Personal Protective Equipment Recommendations
Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities

Personal protective equipment (PPE) is worn to prevent:

• Resident-to-resident, health care provider-to-resident and resident-to-health care provider exposure to and possible colonization or infection with community-and health care-associated infectious agents including MDRO, and
• Occupational exposure to bloodborne pathogens including, but not limited to hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

PPE should be readily available on all nursing units and in ancillary departments (e.g., physical therapy, activities, dining rooms, etc) at all times.

• Contamination of resident’s skin is greatest when they have diarrhea but haven’t started treatment yet.
• All health care providers who may have resident contact or work in resident care areas should be periodically observed for compliance with the PPE policy.
• For detailed instructions on how to put on and remove PPE, the facility should consult CDC: Appendix A: Figure. Example of Safe Donning and Removal of Personal Protective Equipment (PPE).

Put ON in this order:

1. Wash or gel hands
2. Gown
3. Mask (if needed)
4. Eye cover (if needed)
5. Gloves

Take OFF and DISPOSE in this order:

1. Gloves
2. Eye cover (if used)
3. Gown
4. Mask (if used)
5. Wash or gel hands (even if gloves used)

Gloves

Gloves are a crucial element in preventing the spread of disease, including CDI. Most health care acquired infections are transmitted through contaminated hands of health care providers.
Gloves should be:

• Clean, durable, non-sterile, snug-fitting, disposable, examination gloves
• Put on after hand hygiene and immediately prior to contact with the resident’s:
  • Non-intact skin
  • Intact skin soiled with blood and body fluids
  • Clothing and linens soiled with blood and body fluids
  • Mucous membranes
• Worn when in contact with containers of blood and body fluids (e.g., suction canisters, urinals or commodes, emesis basins)
• Removed and hand hygiene performed after completing procedures that involve direct resident contact, contact with blood and body fluids, contact with environmental surfaces
• Changed and hands washed with soap and water when the integrity of the glove is compromised
• Changed and hand hygiene performed when moving from a contaminated body site (perineum or wound) to a clean body site (e.g., face or IV site)
• Removed, disposed of, and hand hygiene performed before moving from one resident to another in a multi-bed room or procedure area
• Removed and hand hygiene performed immediately upon exiting a resident occupied room (e.g., before exiting into a common area such as a corridor)
• Should not be worn for multiple-resident contacts

Gowns

Wear gowns to prevent soiling of clothing with blood and body fluids and the transfer of infectious agents from resident’s skin, clothing, bedding, and environmental surfaces. The physical characteristics of the material (e.g., moisture repelling vs. cloth) are based on the anticipated degree of physical contact with the resident and the potential for fluid penetration. Laboratory coats or jackets worn over personal clothing, uniforms and scrubs are not considered PPE.
Wear disposable moisture repelling gowns when:

Disposable aprons or cloth cover gowns can be worn for routine resident care activities that require prolonged contact (e.g.) bed bath, moving or turning the patient, etc.). They should be worn by only one health care provider and for only one resident.
Gowns should be:

• In contact with non-intact skin (e.g., large draining wounds, extensive dermatological conditions including skin rashes, burns, etc.)
• Handling fluid filled containers that are likely to leak, splash, spill or splatter when moved (e.g., bedside commodes, bedpans, urinals, and emesis basins)
• In contact with residents who soil their bed linens, clothing, and/or environmental surfaces with blood and body fluids
• Performing procedures likely to generate splashes, sprays, splatters or droplets of blood and other body fluids
• Entering a Contact Precautions designated room
• Worn correctly (tied at neck and waist, if applicable)
• Always worn in combination with disposable gloves that cover the cuff of the gown’s sleeve
• Removed after gloves and immediately before or upon exiting the resident’s room or when moving from one resident to another in a multi-bed room.

References

1. “Enhanced Standard Precautions (ESP) for Long-Term Care Facilities”. California Department of Health. 2010.