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COVID-19

News >  Spokane

Providence nurse explains how PPE works – and why health care workers need so much of it

UPDATED: Wed., April 8, 2020

Providence Sacred Heart Medical Center nurse Brooke Henriksen demonstrates how hospital caregivers puts on (dons) and removes (doffs) personal protection equipment in the Dr. James W. Mounsey Clinical Simulation Lab, Wednesday, during a Providence Health Care COVID-19 response media opportunity. (Colin Mulvany / The Spokesman-Review)
Providence Sacred Heart Medical Center nurse Brooke Henriksen demonstrates how hospital caregivers puts on (dons) and removes (doffs) personal protection equipment in the Dr. James W. Mounsey Clinical Simulation Lab, Wednesday, during a Providence Health Care COVID-19 response media opportunity. (Colin Mulvany / The Spokesman-Review)

Much as been made about the importance – and shortage – of personal protective equipment for health care workers on the front lines treating patients with COVID-19.

But what exactly does PPE look like for an intensive care nurse donning gear each time they enter a patient’s room and doffing it when they exit?

Registered intensive care unit nurse Christa Arguinchona walked reporters through that process Wednesday.

Health care workers use gowns, gloves, masks, face shields and a lot of hand sanitizer to treat patients with COVID-19 while following the World Health Organization’s guidelines, which state health officials recommend and Providence facilities follow.

Some PPE materials are reusable, if they do not get wet or soiled. Surgical and N95 respirator masks can be reused up to five times, if they are stored properly, Arguinchona said. She said health care workers can fold masks in a way to keep the outward facing side contained and store them in paper bags with their names on them. Face shields can also be sanitized and decontaminated if they are not soiled.

Colin Mulvany - The Spokesman-Review

Gowns and gloves cannot be reused, however. Before a worker leaves a COVID-19 patient’s room, they must remove and dispose of both the outer pair of the two pairs of gloves they wear and their gown.

Providence health care workers use surgical tie-on or procedure masks when caring for COVID-19 patients and switch to N95 respirators that filtrate the majority of airborne particles when performing aerosolized procedures, like putting a person on a ventilator.

In an effort to conserve PPE amid shortages, health care providers do a lot of planning before they enter a COVID-19 patient’s room, Arguinchona said.

“We make sure and maximize what we need to accomplish to meet the patient’s needs while we’re in that room,” she said.

Trained observers watch health care providers putting on and taking off PPE to ensure they are safely taking precautions they need to, Arguinchona said.

Dan Getz, chief medical officer at Sacred Heart Medical Center and Holy Family Hospital, said they are doing everything possible to be good stewards and preserve their personal protective equipment.

“We have to think that this could be an ongoing process, and the last thing we want to do is not have enough PPE,” Getz told reporters Wednesday.

The process

Putting on PPE:

1. Perform hand hygiene, with hand sanitizer.

2. Put on first pair of gloves.

3. Put on isolation gown, over the head first, then tie at the back.

4. Put on mask, one strap below (or over) the ears, the other on top of the head; ensure it is snugly fit.

5. Put on face shield, strapping it around head, ensuring it extends below chin.

6. Put on second pair of gloves.

7. Enter COVID-19 patient’s room.

Taking off PPE:

1. Perform hand hygiene over gloves.

2. Take off first pair of gloves, using glove-in-glove technique and gently discard them.

3. Perform hand hygiene over second pair of gloves.

4. Take off gown, untying it at the waist and ripping it forward away from body, slowly rolling up gown into itself, ensuring that no external part of the gown is touched, discarding it.

5. Leave COVID-19 patient’s room.

6. Perform hand hygiene over second pair of gloves.

7. Take off face shield by lifting it off and forward; discard it or save it for sanitizing.

8. Perform hand hygiene over second pair of gloves.

9. Take off mask using a forward motion, starting with lower strap and slowly lifting it off, being careful not to touch the exterior of the mask; discard it or fold it and place it in a bag for future use.

10. Practice hand hygiene over second pair of gloves.

11. Take off second pair of gloves using glove-in-glove technique.

12. Practice hand hygiene.

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