Infection control is the cornerstone of safe and effective healthcare. Every year, millions of patients worldwide acquire hospital-associated infections (HAIs), many of which are preventable through proper hygiene, protective equipment, and standardized clinical practices. Nurses, doctors, and other healthcare workers are at the frontline of this battle, relying heavily on Personal Protective Equipment (PPE) and meticulous infection prevention strategies.
This article explores the importance of infection control, the correct procedures for donning and doffing PPE, and evidence-based methods to minimize the risk of HAIs.
Understanding Personal Protective Equipment (PPE)
PPE (Personal Protective Equipment) is designed to protect healthcare workers from exposure to infectious agents and to prevent cross-contamination between patients and staff. Common PPE includes gloves, gowns, masks, respirators, face shields, and goggles.
PPE serves two critical roles:
1. Protecting healthcare professionals from exposure to blood, secretions, and airborne pathogens.
2. Preventing the transmission of infectious organisms between patients, especially in vulnerable hospital settings like ICUs, operating rooms, and isolation wards.
Donning PPE (Putting on PPE)
Donning PPE is the process of safely putting on protective equipment before patient contact. Errors in donning can compromise protection and increase infection risks.
Steps for Donning PPE:
1. Hand Hygiene
- Wash hands with soap and water or use alcohol-based sanitizer.
- Ensures hands are free from pathogens before touching PPE.
2. Gown
- Put on the gown, tying it securely at the neck and waist.
- The gown acts as a barrier against fluids and contaminants.
3. Mask or Respirator
- Secure mask over nose and mouth, ensuring a tight fit.
- For high-risk settings, an N95 respirator or higher is required.
4. Goggles or Face Shield
- Protects eyes and face from splashes, sprays, or airborne particles.
5. Gloves
- Worn last to cover wrists and gown cuffs.
- Prevents contamination during patient care.
Key Rules While Donning PPE:
- Put on PPE before entering the patient’s room.
- Avoid touching the face while wearing PPE.
- Do not touch contaminated areas in the environment unnecessarily.
Doffing PPE (Removing PPE)
Doffing is the process of safely removing PPE to avoid contamination after patient care. Most self-contamination occurs during doffing, making this step critically important.
Steps for Doffing PPE:
1. Gloves
- Remove first since they are most likely contaminated.
- Use glove-in-glove technique to avoid touching skin.
2. Goggles/Face Shield
- Remove from the back or sides without touching the front surface.
3. Gown
- Untie and carefully remove without touching the outside surface.
4. Mask or Respirator
- Remove last, touching only straps.
- Do not touch the front of the mask.
5. Hand Hygiene
- Final step after removal of all PPE.
- Wash thoroughly to eliminate any pathogens acquired during removal.
Key Rules While Doffing PPE:
- Remove PPE at the doorway or outside the patient’s room.
- If hands become soiled while removing PPE, stop and perform hand hygiene before continuing.
- Dispose of PPE properly in designated containers.
Hospital-Associated Infections (HAIs)
Hospital-associated infections are infections patients acquire during the course of receiving healthcare treatment for other conditions. They significantly increase morbidity, mortality, hospital stays, and healthcare costs.
Common Types of HAIs
1. HAI (Hospital-Associated Infection)
- General infections acquired in healthcare settings, often due to inadequate infection control practices.
2. CAUTI (Catheter-Associated Urinary Tract Infection)
- Caused by prolonged use of urinary catheters.
- Prevented by strict aseptic technique and removing catheters as soon as unnecessary.
3. SSI (Surgical Site Infection)
- Occurs after surgical procedures due to contamination.
- Prevented by sterile technique, preoperative antibiotics, and proper wound care.
4. CLABSI (Central Line-Associated Bloodstream Infection)
- Results from improper insertion or maintenance of central venous catheters.
- Prevented with sterile insertion practices and regular line assessments.
- Develops in patients on mechanical ventilation.
- Prevented by elevating the head of the bed, regular oral care, and minimizing sedation.
Hand Hygiene: The First Line of Defense
Hand hygiene remains the single most effective method of infection prevention. The World Health Organization (WHO) emphasizes “Five Moments for Hand Hygiene”:
- Before touching a patient.
- Before clean or aseptic procedures.
- After body fluid exposure risk.
- After touching a patient.
- After touching patient surroundings.
Using chlorhexidine washes and alcohol-based hand rubs further reduces microbial presence and enhances protection.
The Role of Nurses and Healthcare Professionals
Nurses play a vital role in enforcing infection control protocols, including:
- Educating patients and families about infection prevention.
- Monitoring adherence to PPE use among staff.
- Advocating for resources and safe staffing levels to reduce HAIs.
- Reporting breaches in infection control policies promptly.
Comparative Table: Donning vs. Doffing PPE
| Step | Donning (Putting On) | Doffing (Removing) |
|---|---|---|
| 1 | Hand Hygiene | Gloves |
| 2 | Gown | Goggles/Face Shield |
| 3 | Mask/Respirator | Gown |
| 4 | Goggles/Face Shield | Mask/Respirator |
| 5 | Gloves | Hand Hygiene |
Frequently Asked Questions (FAQ)
1. Why is PPE important in infection control?
PPE protects both healthcare workers and patients by reducing exposure to infectious pathogens and preventing cross-contamination.
2. What is the correct order of donning PPE?
Hand hygiene → Gown → Mask/Respirator → Goggles/Face Shield → Gloves.
3. What is the correct order of doffing PPE?
Gloves → Goggles/Face Shield → Gown → Mask/Respirator → Hand Hygiene.
4. How can HAIs be reduced?
By practicing strict hand hygiene, using PPE correctly, sterilizing equipment, and following protocols for catheters, ventilators, and surgical care.
5. What is the most common hospital-associated infection?
Urinary tract infections (CAUTI) are among the most common, followed by surgical site infections.
6. How does hand hygiene help in preventing HAIs?
Proper hand hygiene eliminates pathogens before they can be transmitted between patients, equipment, or surfaces.
