Participant Handouts

AVIAN INFLUENZA COMMODITIES
TRAINING GUIDE
MODULE 1 - PERSONAL PROTECTIVE EQUIPMENT (PPE)
PARTICIPANT HANDOUTS
MARCH 2007

MODULE 1
PARTICIPANT HANDOUTS
Participant Handouts
Participant Handout #1 – Seven-Step Process for Putting on PPE
Participant Handout #2 – Ten-Step Process for Removing and Disposing of
PPE
Participant Handout #3 – Proper Hand Washing
Participant Handout #4 – Important Facts to Remember when Using the
PPEs Supplied by USAID
Participant Handout #5 – Benefits and Barriers to Using PPE
Participant Handout #6 – Why Use PPEs
Participant Handout #7 – The N-95 Particulate Respirator
Participant Handout #8 – Contents of PPE Kit

MODULE 1
Handout #1
Seven-Step Process for Putting on PPE
Before you begin putting on your PPE, it is important to designate a clean location to put
on the equipment, preferably away from anything that could be contaminated with avian
influenza or other viruses. Also try to wash your hands with soap and water – if it is available
– before you begin, and remove watches and other non-smooth jewelry like bracelets.
1. Coveralls
Put on coveralls first. Step into the
“feet” of the coveralls first, and pull
them up. Zip up the front of the
coveralls. You should keep your regular
clothing and shoes on under the
coveralls.
3. Respirators
2. Shoe Covers
Put on shoe covers second. They
should fit over your coverall feet, giving
you another layer of protection to
protect your shoes from contamination.
Put the respirator under your chin
with the nosepiece up. Pull the bottom
strap over your head, and place it
around your neck below the ears.
Then pull the top strap over your head
and rest it high at the top back of
your head. Place your fingertips from
both hands at the top of the metal
nosepiece. Using two hands, mold the
nose area to the shape of your nose
by pushing inward while moving your
fingertips down both sides of the
nosepiece.

5. Apron
Aprons are provided to fit over the
coveralls. They are in a small packet
that you will open up, place the apron
over your head and then tie in the
back.
4. Goggles
Goggles are adjustable and should fit
snuggly over and around your eyes.
If you wear personal eye glasses, the
goggle can be placed over your eye
glasses.

6. Inner Gloves
Put on the inner pair of gloves first
(usually white or clear).
7. Outer Gloves
Will usually be a different color than
the inner gloves and may be thicker.
Pull them over the inner gloves. Pull
the edge of the gloves over the cuff of
your coveralls or gown, if possible.

MODULE 1
Handout #2
Ten-Step Process for Removing and Disposing of PPE
Before you begin the process of removing your PPE, you should find an area that is not
contaminated with blood, soil, feces or other waste.
1. Open the pouch with the germicidal
wipe and use it first on your outer
gloves and then on your outer
boots. Place it in the red biohazard
bag when done.

2. Remove and dispose of your apron
in the red biohazard bag.
4. Remove and dispose of your outer
gloves in the red biohazard bag.
5. Unzip and roll down your coverall
until it is inside-out, and then step
out of it. Place the used coveralls
into the red biohazard bag.
3. Remove and dispose of your outer
shoe covers in the red biohazard
bag.

6. Remove your goggles by pulling
them up over your head. You should
handle them by the headband or
ear pieces. Place them in the red
biohazard bag.
7. Remove your respirator by grabbing
the top and then the bottom elastic
bands and pulling them up over your
head. Place the respirator in the red
biohazard bag.
8. Remove your inside gloves. Begin
with one hand, rolling down the
glove (with your other hand),
starting at the wrist until the glove is
inside out. Hold the removed glove
in your hand in a little ball, and then
roll down the other glove – starting
at the wrist – with your first hand.
Place them in the red biohazard bag.

9. Close the red biohazard bag by tying
a knot at the top or otherwise tying
it shut. The red biohazard bag should
be placed at a designated location
so that it can be collected and
burned or buried.
10. Wash your hands and forearms
with soap and water.

MODULE 1
Handout #3
Proper Hand Washing
How to Wash Your Hands Correctly
• Wet your hands with water and apply soap. Use clean, running water.
• Rub hands together to make a lather and scrub all surfaces.
• Continue rubbing hands for 20 seconds.
• Rinse hands well under running water
• Air dry your hands, or use a towel if you have one.
When to Wash Your Hands While Using PPE
• Before putting on your PPE
• Before putting on your gloves or respirator again after taking a work break
• Before and after changing your respirator
• After taking off your gloves and the rest of your PPE, and placing them in the red
waste bag
• Any other time your ungloved hands have come into contact with potentially
infected animals, equipment or surfaces.

MODULE 1
Handout #4
Important Facts to Remember when Using the PPEs
Supplied by USAID
Wearing PPE
• All of the PPEs supplied in the PPE Kits are disposable and are designed for use one
time only.
• None of the supplied PPEs should be reused or washed for reuse – reuse could result
in infection of you or someone else.
• Do not use, or provide N-95 respirators to others, without instruction on the health
risks associated with them. For example, workers with poor lung function may not be
able to wear these respirators.
• If you can, do a fit test to make sure no particles can get through.
• N-95 respirators should not be hung around your neck when working, always wear
them when working.
• PPEs must be changed immediately if torn or dirty.
• A designated area for putting on PPEs should be identified and all personnel should
use this area to put on their PPEs. This should ideally be in a clean area away from
birds or any other potentially contaminated equipment, such as cages, crates or farm
tools.
• A designated area for removal of PPEs should be identified and all personnel should
use this area to remove their PPEs. This should ideally be located away from the area
that has recently been depopulated and/or decontaminated.
• Workers have said that the use of PPEs can sometimes make the job more difficult to
accomplish because they can be cumbersome, hot, or uncomfortable. However, they
also know that PPEs are necessary to prevent them from becoming infected or from
spreading the virus to other farms or people, especially the people they care most
about.
Disposal
• All PPEs must be removed and discarded before taking breaks. A new set should be
put on after the break.
• Used PPEs must be discarded immediately after use in an approved manner (such as
burying or burning).
• Red plastic bags are provided in the PPE Kits for this purpose. They should be sealed
and disposed of properly. This means following the instructions of the local officials or
person supervising the work on where to place red biohazard bags when they are full.
• The way to dispose of PPE may be different in each situation or location. Local officials
or those supervising the work will likely decide on how best to dispose of used PPE
and other items that have come in contact with the virus.

MODULE 1
Handout #5
Benefits and Barriers to Using PPE
Benefits
• They are effective.
• They help keep the worker safe and healthy
• They protect the workforce—a much needed workforce to help control avian
influenza outbreaks.
• Workers who use them are protecting their families, communities, farms and
businesses. The help protect the economic security of a region.
Barriers
• Difficulty in performing tasks while wearing the equipment; they limit body
movement
• Difficult to communicate: Someone wearing a N-95 respirator is difficult to
understand
• Hard to see/limits visibility: goggles may limit the wearer’s visual field and can fog
up
• Can become hot/uncomfortable to wear; this requires more breaks
• Because they are difficult to take off and put on, personnel are likely to
avoid taking them off during breaks, thus increasing the risk of infection or
contamination of clothing. Workers should be educated on why they have to
change and PPE removal protocols must be enforced
• Recontamination: Wearers may become contaminated as they remove their
equipment unless decontamination and removal protocols are followed carefully.
• Intimidating: When people see workers in PPE it signals a serious problem and
can cause panic which can interfere with worker communication and cooperation.

MODULE 1
Handout #6
Why Use PPEs
• The avian influenza virus can infect a person through their eyes, nose
or mouth. In fact, most cases of human avian influenza infections have resulted
from contact, in some way, with infected poultry or by touching contaminated
surfaces and then touching one’s eyes, nose or mouth. That is why gloves and face
coverings like respirators and goggles are so important.
• The virus can be in the air we breathe. Poultry manure and bedding from
flocks infected with avian influenza virus can contaminate dust and soil. When
the dust and soil is kicked up by wind, walking or movement, the contaminated
dust can be inhaled through the nose and mouth. That is why wearing the N-95
respirator is important for your safety and well-being.
• The virus can be carried to other farms. Hands/skin, clothing or shoes can
become contaminated with avian influenza virus – either from poultry directly
or from manure/bedding – and then carried to uninfected farms, thus spreading
the virus to new areas. The PPE not only will protect the person wearing it, but it
protects the people and farms he will come into contact with in the near future.
• The virus can survive in the environment. The virus can live in the
environment – outside an infected host. It can survive, at cool temperatures, in
contaminated manure for at least three months. In water, the virus can survive
for up to four days at 22o C and more than 30 days at 0o C. Even if it seems
dramatic, we always have to assume that there is virus in the manure, bedding,
dirt, feathers, and dust or chicken parts. Assuming the worst situation can
motivate us to wear PPE for all jobs, every time.
• It only takes a gram to infect 1 million birds. In studies with avian
influenza a single gram of contaminated manure was found to contain enough
virus to infect 1 million birds. A gram is only about the size of a paper clip or nail.
A single worker with contaminated dirt or manure on his shoes or boots could
cause a huge outbreak.

MODULE 1
Handout #7
The N-95 Particulate Respirator
The respirator in your kit is called an N-95 particulate respirator. Here are a few
things to know about your respirators.
• Respirators are designed to fit adults, their use by children is not recommended.
• The use of the N-95 respirators by itself will not fully protect you from acquiring
an avian influenza infection – they must be used in combination with all of the
other PPE items in your kit.
• N-95 respirators must be made to fit each face. An N-95 respirator that has not
been fitted properly can leave unprotected gaps between the respirator and your
face, and these gaps will impair the respirator’s effectiveness.
• Facial hair or unusual facial features make it difficult to fit N-95 respirators properly.
N-95 respirators cannot effectively be worn with beards or unshaven faces.
• The N-95 respirators lose their protective properties and must be changed when
they become wet from saliva or respiratory secretions.
• If a respirator is splashed and becomes wet, it should be changed using strict
hand-washing procedures and gloves.
• The respirators should be discarded and replaced after 4-6 hours of use. The
other PPE can remain on for the duration of your activities.
• Surgical masks are not respirators! Surgical masks are designed to protect patients
from contaminants generated by the person wearing the mask. They filter out
large-size particles in the air but they offer little protection against avian influenza
virus.
• N-95 respirators should not be hung around your neck when working. Always
wear them when working

MODULE 1
Handout #8
Contents of PPE Kit
1 Pair TYVEK COVERALLS
1 Pair BOOT COVERS
2 Pair NITRILE GLOVES
1 PLASTIC APRON [in plastic pouch]
1 N-95 PARTICULATE RESPIRATOR
1 Pair GOGGLES (WITH INDIRECT VENTS)
4 ALCOHOL WIPES
1 PDI SANITARY VIRICIDAL WIPE
1 INFECTIOUS WASTE BAG (RED)

Prepared by the Academy for Educational Development (AED) and Development
Alternatives, Inc. (DAI) for the USAID Avian Influenza Program.