Personal Protective Equipment, commonly called PPE, is special clothing and equipment that health workers wear to create a protective barrier between themselves and germs. PPE acts like a shield that prevents infectious agents (bacteria, viruses, fungi, parasites) from entering your body or spreading from one person to another.

Simple analogy: Think of PPE like a raincoat. When it rains, a raincoat keeps water off your body. When you work with blood, body fluids, or infectious patients, PPE keeps germs off your body and out of your eyes, nose, mouth, and skin.

PPE Protects Four Groups:

Group	How PPE Protects Them
The Nurse (Health Worker)	Prevents you from catching infections from patients
The Patient	Prevents you from passing germs from one patient to another
Other Health Workers	Prevents transmission between staff members
Visitors and Community	Prevents spread beyond the health facility

• A nurse caring for a tuberculosis patient may breathe in TB bacteria and become infected.
• A nurse with a small cut on her hand may get HIV from a patient's blood.
• A nurse may carry germs from a dirty wound to a newborn baby.
• An outbreak may start in the hospital and spread to the community.

Key Message: PPE is not optional. It is a professional and legal requirement. Refusing to wear PPE puts lives at risk, including your own.

PPE must be used whenever there is a risk of contact with:

• Blood (from wounds, IV lines, deliveries, surgery)
• Body fluids (urine, feces, saliva, sputum, vomit, semen, vaginal fluids, amniotic fluid, cerebrospinal fluid)
• Broken skin (wounds, cuts, pressure sores, surgical sites)
• Mucous membranes (eyes, nose, mouth)
• Contaminated surfaces or instruments
• Airborne infectious agents (TB, COVID-19, measles)

Remember: All hospital staff, patients, and visitors should use PPE when there is contact with blood or body fluids.

Type	Examples	Rule
Single-use (Disposable)	Gloves, surgical masks, aprons, some gowns	Use once, then discard properly
Reusable	Some cloth masks, goggles, face shields, some gowns	Clean and disinfect after each use

Never reuse single-use PPE. This is dangerous and can spread infection.

A mask is a protective covering for the face, specifically the mouth and nose. Masks prevent you from breathing in germs and prevent you from spreading germs to others.

Medical masks are designed for health workers in health facilities. They are not reusable. There are two main types of medical masks used to prevent respiratory infections:

1. Surgical Masks (Face Masks)

Definition: A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment.

Key Features:

• Made in different thicknesses
• Different levels of protection against liquids
• Not designed to filter very small airborne particles
• Loose fit—air can leak around the edges

Important Notes:

• Surgical masks are not intended to be used more than once.
• They are not to be shared.
• They may be labeled as surgical, isolation, dental, or medical procedure masks.
• They are effective at blocking splashes and large-particle droplets but NOT very small particles in the air.

When to use a surgical mask:

• Routine patient care when there is risk of splashes
• When caring for patients with droplet-spread infections (flu, COVID-19 in non-aerosol situations)
• During wound dressing when there is no aerosol risk
• When there is risk of spraying body fluids

2. Respirators (N95 and KN95)

Definition: A respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles.

Key Features:

• Edges are designed to form a seal around the nose and mouth
• Filters out at least 95% of very small airborne particles
• Much tighter fit than surgical masks
• More protective but harder to breathe through

Types of Respirators:

• N95: Filters 95% of airborne particles. Commonly used in Uganda.
• KN95: Similar to N95 but made to Chinese standards. Also used in Uganda.

General Respirator Precautions:

• Medical conditions: People with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their healthcare provider before using an N95 respirator. The tight seal can make breathing harder.
• Exhalation valves: Some respirators have exhalation valves that make breathing out easier and reduce heat buildup. However, N95 respirators with exhalation valves should NOT be used when sterile conditions are needed because unfiltered air exits through the valve.
• Single-use: All respirators are labeled as single-use, disposable devices. If your respirator is damaged, soiled, or breathing becomes difficult, remove it, discard it properly, and replace it with a new one.
• Safe disposal: Place used respirators in a plastic bag and put them in the trash. Wash your hands after handling.
• Not for everyone: N95 respirators are not designed for children or people with facial hair. A proper fit cannot be achieved, so full protection is not provided.

Feature	Surgical Mask	Respirator (N95/KN95)
Fit	Loose-fitting	Tight-fitting, forms a seal
Filtration	Blocks large droplets and splashes	Filters 95% of small airborne particles
Purpose	Protects against droplets	Protects against airborne particles
Reusability	Single-use	Single-use
Breathing difficulty	Minimal	Can be harder to breathe
Use in surgery	Yes	Only without exhalation valve
Use for TB/COVID aerosols	No	Yes

DO wear medical masks with:

• A proper fit over your nose and mouth to prevent leaks
• Multiple layers of non-woven material
• The nose wire (if present) molded to your nose shape

DO NOT wear medical masks with:

• Wet or dirty material
• Tears or holes
• Loose straps that do not hold the mask in place

Ways to Improve Fit and Protection with Medical Masks

• Wear two masks: A disposable mask underneath AND a cloth mask on top. The cloth mask helps press the disposable mask against your face.
• Use a mask fitter or brace: A frame that goes over the mask to improve the seal.
• Knot and tuck: For 3-ply masks with ear loops, knot the ear loops where they join the mask edge, then tuck in the side pleats. This reduces gaps.
• Use masks with ties: Masks that attach behind the neck and head with elastic bands or ties often fit better than ear-loop masks.

What are they?
Non-medical masks are made from fabric (cloth). They are sometimes called reusable masks because you can wash, iron, and wear them again.

Ugandan Context:
The community in Uganda is encouraged to use non-medical masks, especially during pandemics like COVID-19. Many people make masks from cotton kitenge, gomesi fabric, or other local materials.

Best Design for Cloth Masks:

• Two layers of cotton with a filter material in between
• Filter materials can include: Paper towel, Coffee filter, Polypropylene (the material often used for non-plastic shopping bags)

How the filter works:
The filter material acts as a barrier that catches small particles. It can be removed before washing the mask. Polypropylene is washable and reusable.

DO wear cloth masks with:

• A proper fit over your nose and mouth to prevent leaks
• Multiple layers of tightly woven, breathable fabric
• Fabric that blocks light when held up to a bright light source (this shows it is tightly woven)

DO NOT wear cloth masks with:

• Gaps around the sides of the face or nose
• Exhalation valves, vents, or other openings
• Single-layer fabric
• Thin fabric that does not block light

Group	Mask Guidance
All adults	Should wear masks when indicated
Children 6 years and above	Should wear masks
Children 2-6 years	Should wear masks ONLY under close supervision (they are very active and cannot take care of their masks or observe hygiene properly)
Children below 2 years	Should NOT wear masks (small lung capacity, risk of suffocation)

Wear a mask when:

• Going to public places (work, public transport, markets, supermarkets, shops, classrooms, places of worship, healthcare facilities)
• Acceptable social distancing is not possible
• You have a cough, cold, or sore throat (even at home)
• You are at home and visited by someone who is not part of your household
• You are in any congested area
• At workplaces, especially when with colleagues

Do NOT wear a mask when:

• Running, jogging, or doing other physical activities (it restricts breathing during heavy exercise)
• You are alone in your car (but keep one ready in case a passenger joins or you step out)

How to put on a mask:

1. Hold the mask by the straps or loops.
2. Place it over your nose, mouth, and all the way down to your chin.
3. Mold the nose wire to your nose shape.
4. Ensure there are no gaps.

While wearing a mask:

• Avoid touching the front and inner sides of the mask. If you touch it, you may transfer germs to your hands or from your hands to the mask.
• Keep the mask on even when talking. Do not pull it down to speak.

If you need to remove it (for eating or drinking):

• Remove it completely by holding the straps only.
• Fold it with the inner side facing inward.
• Place it in a clean container such as an envelope or paper bag.
• You may also hang it on a nail or hook so it does not touch any surfaces.
• Wash hands with soap and water or use hand sanitizer whenever you touch the front or inside of the mask.

How to care for your mask:

• Ensure it covers the nose, mouth, and chin when wearing it.
• Keep the mask hanging in a clean area or in a clean envelope/container when not wearing it.
• Wash and dry reusable fabric (cotton) masks daily.
• Remove the filter before washing the mask.
• If the filter is washable (e.g., polypropylene), wash and dry it separately.
• Do not share masks.
• Discard disposable masks after one use.

Eye protection PPE protects the mucous membranes in your eyes. Mucous membranes are thin, moist layers of tissue that line body openings. Germs can easily enter your body through mucous membranes.

Why eye protection matters: If blood or body fluids splash into your eyes, germs in the fluid can enter your bloodstream through the mucous membranes. This can transmit HIV, hepatitis, and other infections.

• 1. Face Shields: A clear plastic shield that covers the entire face. Worn over masks. Protects eyes, nose, mouth, and face skin. Good for procedures with high splash risk (surgery, wound irrigation, suctioning). Can be cleaned and reused if designed for reuse.
• 2. Goggles: Fit tightly around the eyes. Protect only the eyes, not the rest of the face. Must fit properly to prevent splashes from entering around the edges. Some are reusable after cleaning and disinfection.

When to use eye protection:

• During surgery
• When performing wound irrigation
• When suctioning patients
• When handling blood or body fluids that may splash
• During aerosol-generating procedures (intubation, bronchoscopy)
• When caring for patients with diseases that can infect through eye contact (some hemorrhagic fevers)

Clothing PPE protects your skin and clothing from contamination. These are often used during surgery and when working with bodily fluids.

1. Gowns: Long-sleeved garments that cover most of the body. Used during surgery and invasive procedures. Some are disposable; some are reusable and must be laundered and sterilized. Protect the wearer and the patient.
2. Aprons (Disposable Aprons): Shorter than gowns. Worn over regular clothing. Usually disposable (plastic or paper). Used for procedures with splash risk.
3. Head Covering: Caps or hoods that cover hair. Prevent hair from falling into sterile fields or wounds. Prevent contamination of hair with blood or fluids.
4. Shoe Covers: Covers worn over shoes. Prevent tracking germs from one area to another. Protect shoes from contamination. Used in operating theaters, isolation rooms, and clean areas.

When you MUST wear an apron:

• Performing or assisting in a procedure that might involve splashing of body fluids
• Performing or helping with personal hygiene tasks (bathing, changing soiled linens)
• Carrying out cleaning and tidying tasks in the patient's living space (bed making when heavily soiled)
• Handling contaminated equipment

When you do NOT need an apron:

• Helping a patient walk short distances
• Routine conversation with a patient
• Taking vital signs when there is no fluid risk
• Feeding a patient

Important: Different organizations use different colored aprons for different tasks. Always check your workplace's local policy. For example: Blue aprons for general patient care, Green aprons for food handling, Yellow aprons for isolation cases, Red aprons for high-risk procedures.

How to Put On an Apron:

1. Perform hand hygiene.
2. Pull the apron over your head.
3. Fasten the ties at the back of your waist.
4. Ensure it covers your front from neck to knees.

How to Take Off an Apron:

1. Unfasten (or break) the ties at the back.
2. Pull the apron away from your neck and shoulders.
3. Lift it over your head.
4. Touch only the inside (clean side) of the apron.
5. Fold or roll the apron into a bundle with the inner side outermost.
6. Dispose of the apron in the clinical waste bin.
7. Perform hand hygiene.

Why this order matters: The outside of the apron is contaminated. If you touch it, you transfer germs to your hands. By touching only the inside, you protect yourself.

Gloves are one of the most commonly used types of PPE. They cover the hands and prevent the spread of infection through direct contact.

• Risk of being splashed by body fluids (blood, saliva, sputum, vomit, urine, feces)
• Contact with the patient's eyes, nose, ears, lips, mouth, or genital area
• Contact with instruments that have been in these areas
• Contact with an open wound or cut
• Handling potentially harmful substances (disinfectants, chemicals)

Gloves are NOT necessary for many routine daily care activities:

• Helping a patient wash and dress
• Making a bed (unless heavily soiled)
• Feeding a patient
• Walking with a patient
• Routine conversation

Why not wear gloves "just in case"? Wearing gloves when not needed leads to false security. Nurses may forget to wash their hands because they think gloves protect them completely. Gloves can have tiny holes. Gloves do not replace hand hygiene.

Type	Use	Features
Examination Gloves	General patient examination, non-invasive procedures, taking vital signs when fluid contact is possible	Usually latex, vinyl, or nitrile; less thick than surgical gloves
Surgical Gloves	Surgery, wound dressing, invasive procedures	Sterile, thicker, more precise fit, usually packaged in pairs

• Gloves must fit comfortably. Not too tight (they will tear) and not too loose (they will slip and reduce dexterity).
• Change gloves between patients. Never use the same pair of gloves for two different patients.
• Change gloves between different tasks on the same patient. For example, if you clean a patient's wound and then want to give them oral medication, change gloves in between.
• Never wash or reuse disposable gloves. Washing gloves makes them more likely to tear and does not reliably remove germs.
• Gloves do NOT replace hand hygiene. You must wash your hands before putting on gloves AND after taking them off.

1. Select the correct glove size and type.
2. Perform hand hygiene.
3. Pull the glove to cover your wrists.
4. Ensure there are no tears or holes.

This is a critical skill. Doing it wrong contaminates your hands.

1. Grasp the outside of one glove near the wrist with your opposite gloved hand.
2. Peel it off, turning it inside out as you remove it.
3. Hold the removed glove in your gloved hand.
4. Slide your ungloved finger under the cuff of the remaining glove (touching only the clean inside surface).
5. Peel it off, turning it inside out over the first glove.
6. Dispose of both gloves in the clinical waste bin.
7. Perform hand hygiene immediately.

Why this works: The contaminated outside of the gloves ends up trapped inside, and your bare skin only touches the clean inside surface.

Some gloves contain latex, a natural rubber material that can cause serious allergic reactions.

• Symptoms of latex allergy: Skin rash, itching, redness; Hives; Sneezing, runny nose; Itchy, watery eyes; Difficulty breathing (in severe cases); Anaphylaxis (life-threatening reaction in rare cases).
• What to do: If you know you have a latex allergy, tell your employer immediately. Alternative gloves (nitrile or vinyl) must be provided. Never hide a latex allergy. It can endanger your life.

Some nursing staff experience sore hands because of wet work (bathing patients, washing hands frequently), using alcohol hand gel repeatedly, wearing gloves for long periods, or not drying hands properly.

• What to do: Tell your manager. Report to occupational health. Use moisturizer regularly (check that it is compatible with glove use). Ensure hands are completely dry before putting on gloves.

Situation	PPE Required
Routine patient care (no fluid risk)	Hand hygiene only, or gloves if touching patient
Taking blood, giving injection	Gloves, sometimes apron
Wound dressing (small, clean)	Gloves, apron
Wound dressing (large, infected)	Gloves, gown, face shield/goggles, mask
Surgery	Sterile gloves, sterile gown, mask, cap, shoe covers
Caring for TB or COVID-19 patient (airborne)	N95 respirator, gown, gloves, face shield/goggles
Cleaning contaminated area	Heavy-duty gloves, apron, mask, eye protection
Handling hazardous chemicals	Chemical-resistant gloves, apron, goggles

The order in which you put on and remove PPE is critical. Doing it wrong can contaminate yourself.

1. Perform hand hygiene.
2. Put on gown or apron (if needed).
3. Put on mask or respirator. Secure ties or ear loops. Mold nose piece.
4. Put on eye protection (goggles or face shield).
5. Put on gloves. Ensure gloves cover the cuffs of the gown.

Memory aid for donning: "Gown, Mask, Eyes, Gloves" = GMEG = "Give Me Eyes, Give"

This is the most dangerous part. Most self-contamination happens during doffing.

1. Remove gloves first. (Use glove-to-glove, skin-to-skin technique.)
2. Perform hand hygiene.
3. Remove gown or apron. Untie, peel away from body, roll with contaminated side inward, discard.
4. Perform hand hygiene.
5. Remove eye protection. Touch only the straps or ear pieces. Discard or place in designated container for cleaning.
6. Perform hand hygiene.
7. Remove mask or respirator. Do not touch the front. Remove by ear loops or ties. Discard.
8. Perform hand hygiene.

Memory aid for doffing: "Gloves, Gown, Eyes, Mask" = GG EM = "Goodbye Germs, Eyes Masked"

Key principle: Remove the most contaminated items first (gloves, gown) before removing items that protect your face (mask, eye protection). This prevents you from touching your face with contaminated hands.

Mistake	Why It Is Dangerous	Correct Practice
Reusing disposable gloves	Spreads germs, gloves may have holes	Use once, then discard
Wearing gloves instead of washing hands	Gloves are not 100% protective	Wash hands before AND after gloves
Touching face while wearing contaminated gloves	Transfers germs to eyes, nose, mouth	Never touch your face with gloved hands
Removing mask by touching the front	Front of mask is contaminated	Remove by ear loops or ties only
Wearing a mask below the nose	Nose is unprotected; you breathe in germs	Mask must cover nose, mouth, and chin
Using a wet or soiled mask	Reduced effectiveness; breeding ground for germs	Change immediately
Wearing the same apron for multiple patients	Cross-contamination	Change between patients
Not performing hand hygiene after removing PPE	Hands are contaminated	Always wash hands after removing any PPE
Wearing PPE in the canteen or break room	Spreads germs to clean areas	Remove all PPE before leaving patient areas

1. Prevents Transmission of Infection: PPE breaks the chain of infection between: Patient to patient; Health worker to patient; Patient to health worker; Health worker to health worker.
2. Motivates Health Workers: When nurses feel protected, they are more willing to care for patients with infectious diseases, perform high-risk procedures, work in isolation units, and respond to disease outbreaks and disasters.
3. Legal and Ethical Protection: Using PPE demonstrates that the nurse followed standard precautions. If an infection occurs despite PPE use, it protects the nurse from blame. If a nurse refuses to use PPE and gets infected or infects a patient, they may face disciplinary action.

Fire is a chemical reaction that produces heat, light, and smoke. It is one of the most dangerous hazards in any workplace, including hospitals.
For nurses: Hospitals contain many fire risks—oxygen tanks, electrical equipment, chemicals, cooking areas, and flammable materials. Understanding fire safety is essential for protecting patients, staff, and the facility.

For a fire to exist, four elements must be present simultaneously. This is called the fire tetrahedron (a four-sided shape).

Element	What It Is	In a Hospital Setting
1. Oxygen	The gas that sustains combustion	Air in the room, oxygen cylinders, ventilators
2. Heat	Energy that raises material to its ignition temperature	Electrical sparks, hot equipment, flames, friction
3. Fuel	Material that burns	Paper, cloth, wood, chemicals, alcohol, cooking oil, mattresses
4. Chemical Chain Reaction	The ongoing reaction between the other three elements that keeps fire burning	Once fire starts, it feeds itself

Key Principle: To extinguish a fire, you must remove at least one of these four elements.

• Remove oxygen → Smother the fire (blanket, CO2 extinguisher)
• Remove heat → Cool the fire (water)
• Remove fuel → Starve the fire (turn off gas, remove combustibles)
• Interrupt chemical reaction → Stop the chain (dry chemical extinguisher)

Fires are classified based on what is burning. Using the wrong type of extinguisher can make the fire worse or endanger the user.

• What burns: Ordinary combustible materials (Wood, Paper, Cloth, Rubber, Many plastics, Cardboard, Furniture)
• Examples in a hospital: Paper records catching fire, Wooden furniture burning, Curtains or bed linens on fire, Cardboard boxes in storage
• How to extinguish: Water, foam, dry chemical, or water mist extinguishers.

• What burns: Flammable liquids and gases (Gasoline, Petroleum greases, Tars, Oils, Oil-based paints, Solvents, Alcohols, Propane, Butane)
• Examples in a hospital: Alcohol-based hand sanitizer spill catching fire, Cleaning solvents igniting, Oxygen cylinders leaking and igniting, Fuel for generators
• How to extinguish: Foam, carbon dioxide, dry chemical, or wet chemical extinguishers.
• NEVER use water on a Class B fire—it can spread the flammable liquid.

• What burns: Energized electrical equipment
• Examples in a hospital: Computers and servers, Electrical motors, Transformers, Medical equipment (monitors, ventilators, X-ray machines), Appliances, Wiring and fuse boxes
• Critical point: These fires involve live electricity. If you remove the power (unplug or switch off), the fire becomes a Class A fire.
• How to extinguish: Carbon dioxide, dry chemical, or clean agent extinguishers.
• NEVER use water or foam on energized electrical equipment—you could be electrocuted.

• What burns: Combustible metals (Magnesium, Titanium, Zirconium, Sodium, Lithium, Potassium)
• Examples in a hospital: Specialized medical devices containing these metals, Laboratory equipment, Industrial areas
• How to extinguish: Dry powder extinguishers ONLY.
• NEVER use water on Class D fires—some metals react explosively with water.

• What burns: Cooking oils and greases (Animal fats, Vegetable fats, Cooking oils used in hospital kitchens)
• Examples in a hospital: Deep fryer in the hospital kitchen catching fire, Cooking oil igniting on a stove
• How to extinguish: Wet chemical extinguishers specifically designed for Class K.
• NEVER use water on a grease fire—it will cause the burning oil to splash and spread the fire violently.

Class	Fuel Type	Examples	NEVER Use
A	Ordinary solids	Wood, paper, cloth, plastics	—
B	Flammable liquids/gases	Gasoline, oil, alcohol, propane	Water
C	Energized electrical	Computers, equipment, wiring	Water, foam
D	Combustible metals	Magnesium, sodium, lithium	Water
K	Cooking oils/greases	Kitchen oils, fats	Water

Extinguisher Class	Puts Out
Class A	Ordinary combustibles (wood, paper, cloth)
Class B	Flammable liquids (gasoline, oil, grease)
Class C	Energized electrical fires
Class D	Combustible metals

• How they work: Water extinguishers: Remove the heat element of the fire tetrahedron by cooling. Foam extinguishers: Remove heat AND separate the oxygen element from the fuel.
• Suitable for: Class A fires ONLY.
• DANGER: Do NOT use on Class B or C fires. On Class B (flammable liquids): The water stream can spread the liquid, spreading the fire. On Class C (electrical): Water conducts electricity and can electrocute the user.
• Identification: Usually red with a label indicating water or foam.

• How they work: Remove the oxygen element by displacing air with CO2 gas. Also remove heat because the discharge is very cold.
• Suitable for: Class B and Class C fires.
• NOT effective on: Class A fires (the fire can reignite because CO2 does not cool the fuel enough).
• Advantages: Leaves no residue (good for electrical equipment and clean rooms), Non-conductive (safe for electrical fires).
• Disadvantages: Can cause frostbite if held too close to the discharge horn, Can displace oxygen in enclosed spaces, causing suffocation risk, Not effective for deep-seated Class A fires.
• Identification: Usually red with a black panel or label.

• How they work: Interrupt the chemical reaction of the fire tetrahedron. Also create a barrier between oxygen and fuel on Class A fires.
• Suitable for: Class A, B, and C fires (multipurpose type). Most widely used type of fire extinguisher today because of its versatility.
• Disadvantages: Leaves a powdery residue that can damage sensitive equipment, Can cause respiratory irritation, Requires cleanup after use.
• Identification: Usually red with a blue panel or label.

• How they work: Remove heat from the fire triangle. Prevent re-ignition by creating a barrier between oxygen and fuel.
• Suitable for: Class K fires (cooking oils and fats). Some types can also be used on Class A fires in commercial kitchens. Developed specifically for modern, high-efficiency deep fat fryers.
• Identification: Usually red with a yellow panel or label.

• How they work: Include halon agents and newer halocarbon agents. Interrupt the chemical reaction and/or remove heat.
• Suitable for: Class A, B, and C fires.
• Advantages: Leave no residue, Do not damage sensitive electronic equipment, Safe for use in rooms with computers and medical devices.
• Disadvantages: Halon depletes the ozone layer (being phased out), Expensive, Can cause respiratory effects in enclosed spaces.
• Identification: Usually red with a green panel.

• How they work: Similar to dry chemical but designed for metal fires. Separate fuel from oxygen or remove heat.
• Suitable for: Class D fires ONLY (combustible metals).
• Ineffective on: All other classes of fire.
• Identification: Usually red with a blue panel (specifically labeled for Class D).

• How they work: Remove heat from the fire triangle. Use very fine water droplets (mist) instead of a stream.
• Suitable for: Primarily Class A fires, but safe for Class C fires as well because the fine mist does not conduct electricity like a water stream.
• Advantages: Alternative to clean agents where contamination is a concern, No chemical residue, Safe around electrical equipment.
• Disadvantages: Limited effectiveness on deep-seated fires, Requires clean water source.

Extinguisher Type	Works On	NEVER Use On	Key Feature
Water	Class A	Class B, C	Cools fire
Foam	Class A, B	Class C	Cools and smothers
CO2	Class B, C	Class A	No residue, cold discharge
Dry Chemical	Class A, B, C	—	Most versatile
Wet Chemical	Class K, some A	—	For kitchen fires
Clean Agent	Class A, B, C	—	No residue, safe for electronics
Dry Powder	Class D only	A, B, C, K	For metal fires only
Water Mist	Class A, C	—	Fine mist, no residue

Before attempting to fight a fire, remember the Three A's:

• A1: ACTIVATE: Activate the building alarm system immediately. Or notify the fire department by calling the emergency number. If possible, have someone else do this while you begin evacuation.
• A2: ASSIST: Assist any persons in immediate danger to exit the building. Help patients who cannot walk, are on bed rest, or are confused. Do this WITHOUT putting yourself at unreasonable risk. In a hospital, this means moving patients horizontally first, then vertically if needed.
• A3: ATTEMPT: Only AFTER activating the alarm and assisting people should you attempt to extinguish the fire. Only if it is safe to do so.

Only fight a fire if ALL of the following are true:

Condition	Explanation
The fire is small and contained	If the fire is larger than a wastebasket, do not attempt to fight it. Leave immediately.
You are safe from toxic smoke	If the room is filling with smoke, leave. Smoke kills more people than flames.
You have a means of escape	Never turn your back on a fire without an escape route behind you.
Your instincts tell you it's OK	If you feel afraid or uncertain, leave. Your life is more valuable than property.

If ANY of these conditions is not met, EVACUATE IMMEDIATELY.

Letter	Action	Details
P	PULL the pin	This breaks the tamper seal and allows you to squeeze the handle
A	AIM at the base of the fire	Aim the nozzle or hose at the bottom of the flames, not the top
S	SQUEEZE the lever	This releases the extinguishing agent
S	SWEEP from side to side	Sweep the nozzle across the base of the fire until it is out. Move forward as the fire diminishes. Watch for re-ignition.

Important points when using PASS:

• Stand at the recommended safe distance (usually 2-3 meters, or about 6-10 feet).
• Do not get too close too quickly.
• If the fire does not go out immediately or grows larger, STOP and evacuate.
• Never turn your back on a fire that is not completely out.

• Know Your Extinguishers: Know the locations of all fire extinguishers in your workplace. Know what type each extinguisher is and what fires it can fight. Check them regularly.
• Practice: Fire extinguishers can be heavy. Practice picking one up to know the weight. Read the operating instructions on the label. Practice aiming (without pulling the pin or squeezing the lever) so you know how to aim at the base.

Fire extinguishers must be maintained annually according to local, state, and national codes. What annual maintenance includes: Thorough examination of mechanical parts, Checking the fire extinguishing agent, Checking the expellant gas, Recharging if needed, Replacing worn parts, Lubricating moving parts. Who should do it: A trained fire equipment professional.

Every 30 days, fire extinguishers should receive a quick visual inspection. This is something you CAN do.

• Question 1: Is the extinguisher in the correct location? Has it been moved? Is it blocked by furniture, boxes, or equipment? Can it be reached quickly in an emergency?
• Question 2: Is it visible and accessible? Is the sign above it visible? Is the extinguisher itself clearly seen? Is the path to it clear?
• Question 3: Does the gauge or pressure indicator show the correct pressure? Most extinguishers have a pressure gauge with a green zone (correct pressure) and red zones (overcharged or undercharged). The needle should be in the green zone. If it is in the red, report it immediately for servicing.

1. Read the Instructions: Thoroughly read the operating instructions that came with your fire extinguisher.
2. Use the Right Type for the Fire: Critical safety rule: Never use a fire extinguisher for a class of fire that is not indicated on the label. (e.g. Water on electrical risk = electrocution).
3. Check Expiration Dates: Know the dates on your extinguishers and replace or service them as needed.
4. Location Near Exits: Keep fire extinguishers in easily accessible locations near exterior doors. Consider common places (Kitchens, Electrical rooms, Storage areas).
5. Make Sure Everyone Knows the Location: Everyone in the facility should know where fire extinguishers are kept.

Risk	Why It Is Dangerous
Oxygen use	Oxygen makes fires burn faster and hotter. A small spark near an oxygen source can cause a massive fire.
Alcohol-based products	Hand sanitizers, cleaning solutions, and some medications contain alcohol that is highly flammable.
Electrical equipment	Hospitals have hundreds of electrical devices. Faulty wiring or overloaded circuits can spark fires.
Cooking facilities	Hospital kitchens use large amounts of oil and heat.
Smoking	Despite bans, patients or visitors may smoke in rooms, especially psychiatric wards.
Generators and fuel storage	Backup generators require fuel that is flammable.
Linen and mattresses	Large quantities of cloth and foam burn quickly and produce toxic smoke.

• Prevention: Do not overload electrical outlets. Report faulty wiring or equipment. Ensure oxygen cylinders are stored safely away from heat sources. Enforce no-smoking policies. Store flammable materials properly.
• Preparedness: Know the fire evacuation plan for your ward. Know the location of fire extinguishers, fire alarms, and fire exits. Know your role in a fire emergency. Participate in fire drills.
• Response: Raise the alarm immediately. Follow RACE (Rescue, Alarm, Confine, Extinguish/Evacuate). Assist in patient evacuation. Use fire extinguishers only if safe and trained. Close doors behind you to slow fire spread.

• Order of evacuation: Ambulatory patients (can walk) evacuate first. Wheelchair patients evacuate next. Bedridden patients evacuate last because they need the most assistance.
• Methods for moving bedridden patients: Horizontal evacuation first: Move patients to a safe area on the same floor, away from the fire. Vertical evacuation: Use stairs, NEVER elevators. Carry methods: Use blankets, sheets, or stretchers. In extreme emergencies: Drag patients on mattresses or blankets.

• Masks
• Eye protection
• Clothing (gowns, aprons)
• Gloves

• Gown
• Mask
• Eye protection
• Gloves

• Gloves
• Gown
• Eyes (eye protection)
• Mask

• A = Ordinary combustibles
• Boy = Liquids
• Can = Electrical
• Dance = Metals
• Karen = Kitchen oils

• Pull the pin
• Aim at the base
• Squeeze the lever
• Sweep side to side

• Activate alarm
• Assist people
• Attempt to extinguish

• Oxygen
• Heat
• Fuel
• Plus the chemical chain Reaction

• Smoke too thick? Don't fight.
• Instincts say no? Don't fight.
• Zero escape route? Don't fight.
• Enormous fire? Don't fight.

Nurse Akello is assigned to care for a patient with confirmed COVID-19 in an isolation ward. The patient requires suctioning, which is an aerosol-generating procedure. Nurse Akello has a surgical mask, gloves, and an apron. She does not have an N95 respirator, goggles, or a gown.

Nurse Otim is caring for three patients in a row. He puts on one pair of gloves at the beginning of his shift and keeps them on while caring for all three patients, changing bed linens, taking vital signs, and giving medications. He believes gloves protect him all day.

At 2 AM, sparks start coming from an oxygen concentrator in the pediatric ward. A small fire starts near the machine. There are 20 children in the ward. Nurse Sarah is the only nurse on duty. She sees a water extinguisher nearby.

The hospital kitchen catches fire when oil in a deep fryer overheats. A cook tries to throw water on the fire. The fire explodes and spreads to the ceiling.

Nurse Betty develops a red, itchy rash on her hands every time she wears gloves. She also sneezes and has a runny nose during her shifts. She has been hiding this because she is afraid of losing her job.

• PPE is about protecting THREE groups: The wearer, the patient, and others. Never forget the patient-to-patient transmission route.
• Hand hygiene is the foundation of PPE. Gloves do not replace hand washing. Always wash before donning and after doffing.
• Surgical mask vs. Respirator: Know the difference by heart. Loose fit vs. tight seal. Droplets vs. airborne particles. This is tested in almost every exam.
• The order of donning and doffing is critical. Practice it until it is automatic. Wrong order = self-contamination.
• Fire classes: Know what burns in each class and what extinguisher to use. The most common mistake is using water on electrical or grease fires.
• PASS technique: Pull, Aim, Squeeze, Sweep. Aim at the BASE of the fire, not the flames.
• The Three A's: Activate, Assist, Attempt. Never attempt to fight a fire before raising the alarm and helping people escape.
• Monthly fire extinguisher checks: Location, visibility, pressure gauge in green zone.
• Hospital fire risks: Oxygen, alcohol-based products, electrical equipment, and cooking oils are the big four.
• Class K fires: Water on a grease fire causes explosive splattering. This is a classic exam question.
• CO2 extinguishers: Safe for electrical fires, leave no residue, but can cause frostbite and suffocation in enclosed spaces.
• Dry chemical extinguishers: The most versatile (A, B, C) but leave residue.
• In a hospital fire: Evacuate horizontally first, then vertically. Use stairs, never elevators. Close doors to slow fire spread.
• Nurses must participate in fire drills. Knowing the theory is not enough; you must practice.
• Connect to disaster management: PPE is essential during disease outbreaks (Ebola, COVID-19). Fire safety is essential in mass casualty events where oxygen, electricity, and panic create deadly combinations. Both are disaster preparedness skills.

• World Health Organization (WHO). Guidelines on Personal Protective Equipment (PPE) use in healthcare settings.
• Centers for Disease Control and Prevention (CDC). Infection Control and Hospital Fire Safety Protocols.
• National Fire Protection Association (NFPA). Standards for portable fire extinguishers and hospital safety.
• Standard Nursing Textbooks on Clinical Skills and Workplace Hazard Management.