Personal Protective Equipment (PPE) provides a physical barrier between a person and infectious material, including bodily fluids. When dealing with a patient who is actively or frequently vomiting, the hazard level increases significantly due to the volume and force of the expelled material, known as emesis. The primary goal of wearing appropriate PPE is to prevent infectious agents from reaching the wearer’s mucous membranes, skin, and clothing. This comprehensive barrier protects against both direct contact with contaminated surfaces and the ballistic nature of the expulsive event.
Understanding Transmission Risk
Vomiting, particularly when forceful, presents a considerable and unique infection control challenge because it involves two main routes of potential pathogen exposure. The first is contact transmission, where infectious agents are spread through direct contact with the contaminated fluid or indirectly by touching surfaces where the emesis has settled. Vomitus can contain high concentrations of pathogens, such as norovirus, which is a common cause of gastroenteritis. This high viral load leads to significant environmental contamination, turning nearby surfaces into potential sources of infection.
The second major risk comes from the mechanical action of vomiting itself, which can generate a fine spray of infectious droplets. This spray can travel beyond the immediate area of the patient, a process sometimes referred to as aerosolization. These infectious particles are small enough to be inhaled or land directly on the sensitive mucosal surfaces of the eyes, nose, and mouth. The velocity of the expulsion means that droplets can become airborne, necessitating protection that goes beyond what is required for a simple cough or sneeze. The potential for widespread, high-level contamination from both direct splash and airborne particles dictates the need for comprehensive barrier protection.
Required Protective Equipment
The high-risk nature of frequent vomiting requires the use of an ensemble of specialized Personal Protective Equipment to create a complete barrier. The first layer of defense is the isolation gown, which should be fluid-resistant or, ideally, impervious to liquids. For a high-splash risk scenario like vomiting, a Level 2 or Level 3 AAMI (Association for the Advancement of Medical Instrumentation) isolation gown is generally appropriate.
This gown must cover the torso completely, extending from the neck to the knees, with full-length sleeves that end in elastic cuffs. The back of the gown should be tied securely at both the neck and the waist to ensure full coverage and prevent clothing exposure. The fluid-resistant material prevents large volumes of liquid from soaking through and reaching the wearer’s clothes and skin.
Non-sterile disposable gloves are worn over the gown’s cuffs, ensuring the junction between the sleeve and the hand is completely sealed. The gloves must be pulled up to cover the elasticized wrist of the gown, creating a continuous barrier along the arm. Gloves should be changed immediately if they become heavily soiled or torn to maintain the integrity of the barrier.
Facial protection is mandatory to guard the eyes, nose, and mouth from infectious droplets and splashes. A surgical mask is worn to cover the nose and mouth, filtering out larger droplets expelled during the event. The mask must be supplemented with a full face shield or tight-fitting goggles to protect the eyes from a direct splash. The face shield offers the most comprehensive protection, covering the entire face and wrapping around the sides. This combination ensures that all mucous membranes are shielded from the ballistic spray of emesis.
Safe Donning, Doffing, and Disposal
Putting on the protective equipment, known as donning, must be done in a specific order to ensure maximum protection and a proper seal. The correct sequence begins with performing hand hygiene, followed by putting on the isolation gown first. Next, the face mask should be secured over the nose and mouth, followed by placing the eye protection (goggles or face shield) over the mask. The final step in the donning sequence is putting on the gloves, making sure they extend over the gown’s cuffs. This order ensures that the gloves create an overlap with the gown, sealing the entire ensemble.
Removing the equipment, or doffing, is the highest-risk step for self-contamination and must be performed slowly and methodically. The sequence begins with removing the gloves and the gown together, using an inside-out technique to avoid touching the contaminated outer surfaces. The contaminated bundle of the gown and gloves should be immediately discarded into a designated biohazard receptacle. Next, the eye protection is removed by handling the headband or ear pieces, avoiding the front surface. Finally, the face mask is removed by its ties or ear loops, and then discarded. The absolute final step is performing thorough hand hygiene immediately after all PPE has been removed.