Stay Well 41 - Regarding the Care of Patients in Isolation

By: Lenore DiPietro

In light of the Ebola threat, I would like to devote this month’s column to the explanation of the procedure and importance of Personal Protective Equipment, or PPE.

As a registered nurse, I frequently cared for patients who had a specific condition that required isolation. Isolation carts are placed outside of these patients’ rooms, which contained all the equipment necessary to don before caring for such patients.

This equipment, mandated by OSHA, (Occupational Safety and Health Administration), is to be used by anyone entering this room. All visitors are instructed by nurses on what PPE to wear, and to make no contact with the patient.

---

All other equipment in an isolation room, such as stethoscopes, blood pressure cuffs, thermometers, etc., are disposable.

All healthcare workers are instructed on the proper donning and doffing of PPE. In Nursing School, this is basic Nursing 101.

When the media initially suggested that the nurse who cared for the deceased Ebola patient, broke protocol, I was infuriated. Thankfully, they walked that statement back.

Here is the list in order:
1. Hand washing
2. Don gown, tying in back at neck and waist
3. Mask or respirator – surgical mask: secure elastic straps around each ear, then pinch nose area to make a tight fit; surgical masks are used for droplet protection; they often come with eye protection attached;  a respirator mask is required for micro airborne contaminant protection and must be individually selected to fit the wearer’s face, to provide a proper seal, preventing any gaps where inhalation may occur.
4. Goggle or protective glasses – if not attached to surgical mask, or if respirator mask is used
5. Glove – comes in various sizes. The fit is important; extended to cover wrist of isolation gown

Removal of PPE: Note: all PPE is discarded in a biohazard “red” bag in room.
1. Gloves- dirtiest; grasp near cuff and peel off inside out holding with gloved hand; slide finger of ungloved hand into other glove removing it inside out and over the first glove; dispose in waste.
2. Goggles- touch ear pieces only.
3. Gown – front and sleeves are most contaminated; unfasten ties; remove from shoulders, touching inside only, turn inside out and roll into a bundle and discard.
4. Mask or respirator – grasp bottom then top ties or elastics and remove, never touching front, and discard.
5.Wash hands.
I am explaining this procedure so that you fully understand that there is a protocol and that this is how it is properly performed. Blaming nurses, especially those who regularly care for patients in isolation, is unacceptable.

It is of utmost importance that we ALL get flu shots this season.

The early symptoms of Ebola virus mimic those of the flu. In those people who did not get the flu vaccine, and may contract the flu, panic may set in when it could mistakenly be taken for Ebola.