Since the start of the COVID-19 pandemic, healthcare professionals and essential workers have faced dire circumstances due to massive shortages in PPE. Many have been forced to work with bandanas for masks and trash bags for gowns; reusing the same materials multiple times before disposal. The World Health Organization (WHO) cites rising demand for this problem.
What qualifies as PPE? Who needs it? How do you properly put it on and remove it? Here is everything you need to know about PPE.
What is PPE?
PPE (Personal Protective Equipment is used to limit exposure to hazards which can cause serious illnesses and injuries at a workplace. It is used in an array of environments, depending on various types of workplace mishaps. This includes:
1. Physical risks
Includes factors such as heights, high pressure, radiation and noise, among others.
2. Chemical exposures
Workers who handle compounds that are toxic, flammable, corrosive or explosive in nature are at high risk. Without PPE, these substances can cause immense damage to an individual.
3. Biological hazards
This includes disease-causing organisms, such as fungi, bacteria and viruses. Employees who work in clinical labs, hospitals and farms, among others, are highly susceptible to being infected by the bio-active germs. However, since COVID-19, all frontline workers, regardless of workplace, are considered highly exposed.
PPE for COVID-19
The Center for Disease Control and Prevention has issued certain guidelines for healthcare workers battling the rampant virus on the frontlines. When used correctly, PPE acts as a barrier; protecting an individual’s eyes, nose, mouth and skin from the virus. Not only does it protect doctors and nurses but also other citizens and patients who are at a high risk of contracting infections after a surgical procedure or due to a medical condition.
COVID-19 is spread mainly between people through droplets and close contact, not by airborne transmission. Therefore, PPE includes the following items which may differ between healthcare professionals, patient visitors and other frontline workers.
COVID-19 PPE consists of items, such as…
N95 respirators offer a high level of protection as they filter out bacteria and viruses. It is critical they are used while performing an aerosol-generating procedure. The other options include disposable filtering facepiece respirators, powered air-purifying respirators (PAPRs), or elastomeric respirators. If none are available, workers should wear masks which offer the next best level of protection, such as a face mask. Cloth masks are not considered PPE and should not be worn near a COVID-positive patient.
Often used interchangeably; Coveralls offer three sixty-degree protection including lower legs, back and head. Gowns, on the other hand, don’t provide continuous full body protection but are easier to take off. It is important to consider design and fabric, depending on where they will be used.
Coveralls and gowns as shown by the CDC
· Gloves
Include nitrile, natural, rubber, polychloroprene, and vinyl gloves. The CDC does not recommend using double gloves, and instead asks workers to follow the usual infection control practice.
These can be goggles or face shields. Disposable eye protection should be discarded after use unless you are following protocols for their extended use or reuse. Eye gear, along with other infection control practices, such as hand-washing and social distancing, dramatically reduce the chances of virus transmission. The Food and Drug Administration (FDA) requires all PPE intended for use as a medical device to follow FDA regulations and meet applicable voluntary consensus standards for protection.
Who Should Use PPE?
The CDC recommends:
1. Patients with confirmed or possible Sars-CoV-2 infection should wear a facemask when being evaluated medically.
2. Healthcare workers should follow Standard and Transmission-based Precautions when caring for a patient who is COVID-positive.
3. Citizens should wear a mask in public. While the FDA does not regulate regular facemasks, they do check the critical supplies. PPE, such as surgical masks and N95 respirators, should be reserved for frontline workers as the shortage is significantly affecting the essential workers.
4. In some cases, health care providers may recommend that caregivers use PPE along with other infection-control protocols while caring for an ill person at home.
In an interview with Health, Dr Lauren Pischel, MD, who also has a fellowship in infectious diseases from Yale School of Medicine, explains that certain procedures necessitate a greater need for PPE. Intubation, the process of inserting a tube through a patient's mouth and into their airway, and nebulizer treatments, a machine that delivers medicated mist to the lungs, create a large amount of virus in the air, so anyone around would definitely need PPE. But on the whole, anyone in close contact with a COVID-19 positive patient and other frontline workers require PPE.
Training and practicing with material similar to what’s used at your workplace is critical. One method of putting on PPE is:
1. Identify and arrange the PPE. Make sure the sizes are as required.
2. Perform hand hygiene using sanitizer.
3. Put on the gown or coverall. Assistance may be necessary to ensure it’s well-fitted with no loose ends.
4. Put on NIOSH-approved N95 respirator or higher. Use a facemask, if a respirator is not available. Respirator/facemask should be extended under the chin as both the mouth and nose should be protected. If it a nosepiece, it should be fitted to the nose with both hands without being bent or tented.
5. Put on goggles or face shields. Select proper eye protection that does not interfere with the respirator, and vice versa. Face shields provide full protection and though googles are excellent, they tend to fog up.
6. Put on gloves that cover the wrist of the gown or coverall.
7. Check thoroughly to ensure everything is perfect before you can enter the workplace.
Even if PPE is worn successfully, incorrect removal and disposal methods can infect an individual and others.
1. Remove gloves. Ensure this does not cause contamination of the hands. It can be removed using more than one technique, i.e. glove-in-glove or bird beak.
2. Remove gown. Some gown ties can be broken rather than untied. Do so in a gentle manner, avoiding any forceful movement. Reach up to the shoulders and carefully pull the gown down and away from the body. Rolling down the gown is an acceptable approach. Dispose it off in a trash can.
3. Healthcare personnel may now exit the patient room.
4. Perform hand hygiene.
5. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from the head. Do not touch the front of the piece.
6. Remove and discard respirator (or facemask if used instead of respirator).
7. Perform hand hygiene after removing the respirator/facemask.
The facilities implementing the reuse or extended use of PPE will need to adjust their procedures to accommodate the practices.
Can PPE be Reused?
As the FDA states, most PPE is intended to be used only once, and by one person. Some exceptions include elastomeric respirator masks and protective eyewear, such as goggles, which can be reused if the user thoroughly follows the decontamination procedures as stated on the product’s labelling. Importantly, washing the disposable PPE is not recommended as this changes its protective capabilities and it may no longer be effective.
PPE Burn Rate Calculator
The PPE burn rate calculator is a spreadsheet-based model provided by the CDC that will help healthcare facilities to plan and optimize the use of PPE. Non-healthcare facilities, such as correctional facilities or department stores, may also find this tool quite handy.
To use the calculator, one needs to enter the number of full boxes of each type of PPE in stock, and the total number of patients at the facility. The tool will calculate the average consumption rate, also referred to as a “burn rate,” for each type of PPE entered into the spreadsheet. This information will be used to estimate the remaining supply availability of PPE, based on the average consumption rate. The calculator can help facilities make projections for future needs. There is now a mobile app version available for both Android and iOS devices.
PPE Needed After A Vaccine?
With multiple top-notch pharmaceutical companies around the world in a race to develop vaccines against COVID-19, many think PPE will no longer be required. This is simply untrue. “Even with a vaccine, there is no going back to normal anytime soon. Prepare for at least 8 to 12 months of this situation,” said Thomas Frieden, former director of the Centers for Disease Control and Prevention, in an interview with CNBC.
PPE will be required and so will infection-control measures, such as social distancing, before life returns to pre-COVID times.
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