PROTECTIVE BARRIERS

Elastria Widita, drg. M.Sc

 Protective Barriers (PPE)
Personal protective equipment (PPE) or personal protective attire
(PPA) are selected and worn based upon the nature of the
patient interaction* and the likely mode of pathogen
transmission.** PPE include:

• Gloves
• Masks
• Gowns & other apparel
• Eye, face, mouth, & inhalation protection

*Naturally the CDC has recommendations on when to use PPE. The Yale-New Haven
Hospital (http://www.med.yale.edu/ynhh/infection/precautions/intro.html) offers
more on the use of PPE along with instruction on how to don (put on) the equipment &
remove the equipment. This is presented in the following slides.
**A presentation of Transmission-Based Precautions follows the PPE information.
PPE: When to use

CDC: 2007 Guidelines for Isolation Precautions, p. 134, retrieved

12/1/09 from
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf.
 PPE: Gloves
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.

Gloves are worn to prevent the health care worker's hands from becoming
contaminated with blood or body substances. Gloves should be worn
for:

• Procedures involving direct contact with the blood and body substances of any patient.

• Procedures where contact with blood and body substances might be expected to occur.

• Procedures involving direct or potential contact with the mucous membranes of any
patient.

• Procedures involving direct or potential contact with the non-intact skin of any patient.
Non-intact skin is skin that is cut, chapped, abraded, cracked, afflicted with weeping or
exudative lesions, or is otherwise broken. Touching or handling any instruments,
equipment, or surfaces that have been, or may have been, in contact with blood or body
substances.

• In addition, gloves should be worn in providing care to a patient or in managing

equipment when the health care worker has cuts, scratches, or other breaks in the skin
on his/her hands.
 PPE: Gloves
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.

Sterile gloves should be used for all sterile procedures and for
activities that involve contact with areas of the body that
are normally sterile.

There should be an adequate supply of clean disposable

gloves on the standard precautions stations or in other
locations that are convenient to each patient's room.

Gloves used in patient's care should be worn only for contact

with the patient. Once used, gloves must be discarded
before leaving the patient's room.
 PPE: Gloves
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.

Procedure for donning sterile gloves:

1. Remove all jewelry, including rings.
2. Wash hands using an antimicrobial cleansing agent.
3. Dry hands thoroughly with a paper towel. Use the towel to turn off the faucet.
4. Remove the packet of gloves from the outer wrapper. Place this packet on a clean, dry, flat
surface.
5. Unfold the packet as if opening a book. Position the packet so that the cuffed ends of the
gloves are nearest to you.
6. Grasp the center flaps and open. Both gloves must have folded cuffs. Position the packaging
so that it lies flat.
7. Use one hand to glove the other. Grasp the edge of the right glove cuff with the fingers of the
left hand, and slip the right hand into this glove. Pull it on by holding onto the cuff, but do
not touch the outside of the glove.
8. Adjust both gloves so they fit properly. Make sure there are no gaps between the fingertips
and the ends of the gloves.
9. Inspect the gloves for nicks and tears before and during the procedure. Obtain a new pair of
sterile gloves if there is a break in aseptic technique or if a nick or tear occurs.
 PPE: Gowns
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
 PPE: Gowns
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
PPE: Eye, face, mouth, & inhalation protection
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
PPE: Eye, face, mouth, & inhalation protection
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
PPE: Eye, face, mouth, & inhalation protection
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
PPE: Eye, face, mouth, & inhalation protection
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
 Transmission-Based Precautions
The three categories of Transmission-Based Precautions come into effect when
Standard Precautions are insufficient to interrupt the route(s) of transmission.
(This means that Standard Precautions AND the indicated Transmission-Based
Precautions should be in effect.) The categories are:
• Contact precautions
– Apply when excessive wound drainage, fecal incontinence, or other discharges
– Ideally entails single room or spatial arrangements to protect others in shared room
– Caregiver wears gown & gloves
• Droplet precautions
– Apply with respiratory illnesses spread through relatively close approximation to others
– Ideally entails single room or spatial arrangements & curtain to protect others in shared room
– Caregiver wears mask
• Airborne precautions
– Apply when infectious agents may be suspended in the air over long distances
– Preferred placement for patient in airborne infection isolation room
– Caregiver wears mask or respirator as indicated by disease-specific recommendations
 Transmission-Based Precautions
One example

CDC: 2007 Guidelines for Isolation Precautions, p. 121, retrieved 12/1/09 from
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf.
 Precautions for Specific Conditions
The CDC’s 2007 Guidelines for Isolation Precautions contains a 23 page Appendix listing precautions for
selected infections & conditions. A sample of this (retrieved 12/1/09 from page 94 of that document at
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf) is displayed below.
Additional Precautions: Sharps
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
Additional Precautions: Sharps
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual at
http://www.med.yale.edu/ynhh/infection/precautions/intro.html.