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The 14-step process to putting on an Ebola protective suit

Treating someone with Ebola involves a painstaking process of suiting up and peeling off protective gear, or in hospital speak, “donning and doffing.” Last month, after two Dallas nurses became infected after caring for an Ebola patient, the CDC revised its guidelines. Suiting up properly is key to protecting against the fluids that transmit Ebola. Correctly taking off a suit that could be hot with the virus is critical.

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In New York State, eight hospitals were recently designated as Ebola care centers. We wanted to know just how long it took and how many steps were involved. Here’s an inside look at preparing to treat Ebola from a training at The Mount Sinai Hospital in Manhattan.

And here are the 14 steps from the CDC. Note: we don’t show every step in the video.

1. Engage Trained Observer: The donning process is conducted under the guidance and supervision of a trained observer who confirms visually that all personal protective equipment, or PPE, is serviceable and has been donned successfully. The trained observer will use a written checklist to confirm each step in donning PPE and can assist with ensuring and verifying the integrity of the ensemble. No exposed skin or hair of the healthcare worker should be visible at the conclusion of the donning process.

2. Remove Personal Clothing and Items: Change into surgical scrubs (or disposable garments) and dedicated washable (plastic or rubber) footwear in a suitable, clean area. No personal items (e.g., jewelry, watches, cell phones, pagers, pens) should be brought into patient room.

3. Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to be worn to ensure it is in serviceable condition, all required PPE and supplies are available, and that the sizes selected are correct for the healthcare worker. The trained observer reviews the donning sequence with the healthcare worker before the healthcare worker begins and reads it to the healthcare worker in a step-by-step fashion.

4. Perform Hand Hygiene: Perform hand hygiene with alcohol-based hand rub, or ABHR. When using ABHR, allow hands to dry before moving to next step.

5. Put on Inner Gloves: Put on first pair of gloves.

6. Put on Boot or Shoe Covers.

7. Put on Gown or Coverall: Put on gown or coverall. Ensure gown or coverall is large enough to allow unrestricted freedom of movement. Ensure cuffs of inner gloves are tucked under the sleeve of the gown or coverall.

8. Put on N95 Respirator: Put on N95 respirator. Complete a user seal check.

9. Put on Surgical Hood: Over the N95 respirator, place a surgical hood that covers all of the hair and the ears, and ensure that it extends past the neck to the shoulders. Be certain that hood completely covers the ears and neck.

10. Put on Outer Apron (if used): Put on full-body apron to provide additional protection to the front of the body against exposure to body fluids or excrement from the patient.

11. Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall.

12. Put on Face Shield: Put on full face shield over the N95 respirator and surgical hood to provide additional protection to the front and sides of the face, including skin and eyes.

13. Verify: After completing the donning process, the integrity of the ensemble is verified by the trained observer. The healthcare worker should be comfortable and able to extend the arms, bend at the waist and go through a range of motions to ensure there is sufficient range of movement while all areas of the body remain covered. A mirror in the room can be useful for the healthcare worker while donning PPE.

14. Disinfect Outer Gloves: Disinfect outer-gloved hands with ABHR. Allow to dry prior to patient contact.