated clean area.
Ensure that: - Your shoes are compatible with the coverings,
and allow for easy removal.
- The foot and leg coverings are long enough to cover
your legs below the gown.
- And fit securely to avoid the risk of tripping.
STEP 4: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DONNING STEP 1.
STEP 5: Put on fluid-resistant mask (if an aerosol-generating
medical procedure is not being performed)
- Mould the metal piece to the bridge of your nose
with three fingers simultaneously on both sides.
- Ensure that your nose, mouth, and chin are fully covered
with minimal gap between the mask and your face.
If there is a gap between the mask and your face,
make a knot in each ear loop to tighten it.
Note that masks with attached visors are not suitable.
ALTERNATE STEP 5: Put on respirator
(instead of a face mask, if an aerosol-generating medical
procedure is being performed)
- Confirm that proper fit-testing was completed,
as per your jurisdiction's or organization's
policies and procedures.
- Place elastic bands, as per user instructions,
to hold the respirator in place.
The Trained Monitor can position the elastic bands
properly to ensure a secure fit.
- Perform a seal check to assess adequate fit.
STEP 6: Put on fluid-resistant head and neck covering
- Ensure that the head and neck covering covers all of your
hair and ears, and extends past your neck and shoulders.
- Secure the ties at the back of your head.
The Trained Monitor can help fasten the ties
at the back of your head.
The Trained Monitor verifies that the covering fits
securely and comfortably around your face.
STEP 7: Put on inner gloves
- Ensure that the gloves are durable
and fit appropriately for the task.
- Examine the gloves for intactness and proper fit.
STEP 8: Put on fluid-impermeable gown
- Ensure that the gown is cuffed and long enough to cover
from your neck to below your foot and leg coverings,
and also to your wrists (including sleeves).
- Fasten the gown securely at the neck and waist.
If the gown has two sets of waist ties:
Tie the inner tie first, followed by the outer tie,
with edges overlapping to completely cover your clothing,
both front and back.
The Trained Monitor can help fasten the gown at your neck
and waist to ensure that no clothing is visible.
The Trained Monitor ensures that:
- Your inner gloves fit securely under the gown cuffs.
- And the ties of the head and neck covering
are also under the gown.
STEP 9: Put on fluid-impermeable apron
- Don the apron to the front of your body for additional
protection against exposure to patient blood or bodily fluids.
The Trained Monitor ties the apron slightly adjacent to,
but away from, the gown ties to ease doffing.
Do not tie the apron at the front.
STEP 10: Put on faceshield
- Ensure that the faceshield is long enough to prevent
splashing underneath and that it fits over
your prescription eye glasses, if wearing.
- Secure the strap at the back of your head.
-Adjust the faceshield to ensure that no skin is exposed,
as directed by the Trained Monitor.
Note that eye glasses are not suitable eye protection.
STEP 11: Put on outer gloves
- Ensure that the gloves are durable
and fit appropriately for the task.
- Fit them securely over your gown cuffs.
The Trained Monitor can help position the outer
gloves over your gown cuffs.
- Examine the gloves for intactness and proper fit.
The DONNING procedure for higher risk of exposure
to blood or other bodily fluids is now complete.
To ensure proper fit of personal protective equipment,
perform a few range of motion exercises,
such as looking up and down, bending forward at the waist and
extending arms above your head.
The Trained Monitor inspects front and back to ensure
proper fit of personal protective equipment
- that is, all skin and clothing are completely covered.
You are now appropriately attired to provide care to a
patient suspected or confirmed to have Ebola Virus Disease,
where there is a higher risk of exposure to blood
or other bodily fluids.
If, at any point while providing care to the patient,
you have any difficulties or unintended breaches with your
personal protective equipment (such as fogging of the
faceshield or tearing of the gloves),
OR unprotected exposure to blood or other bodily fluids,
you should: stop providing patient care after ensuring
the patient is safe,
leave the patient room, and calmly and methodically
remove your personal protective equipment.
Then, as required, follow your health facility's Ebola exposure
management plan and put on a new set of personal
protective equipment before continuing patient care.
This video segment demonstrates the DOFFING sequence of personal
protective equipment for higher risk of exposure to
blood or other bodily fluids.
DOFFING STEP 1: Prepare for doffing enhanced personal
protective equipment in a designated soiled area
located immediately outside the patient room.
The Trained Monitor performs a point-of-care risk
assessment and dons the personal protective equipment
required, ahead of time, in order to safely assist you,
the health care worker, as soon as provision
of care is completed.
After leaving the patient room, you step into and remain in the
designated soiled area right outside the patient room to
remove and immediately discard your personal protective
equipment, including respirator (if used) into
a designated sturdy no-touch leak-resistant biohazard
waste receptacle located there.
In the following demonstration, as the health care worker
is visibly soiled, the point-of-care risk assessment
indicates higher risk of exposure to the Trained Monitor.
Therefore, the personal protective equipment used by
the Trained Monitor mirrors that of the health care worker.
The Trained Monitor remains in the designated clean area the
entire time while helping the health care worker
in the doffing process.
The Trained Monitor reads aloud all steps throughout the
doffing process and ensures that you are attentive, careful,
and taking your time to reduce your risk of self-contamination.
- Inspect your personal protective equipment for visible
contamination, cuts or tears.
Most importantly, be attentive and careful,
and take your time in doffing your personal protective
equipment to reduce the risk of self-contamination.
STEP 2: Remove outer gloves
- Use glove-to-glove technique to remove gloves
away from your body, taking care not to
contaminate inner gloves, as follows:
- Grasp the outside edge near your wrist and peel it away,
rolling the glove inside-out.
- Then reach under the glove on your other hand
and peel it away.
- Discard both gloves immediately into the
designated waste receptacle.
STEP 3: Remove apron
Loop your thumbs onto the neck strap,
being careful to minimize contact with your gown
and not touch the head and neck covering.
To reduce your risk of self-contamination,
the Trained Monitor then:
- Carefully cuts the neck strap at the back with
disposable blunt scissors.
- Discards the scissors into the designated sharps receptacle
in the designated soiled area.
- And undoes the waist ties.
You then: - Pull the two fragments of the cut neck strap
forward, away from your body.
- And remove the apron, without contaminating yourself,
rolling it from inside to outside.
- Discard the apron immediately into the waste receptacle.
The Trained Monitor:
- Removes and immediately discards outer gloves into the
same waste receptacle, and puts on new gloves.
STEP 4: Remove gown
To reduce your risk of self-contamination,
the Trained Monitor:
- Unties the outer waist tie to open your gown
at the back and expose the inner tie.
- Then unties your inner tie at the back.
- And unfastens your gown at the neck,
gently pushing the gown off your shoulders,
being careful not to touch the inside of your gown.
You then: - Reach under the gown cuff of one sleeve
and gently slide it over your hand.
- With your hand covered by the gown cuff,
pinch the gown cuff of your other sleeve to remove it.
- Pull and remove your gown without touching your skin
or clothing, or agitating the gown unnecessarily.
- Turn the gown inside-out on itself, and roll it up.
- Discard the gown immediately into the waste receptacle.
The Trained Monitor: - Removes and immediately
discards outer gloves into the same waste receptacle,
and puts on new gloves.
STEP 5: Remove inner gloves
- Use glove-to-glove / skin-to-skin technique
to remove gloves away from your body, as follows:
- Grasp the outside edge near your wrist
and peel it away, rolling the glove inside-out.
- Then reach under the glove on your other hand
and peel it away.
Discard both gloves immediately into the waste receptacle.
STEP 6: Perform hand hygiene... thoroughly and effectively
- Use alcohol-based hand rub.
The Trained Monitor pumps it into your hands
without touching you.
(Note: The proper technique and complete hand hygiene
procedure is being demonstrated in this step.
Subsequent hand hygiene steps have been abbreviated.)
STEP 7: Put on gloves
- Examine the gloves for intactness and proper fit.
STEP 8: Remove faceshield
- Bending forward from the waist, grab the strap toward
the back and pull it over your head, ensuring that
the bottom of the faceshield does not touch yourself.
- Gently allow the faceshield to fall forward.
- Avoid touching the front of the faceshield to
prevent contaminating yourself.
- Discard the faceshield immediately into
the waste receptacle.
If you wear prescription eye glasses,
be careful not to drop them when removing the faceshield.
STEP 9: Remove gloves
- Use glove-to-glove / skin-to-skin technique
to remove gloves away from your body.
- Discard both gloves immediately into
the waste receptacle.
STEP 10: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DOFFING STEP 6.
STEP 11: Put on gloves
- Examine the gloves for intactness and proper fit.
STEP 12: Remove head and neck covering
- Unfasten the ties at the back of your head.
- Bend forward from the waist.
- Pinch the top of and gently pull the covering away from
your face, while holding the ties in the same hand.
(This is especially important if the ties hang past the bottom
of the covering when undone).
- Discard the head and neck covering immediately
into the waste receptacle.
Remember NOT to touch your face or hair.
STEP 13: Remove gloves
- Use glove-to-glove / skin-to-skin technique
to remove gloves away from your body.
- Discard both gloves immediately
into the waste receptacle.
STEP 14: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DOFFING STEP 6.
STEP 15: Put on gloves
- Examine the gloves for intactness and proper fit.
STEP 16: Remove mask OR respirator
- Grasp the mask loops (or respirator straps)
from behind your ears (or head).
- Pull them forward off your head,
bending forward from the waist to allow the mask
(or respirator) to fall away from your face.
- Avoid touching the front of the mask (or respirator) to
prevent contaminating yourself.
- Discard the mask (or respirator) immediately
into the waste receptacle.
If you wear prescription eye glasses,
be careful not to drop them when removing the mask
(or respirator).
STEP 17: Remove gloves
- Use glove-to-glove / skin-to-skin
technique to remove gloves away from your body.
- Discard both gloves immediately into
the waste receptacle.
STEP 18: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DOFFING STEP 6.
STEP 19: Put on gloves
- Examine the gloves for intactness and proper fit.
STEP 20: Remove foot and leg coverings
- Sit down (on a swivel stool or other wipeable surface)
in the designated soiled area.
- Roll down and pull off the covering of the leg closest
to the designated clean area, without contaminating yourself,
or agitating the covering unnecessarily.
- Slowly pivot the clean (uncovered) foot into the
adjacent designated clean area.
- Discard the foot and leg covering immediately
into the waste receptacle.
- As just described, remove the other covering,
slowly pivot the second foot into the designated clean area,
and discard the foot and leg covering immediately
into the waste receptacle.
The Trained Monitor can help you remove the foot
and leg coverings if needed.
STEP 21: Remove gloves (while seated)
- Use glove-to-glove / skin-to-skin technique
to remove gloves away from your body.
- Discard both gloves immediately into
the waste receptacle.
STEP 22: Perform hand hygiene... thoroughly and effectively,
as demonstrated in DOFFING STEP 6.
STEP 23: Exit designated soiled area
Remember to perform self-care, as required.
The Trained Monitor doffs personal protective equipment,
as appropriate, and discards all materials contaminated or
potentially contaminated during the doffing process
into the waste receptacle.
The DOFFING procedure for higher risk of exposure
to blood or other bodily fluids is now complete.
Hi. I'm Erin Henry, Director of the
Communicable Disease Control Division in the
First Nations and Inuit Health Branch of Health Canada.
These videos were developed to complement comprehensive
in-person training and practice sessions provided to health care
professionals working in First Nations on-reserve health
facilities across Canada.
It is important to remember that in order for personal protective
equipment to be effective, you must receive prior
training in selecting and using the equipment based on the
point-of-care risk assessment.
This includes using and practicing the correct
techniques for donning and doffing,
discarding into designated waste containers,
and effective hand washing to minimize the
risk of transmission.
The information presented in the videos is based on
currently available scientific evidence, and may be reviewed
and revised as new information becomes available.
What is key is that all techniques shown are based on
infection prevention and control principles and precautions
to guide you in protecting yourself, your patients,
colleagues, and others.
For further information, please visit canada.ca/ebolavirus
and royalcollege.ca/ebola.
This video is made possible by a joint collaboration between
Health Canada, the Royal College of Physicians and Surgeons of
Canada, the Public Health Agency of Canada, and IPAC Canada.