What are the key components of personal protective management in a clinical or medical context?

Key Components of Personal Protective Management in Clinical Settings

The most effective personal protective management in clinical settings requires proper hand hygiene, appropriate use of personal protective equipment (PPE), and adherence to infection control protocols to prevent disease transmission between healthcare workers and patients.

Hand Hygiene

• Perform regular handwashing with soap and water or use alcohol-based hand rubs before and after every patient contact, following the "Five Moments for Hand Hygiene" 1
• Keep fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears 2
• Use hand lotions to prevent skin dryness associated with handwashing 2
• Consider the compatibility of lotion and antiseptic products, as petroleum or oil emollients can affect glove integrity 2
• Do not wear artificial fingernails or extenders when having direct contact with high-risk patients (e.g., those in intensive care units or operating rooms) 2
• Do not wear hand or nail jewelry if it makes donning gloves more difficult or compromises glove fit and integrity 2

Personal Protective Equipment (PPE)

Masks and Respiratory Protection

• Wear a surgical mask and eye protection with solid side shields or a face shield during procedures likely to generate splashing or spattering of blood or other body fluids 2
• Change masks between patients or during patient treatment if the mask becomes wet 2
• For aerosol-generating procedures (e.g., intubation, bronchoscopy), use respirators (N95, FFP2, or FFP3) rather than standard medical masks 2
• Consider using powered air-purifying respirators (PAPRs) for high-risk procedures like intubation of patients with highly infectious diseases 3

Protective Clothing

• Wear protective clothing (e.g., gown, laboratory coat, or uniform) that covers personal clothing and skin likely to be soiled with blood or other potentially infectious materials 2, 1
• Change protective clothing if visibly soiled; change immediately if penetrated by blood or other potentially infectious fluids 2
• Remove barrier protection before departing work areas (e.g., patient care, instrument processing, or laboratory areas) 2
• Consider sealed gown and glove combinations for better protection against contamination when dealing with highly infectious diseases 3

Gloves

• Wear medical gloves when potential exists for contacting blood, body fluids, or mucous membranes 2, 1
• Use a new pair of medical gloves for each patient, remove them promptly after use, and wash hands immediately 2
• Remove gloves that are torn, cut, or punctured as soon as feasible and wash hands before regloving 2
• Do not wash or reuse gloves 2
• Ensure appropriate gloves in the correct size are readily accessible 2
• Consider double-gloving for high-risk procedures to reduce contamination risk 3

Eye Protection

• Clean with soap and water, or if visibly soiled, clean and disinfect reusable facial protective equipment (e.g., protective eyewear or face shields) between patients 2
• Use eye protection that provides good peripheral vision and does not fog during use 4

Donning and Doffing Procedures

• Follow standardized protocols for putting on (donning) and removing (doffing) PPE 3
• Remove PPE under careful supervision of an infection control officer when dealing with highly infectious diseases 2
• Consider one-step removal of gloves and gown to reduce bacterial contamination 3
• Use additional spoken instructions during doffing to reduce errors and contamination 3
• Perform hand hygiene immediately after removing PPE and avoid touching hair or face before proper hand hygiene 2
• Consider extra sanitation of gloves before doffing with appropriate disinfectants 3

Environmental Controls

• Implement appropriate cleaning and disinfection of patient-care equipment and environmental surfaces to reduce transmission 2
• Store liquid hand-care products in either disposable closed containers or closed containers that can be washed and dried before refilling 2
• Do not add soap or lotion to a partially empty dispenser (i.e., do not "top off") 2

Training and Education

• Provide face-to-face instruction on proper PPE use, which has been shown to reduce noncompliance with doffing guidance more effectively than providing written materials or videos alone 3
• Consider using computer simulation training to reduce errors in PPE donning and doffing 3
• Ensure policies for infection prevention and control are written, readily available, updated annually, and enforced 1
• Train all healthcare personnel regarding routes of transmission and techniques to prevent transmission of infectious agents 1

Special Considerations for Highly Infectious Diseases

• For highly infectious diseases like COVID-19, implement more stringent PPE protocols, including respirators rather than surgical masks 2
• Consider using PPE made of more breathable material to improve user comfort while maintaining protection 3
• Implement skin protection measures when wearing PPE for extended periods, including skin preparation with sealants or barrier creams, and regular PPE offloading to relieve pressure 5
• Treat visible skin injuries caused by PPE immediately to minimize future infection risk 5

Common Pitfalls and How to Avoid Them

• Improper doffing technique is a major source of contamination; follow established protocols and consider using a buddy system with checklists 3
• Extended PPE use can cause skin injury; implement preventive measures like proper skin care and periodic relief from pressure points 5
• Inadequate training leads to improper PPE use; ensure comprehensive training programs are in place 1, 3
• Fogging of goggles during procedures can compromise visibility; use anti-fog measures 2
• Focusing only on PPE while neglecting other infection control measures; remember PPE is just one component of a comprehensive infection control strategy 1