Proper Use of PPE for Healthcare Workers in Different Settings

Rational Use of Personal Protective Equipment:

PPE use is based on the risk of exposure (e.g., type of activity) and the transmission dynamics of the pathogen (e.g., contact, droplet or aerosol). Observing the following recommendations will ensure rational use of PPE.

• The type of PPE used when caring for COVID-19 patients will vary according to the setting and type of personnel and activity (Below Table).
• Healthcare workers involved in the direct care of patients should use the following PPE:

1. Gowns
2. Gloves
3. Medical Mask
4. Eye protection (goggles or face shield).

• Specifically, for aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy) healthcare workers should use respirators (N95), eye protection, gloves and gowns; aprons should also be used if gowns are not fluid resistant.
• Respirators (e.g., N95, FFP2 or equivalent standard) have been used for an extended time during previous public health emergencies involving acute respiratory illness when PPE was in short supply. This refers to wearing the same respirator while caring for multiple patients who have the same diagnosis without removing it, and evidence indicates that respirators maintain their protection when used for extended periods. However, using one respirator for longer than 4 hours can lead to discomfort and should be avoided.
• Among the general public, persons with respiratory symptoms or those caring for COVID-19 patients at home should receive medical masks.
• For asymptomatic individuals, wearing a mask of any type is not recommended.
• Wearing medical masks when they are not indicated may cause unnecessary cost and a procurement burden and create a false sense of security that can lead to the neglect of other essential preventive measures.

Decontamination and Waste Management:

• In addition to using the appropriate PPE, frequent hand hygiene and respiratory hygiene should always be performed. PPE should be discarded in an appropriate waste container after use, and hand hygiene should be performed before putting on and after taking off PPE.
• Any surface or material known to be, or potentially be, contaminated by biological agents during laboratory operations must be correctly disinfected to control infectious risks.
• Proper processes for the identification and segregation of contaminated materials must be adopted before decontamination and/or disposal.
• Where decontamination cannot be performed in the laboratory area or onsite, the contaminated waste must be packaged in an approved (that is, leakproof) manner, for transfer to another facility with decontamination capacity.

Donning (putting on) PPE:

These requirements apply to all staff entering the room of a corona virus infected patient. The following PPE is required to be donned prior to entry into the patient room. Donning in the following order is recommended.

• Gown: A clean, nonsterile, disposable, isolation gown must be worn. Ensure that gown is tied in back and provides full coverage.
• N-95 respirator:

1. All staff must wear approved respiratory protection (N-95 respirator).
2. Before using an N-95 respirator, staff must be medically cleared and trained in how to wear/use each device.
3. For N-95 respirators, staff must have been fit-tested within the past year to ensure proper size and fit.
4. A “fit-check” (also known as a “seal check”) should be performed before each N-95 respirator use.
5. The N-95 respirator must be discarded after each use.

• Goggles/Face shield:

All staff must wear goggles or face shield to protect mucous membranes from exposure due to splash or potential for hand contamination of eyes, nose or mouth.

• Gloves:

All staff must wear clean, nonsterile gloves. Gloves must be pulled over the sleeves/cuffs of gown.

Removal:

• For Airborne Infection Isolation (AII) room with anteroom:

Remove all PPE in anteroom. Make sure the door from the anteroom into the patient room is closed and negative airflow into patient room has been confirmed.

• For AII room without anteroom:

Except for respiratory protection, remove and discard PPE (gloves, gown, face shield or goggles) just inside doorway before exiting to hall. Remove respiratory protection (N-95) after leaving the patient room and closing door.

Doffing sequence if N-95 respirator is worn - See Doffing Checklist- N-95 Respirator (for removal sequence. Avoid touching face.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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