Annex 1: Elements of personal protective equipment (PPE).

 

PPE will be required in any procedure considered as “close contact”, which includes surgical intervention, as well as other operating room procedures (intubation, regional anesthesia, IV cannulation, etc.).

 

Required equipment:

 

1. Impermeable gown.

2. Mask: conventional surgical masks do not offer protection if aerosols are present. N95 or FFP2/FFP3 type masks are necessary (filtering 96 and 99%, respectively).

3. Glasses: if aerosols are produced in the procedure (we assume that this may be the case, depending on the type of surgery), full-screen eye coverage is essential.

4. Face shield: does not protect from aerosols but is necessary when there is a risk of splashes (blood, vomit, or other biological liquids).

5. Long nitrile gloves.

6. It is advisable for all personnel with long hair to tie it up completely in a low bun and secure it properly. It is also recommended to shave the beard to favor the proper fixation and functioning of the masks.

7. Once the PPE equipment has been put on, the sterile equipment necessary for the surgical intervention will be placed on it: the surgical wash with alcoholic gel will be performed on the basic gloves and the usual sterile gown and gloves will be put on.

 

Step-by-step instructions for

EPP (donning) placement

 

It is essential that the entire surgical team has undergone prior training in PPE donning and doffing before performing an actual procedure. The collaboration of all members of the surgical team with each other is very important.

 

Steps:

 

1. Remove ALL personal items from pajama pockets, as well as any accessories (watch, earrings, jewelry, etc.) before donning PPE.

2. Wash hands with hydroalcoholic solution.

3. Unfold the waterproof gown and put on the sleeves.

4. Then, the mask is put on. For proper fixation, the ideal is to hold it by the convexity, apply it to the chin and pass the straps behind the head, it is recommended to cross them for a better grip. Subsequently, the metal piece is adapted on the bridge of the nose.

5. Putting on goggles or protective screen. The straps of the goggles should be adjusted approximately to the size of the head before putting them on to avoid later manipulation. First, goggles are placed on the face, then the straps are pulled over the back of the head.

6. Put on a pair of nitrile gloves (appropriate size) on the outside of the suit, covering the sleeves of the suit at the cuffs.

7. Put on a surgical cap (if it has not previously done put on another one).

8. Mask: it is enough with the one that has already been placed if the level of protection is adequate.

9. Washing (surgical) with alcohol gel on the gloves.

10. Put on the usual surgical gown.

11. Put on usual sterile gloves.

 

Step-by-step instructions for

epp removal (doffing)

 

It is essential to remove the equipment calmly, slowly, avoiding abrupt movements and under the supervision of a trained colleague. Ideally, the personnel who have been in the operating room should remove the PPE one at a time. This should be done as far away as possible from the patient and close to the door.

 

1. Remove surgical gown and gloves as usual, avoid touching it, fold it with the outside (where blood contamination, splashes, etc.) facing inward, and the gloves turned back on themselves. Discard in the container.

2. Wash the base gloves with disinfectant.

3. Remove the protective screen, holding it from behind, bending the head down.

4. Wash with hydroalcoholic solution.

5. Removal of the base gloves. Remove the first one by the external part with one finger, and the second one by the internal part (putting the “clean” finger between the glove and the suit). Discard in the bucket being careful not to touch them, that they do not touch anything or fall out.

6. Wash hands with hydroalcoholic solution.

7. Removal of the protective gown. First, loosen the side knot, then, without touching the skin on the neck, pull the gown from the top to undo the Velcro. When removing the gown, it is essential not to touch more than the inner side of it and fold it over itself so that the outer part is wrapped and covered. It should be lifted carefully to prevent the ribbons from touching anything and placed in the container.

8. Wash hands with hydroalcoholic solution.

9. Removal of the goggles: bend the head forward, closing the eyes and mouth. Grasp the straps at the back and remove them carefully.

10. Wash hands with hydroalcoholic solution.

11. Removal of the mask: again, bending the head down and closing the eyes and mouth, grasp the head straps from behind, and remove it forward and downward. DO NOT touch the front of the mask, as it may be contaminated.

12. Wash hands with hydroalcoholic solution.

13. Exit from the operating room.

14. Disinfection of footwear, either by introduction in a disinfectant (stepping on filters) solution or carefully removal and disinfection by immersion.

15. Complete hand washing up to the elbows.

16. Showering is recommended after completion of the process.