National Nursing Home Training Series: Week 5 Recap

Personal Protective Equipment (PPE) Strategies for COVID Care

Until the advent of COVID-19, Personal Protective Equipment (PPE) programs within nursing home settings were usually far less developed than PPE programs housed within inpatient settings. Now PPE is a must for resident care — yet many questions about its use and management remain. Telligen Quality Innovation Network-Quality Improvement Organization (QIN-QIO) Medical Director Jane Brock, MD, MSPH and Senior Quality Improvement Facilitator Sherry Longacre, MS, RN, addressed the role of PPE in infection prevention in the nursing home setting, how to properly use PPE within your facility, how to use audits to track staff training and compliance and how to optimize your PPE supply in their June 25, 2020 presentation for the Centers for Medicare & Medicaid Services (CMS) National Nursing Home Training Series.

PPE Compliance Starts with Training

PPE includes specialized clothing or equipment worn to protect against infectious materials, including gloves, gowns, facemasks, respirators, eye protection and face shields. PPE isn’t just confined to caregivers; residents with confirmed or suspected COVID-19 should wear facemasks, too.

Brock and Longacre noted that facility leaders should communicate these key points about PPE to their clinical and non-clinical staff:

  • PPE must be donned (put on) correctly
  • PPE must remain in place for the duration of work in potentially contaminated areas
  • PPE should not be adjusted during resident care
  • PPE must be doffed (removed) slowly and deliberately in a sequence that prevents self-contamination
  • A step-by-step process should be developed and used during training and resident care

Ongoing, daily staff training and practice is critical for PPE compliance, including step-by-step procedures for donning and doffing PPE. All staff members should be included in PPE training, including housekeeping and dietary staff. Use pictures, videos, webinars, written documents and emails to reinforce the message and accommodate different learning styles. The Centers for Disease Control and Prevention (CDC) offers a variety of tools to help train staff on how to don and doff PPE appropriate to the patient care situation, including printable reference posters on donning and doffing PPE, a Facemask Do’s and Don’ts poster, a Respirator On/​Respirator Off poster and a four-minute video that shows staff how to put on PPE.

CDC recommendations for PPE selection and use are excerpted below from the standard and transmission-based precautions guidance and strategies to optimize PPE. Recommendations include:

  • Gloves protect from blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment. Gloves should be worn for any contact with the resident or their environment.
  • Gowns protect skin and prevent soiling of clothing during procedures and activities that could cause contact with blood, body fluids, secretions or excretions. Gowns should be prioritized where splashes and sprays are anticipated or for high-contact resident care activities, such as dressing, bathing or showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use and wound care.
  • Protective eyewear and masks or face shields protect the mucous membranes of the eyes, nose and mouth during procedures and activities that could generate splashes or sprays of blood, body fluids, secretions and excretions.
  • Extended use of eye protection, N95 respirators, and facemasks means these items are worn for the care of multiple patients without removing them. Prioritize N95 during shortages for high-risk activities (like aerosol-generating procedures).
  • Ensure that health care personnel have immediate access to and are trained and able to select, put on, remove and dispose of PPE in a manner that protects themselves, the patient and others.
  • Personnel who do not interact or come within six feet of residents or who do not clean patient environments or equipment do not need to wear PPE except as part of universal masking.

With Training Comes Auditing

Consider using an audit tool to help identify gaps in training and practice and to provide feedback to staff. All clinical and non-clinical staff — licensed and unlicensed health care personnel, physicians, volunteers and trainees — should be included in the audit process. Printable PPE audit tools from the CDC and Telligen are available and are free to use.

A documented audit process will help gather objective data on PPE compliance within your facility. Armed with these data, facility leaders can test interventions, gather feedback and refine training.

Mind Your PPE Supply

PPE is essential for the safety of your residents and staff, so it’s wise to ahead plan for continued PPE shortages. If your management team hasn’t done so already, now is the time to cultivate relationships with your state health department and back-up vendors. PPE needs will continue to evolve based on infection rates in your area and your facility burn rate. The CDC offers a PPE burn rate calculator in a downloadable spreadsheet and through the National Institute for Occupational Safety and Health (NIOSH) app. This 12-minute video from the CDC offers tips on how to conserve PPE along with a good overview of PPE procedures.

To Learn More

Download the Telligen QIN-QIO slides and resources from the National Nursing Home Training Series page, visit www.QIOProgram.org to connect with the QIN-QIO serving your state or territory and sign up for updates about the CMS National Nursing Home Training Series.