Blog by the Centers for Disease Control and Prevention

SEQUENCE FOR PUTTING ON PERSONAL PROTECTIVE EQUIPMENT (PPE)

The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of PPE.

  1. GOWN

    • Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back Fasten in back of neck and waist
  2. MASK OR RESPIRATOR

    • Secure ties or elastic bands at middle of head and neck Fit flexible band to nose bridge Fit snug to face and below chin Fit-check respirator
  3. GOGGLES OR FACE SHIELD

    • Place over face and eyes and adjust to fit
  4. GLOVES

    • Extend to cover wrist of isolation gown

USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION

  • Keep hands away from face
  • Limit surfaces touched
  • Change gloves when torn or heavily contaminated
  • Perform hand hygiene

 

HOW TO SAFELY REMOVE PERSONAL PROTECTIVE EQUIPMENT (PPE) EXAMPLE 1

There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials. Here is one example. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door. Remove PPE in the following sequence:

  1. GLOVES

    • Outside of gloves are contaminated!
    • If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove
    • Hold removed glove in gloved hand
    • Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove
    • Discard gloves in a waste container
  2. GOGGLES OR FACE SHIELD

    • Outside of goggles or face shield are contaminated!
    • If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Remove goggles or face shield from the back by lifting head band or ear pieces
    • If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container
  3. GOWN

    • Gown front and sleeves are contaminated!
    • If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties
    • Pull gown away from neck and shoulders, touching inside of gown only
    • Turn gown inside out
    • Fold or roll into a bundle and discard in a waste container
  4. MASK OR RESPIRATOR

    • Front of mask/respirator is contaminated — DO NOT TOUCH!
    • If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front
    • Discard in a waste container
  5. WASH HANDS OR USE AN ALCOHOL-BASED HAND SANITIZER IMMEDIATELY AFTER REMOVING ALL PPE

PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS BECOME CONTAMINATED AND IMMEDIATELY AFTER REMOVING ALL PPE

 

HOW TO SAFELY REMOVE PERSONAL PROTECTIVE EQUIPMENT (PPE) EXAMPLE 2

Here is another way to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door. Remove PPE in the following sequence:

  1. GOWN AND GLOVES
    • Gown front and sleeves and the outside of gloves are contaminated!
    • If your hands get contaminated during gown or glove removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Grasp the gown in the front and pull away from your body so that the ties break, touching outside of gown only with gloved hands
    • While removing the gown, fold or roll the gown inside-out into a bundle
    • As you are removing the gown, peel off your gloves at the same time, only touching the inside of the gloves and gown with your bare hands. Place the gown and gloves into a waste container
  2. GOGGLES OR FACE SHIELD
    • Outside of goggles or face shield are contaminated!
    • If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Remove goggles or face shield from the back by lifting head band and without touching the front of the goggles or face shield
    • If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container
  3. MASK OR RESPIRATOR
    • Front of mask/respirator is contaminated — DO NOT TOUCH!
    • If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer
    • Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front
    • Discard in a waste container
  4. WASH HANDS OR USE AN ALCOHOL-BASED HAND SANITIZER IMMEDIATELY AFTER REMOVING ALL PPE

PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS BECOME CONTAMINATED AND IMMEDIATELY AFTER REMOVING ALL PPE

 

Click here to view the pdf.

Proper Washing Guide for Homemade/Donated Cloth Masks

  • Before Your First Wear, Wash or Soak in Vinegar to Preserve the Color—Since They will be Washed Often
  • Washing Machine Recommended Versus Handwashing
  • If You Wash Multiple Masks Together, Tie the Strings Beforehand to Prevent Tangling
  • Feel Free to Throw in Regular Wash or Use a Garment Bag
  • Wash on Warm to Hot with Detergent: Click here to see a list of approved detergents to fight the Novel Coronavirus.
  • Dry in a Dryer

We had a Great Time at the MCHS Back-to-School Bash

Thanks for including us, Metcalfe Health Care Center, at the Back to School Bash. We are proud to be your partner in therapy!

“Starting the School Year off Strong! We had a great time at the MCHS Back to School Bash last Thursday. Amy Neighbors and our therapy department conducted grip strength testing for both adults and kids and made it a bit of healthy competition. We are proud to provide outpatient therapy services for all ages. Just another way we serve our entire community. Here’s to a great 2019-2020 school year. Go Hornets!”

Follow along with our Facebook page to see how we’re helping communities just like yours!

The Bungee Mobility Trainer by Neurogym Tech. available through Medline

“Therapists like this piece of equipment because it allows our rehab guests to work on static and dynamic balance while eliminating the fear of falling. I witnessed a new CABG patient with sternal precautions dancing with one of our therapists using this device. Pretty amazing stuff!

Also, I like the design and smaller footprint of this piece as before our only options for partial weightbearing were to purchase ceiling tracks and harnesses, or large, expensive equipment that fits over treadmills and takes up too much space in the rehab gym. We have heard nothing but good reviews from our therapists on this piece of equipment. It’s becoming the next “must have” in addition to the Biodex Balance Trainer and the ACP Omnicycle which are always popular.”

–  Amanda Green, Executive Director Marketing & Strategic Development

Check it out now!

Article By:  PT in Motion, www.apta.org

Patients with low back pain (LBP) who see a single physical therapist (PT) throughout their episode of care may be less likely to receive surgery and may have lower downstream health care costs, researchers suggest in a study published in the December issue of PTJ (Physical Therapy). “Limiting the number of physical therapy providers during an episode of care might permit cost savings,” authors write. “Health care systems could find this opportunity appealing, as physical therapy provider continuity is a modifiable clinical practice pattern.”

Authors examined data from nearly 2,000 patients in Utah’s statewide All Payer Claims Database (APCD) to look for associations between continuity of care for LBP patients and utilization of related services such as advanced imaging, emergency department visits, epidural steroid injections, and lumbar spine surgery in the year after the first primary care visit for LBP. APTA members John Magel, PT, PhD; Anne Thackeray, PT; and Julie Fritz, PT, PhD, FAPTA, were among the authors of the study.

Patients were between the ages of 18 to 64 who saw a PT within 30 days of a primary care visit for LBP. Researchers excluded patients with certain nonmusculoskeletal conditions; neurological conditions, such as spinal cord injury, that could affect patient management; and “red flag” conditions such as bone deficit or cauda equina syndrome.

Researchers found that greater provider continuity significantly decreased the likelihood of receiving subsequent lumbar spine surgery, noting that “disparate management strategies across a variety of providers might inhibit or prolong the recovery in a patient with a worsening condition and contribute to the patient eventually receiving lumbar surgical intervention.” They also note that a strong therapeutic alliance is associated with improved outcomes.

Contrary to authors’ expectations, high provider continuity was not associated with decreased use of advanced imaging, steroid injections, or emergency department visits. “The timing of physical therapy for LBP might have a greater impact on these outcomes than does provider continuity,” they suggest. Researchers did find a link between use of these services and the presence of comorbidities, previous lumbar surgery, and use of prescription opioids or oral steroids.

The average cost of care in the year following the initial primary care visit was $1,826 per patient. Costs were slightly less, at $1,737, for the 90% of patients with high provider continuity but rose to $2,577 for patients with a lower level of provider continuity.

While the study’s findings do not identify any cause-and-effect relationships, “it seems reasonable that physical therapists should consider approaches to managing patients with LBP that limit provider discontinuity,” authors write.

Click here to continue reading this article.

 


 

Speak with your doctor to find out how therapy could benefit you!

HTS Receives INALA Industry Award

HTS is excited and honored to receive the Industry Award from the Indiana Assisted Living Association (INALA).  HTS was nominated by Justus Senior Living which own and operate 6 independent and assisted living communities in the Indianapolis and surrounding area. HTS has partnered with Justus to provide exceptional outpatient therapy.

“HTS continues to be a true partner in our communities. They take a proactive approach and when a resident has a unique diagnosis, they go the extra mile to communicate and educate staff. They are helpful and offer creative solutions, but at the same time are totally appropriate. Our residents trust the therapists and appreciate their courteous approach. The HTS Staff Work well with community teams. At the corporate level we are able to communicate openly and honestly, sharing many of the same values. They truly represent what partnership means.”

Thank you for sharing this thoughtful testimonial. We are extremely happy to work with each of our communities to ensure the residents receive the best care possible. We are honored to receive this award from the INALA Industry Awards. Click here to see all of the 2018 INALA award winners.

About INALA

Indiana Assisted Living Association’s (INALA) mission is to promote the interests of the assisted living industry in Indiana and to enhance the quality of life for the population it serves. The Indiana Assisted Living Association believes assisted living brings a housing option to seniors which offers quality housing and caring assistance in the least prescriptive manner, provided by individuals with the highest professional standards. The Association encourages a residential environment that enhances social interaction and promotes the quality of life. Click here to learn more about INALA.

In this picture: Amanda Green, Executive Director of Marketing/Strategic Development, LaChelle Henkle-Weaver, INALA Board President, Aretoula Nahas, Director of Outpatient Therapy.


 

Speak with your doctor to find out how therapy could benefit you!

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

Click here to continue reading this article.

Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

As the average age of entry for licensed assisted living is 85 years of age, senior living providers are very focused on keeping their residents as independent for as long as possible. As a provider of contract physical, occupational and speech therapy in Assisted Living and Continuing Care Retirement Communities (CCRCs), our goal is to proactively address functional and cognitive decline so that residents can maintain their highest level of ability. From what we see on a daily basis, and reviewing ER admissions and national reports, most functional declines in active adults happen because of five primary reasons:

Lack of muscle building exercise

  1. Environmental factors
  2. Chronic illness
  3. New injury or illness
  4. Medications

Functional decline means that a person shows a decreased ability to do daily tasks properly compared to their ability to do these same tasks three months prior. A decline often signifies the presence of an acute onset, a new underlying medical condition or exacerbation of an existing condition.

Falls are the single largest reason of decline among active adults. Falls can happen any due to any of the five primary reasons listed above. Think of a fall as the ultimate loss of balance. There are multiple factors to a fall that present themselves well before a fall takes place. Through QAPI, standardized therapy testing and formalized Fall Risk Management programs, we are able to peel back the layers to determine “root cause” for the fall. A strong Fall Risk Management program is often tailored to treating the root cause factor that caused the fall, rather than all of the risk factors a patient has for falling. Falls are due to intrinsic factors (illness or medications) may not be prevented easily. Falls due to extrinsic factors (environmental factors) can be prevented or significantly reduced with extra precautions and education.

Provision of safety devices such as: grab bars & handles, high friction floors and footwear, as well as even (meaning no shadows to throw off depth perception) high power lighting can prevent or reduce a significant number of environmental falls. Regular exercise focused on core and lower body strength, consistent monitoring of and review of medications and therapeutic interventions for ongoing medical problems can significantly help to reduce the number of falls associated functional decline.

Functional Decline could be physical and/or cognitive in nature. When partnering with senior living providers, we take special care to train all staff including environmental, housekeeping and dietary to identify functional and cognitive decline. This could be anything from “furniture walkers”, increased maintenance calls to someone coughing through a meal in the dining room. There are consistent characteristics for a resident at risk for falling:

  • Functional decline include difficulty with ADLs (Activities of Daily Living) such as dressing or undressing safely.
  • Lack of balance, any unexplained bruises
  • Loss of flexibility
  • New pain, taking more medication than usual
  • New medication
  • Significant weight loss within 30 days
  • Speech impairment or inability to follow simple commands
  • Signs of anti-social behavior or depression, not participating in life enrichment as usual
  • Decreased activity tolerance or coordination, lack of attention
  • Decreased stamina or strength.

Everyone working around active adults should be trained and be able to report a decline to the clinical team. Although prevention is best for any decline, recognizing and reporting resident declines in a timely manner helps to manage the decline efficiently. Timely intervention will help the resident maintain or regain functional independence.

Aretoula Nahas is a Physical Therapist Assistant (PTA) and the Director of Outpatient Services for Healthcare Therapy Services, Inc. (HTS). HTS is an independent, therapist-owned contract provider of physical, occupational, speech therapy and wellness for assisted living, skilled nursing facilities and hospitals. HTS currently employs over 1,800 therapists and provides contract rehabilitation to over 100 clients in Indiana, Kentucky, Tennessee, Michigan and Ohio. For more information, contact www.htstherapy.com.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

Heart disease causes more deaths in the United States than cancer, AIDs and car accidents combined. It is the leading cause of death for both men and women, claiming the lives of almost two people per minute. Keeping our hearts healthy is important and can be done with regular doctor visits, regular exercise and having a well balanced diet, filled with antioxidant rich foods to help avoid free radical damage. Read more

Thanks to today’s quality post cardiac rehabilitation programs, these days more and more people manage to survive severe heart problems that often cause millions of fatalities worldwide.  This quality care allows cardiac patients to avoid further complications and make positive changes to enhance their life expectancy and improve their overall heart health. Read more