Personal Protective Equipment (PPE)
Introduction
- Personal protective equipment, “PPE”, is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.
Types
A. Face shields (protect face, mouth, nose, and eyes)
B. Masks (protect mouth/nose)
1. Medical Mask (Surgical mask)
- Disposable, loose-fitting face masks that cover your nose, mouth, and chin.
- Good breathability.
2. Particulate Respirator
-
- American standard of Particulate respirator are managed by NIOSH – part of the Center for Disease Control (CDC). e.g. N95, N100
- European standard of Particulate respirator comes from EN standard 149:2001 – drafted and maintained by CEN based on “Filtering Face Piece” score (FFP). e.g. FFP1, FFP2, FFP3
| Respirator standard | Filter capacity (removes x% of all particles that are 0.3 microns in diameter or larger) |
| FFP | 80% |
| FFP2 | 94% |
| N95 | 95% |
| FFP3 | 99.95% |
| N100 | 99.97% |
3. Surgical Particulate Respirator
C. Eye Protectives
- e.g. Goggles
D. Clothing
- e.g. Gown, Aprons, Head covering, Shoe covers
E. Gloves (protect hands)
Donning & Doffing PPE
Sequence for Donning PPE
Gown (first)
⇓
Mask or respirator
⇓
Goggles or face shield
⇓
Gloves
Sequence for Doffing PPE
Gloves
⇓
Face shield or goggles
⇓
Gown
⇓
Mask or respirator
PPE for at-risk health facilities
Airborne precautions for aerosolized generating procedures:
1. Gloves
- Gloves nitrile, powder-free, non-sterile. (eg. minimum 230mm total length). Various sizes ranging from small, medium, large.
2. Mask (healthcare worker)
a. Medical mask (Surgical mask)
- Good breathability, internal and external faces should be clearly identified.
b. Face Shield
- Made of clear plastic and provides good visibility to both the wearer and the patient, Adjustable band to attach firmly around the head and fit snuggly against the forehead, Fog resistant (preferable), Completely cover the sides and length of the face, May be re-usable (made of robust material which can be cleaned and disinfected) or disposable.
c. Particulate respirator (grade N95 or higher)
- American standard of Particulate respirator are managed by NIOSH – part of the Center for Disease Control (CDC). e.g. N95, N100
- European standard of Particulate respirator comes from EN standard 149:2001 – drafted and maintained by CEN based on “Filtering Face Piece” score (FFP). e.g. FFP1, FFP2, FFP3
N95 or FFP2 respirator or higher Good breathability with design that does not collapse against the mouth (e.g. duckbill, cup-shaped)
Are N95/N100 actually better than FFP2/FFP3?
- Whilst the specifications for the NIOSH (N95/N100) are marginally higher than FFP, that doesn’t mean the respirators are any better.
Can Surgical Masks Filter the Corona virus?
- Whilst FFP2/FFP3 or N95/N100 are the gold standard as far as face protection goes, what about surgical masks, do they provide any protection?
- Surgical masks are primarily designed to protect vulnerable patients from medical professionals.
- Stopping the wearer from spreading their germs when coughing/sneezing/speaking. So they’re designed to protect patients, not to protect the wearer. There isn’t currently research available on the efficacy of surgical masks (or even respirators), for protecting wearers against the corona virus.
Recommendations for usage of Surgical Triple Layer Mask / Respirators
- Asymptomatic individuals wearing masks of any type is not recommended.
- Wearing masks when they are not indicated results in unnecessary cost and a procurement burden especially during the time of an epidemic/pandemic.
- People with respiratory symptoms or who are taking care of COVID-19 patients at home should receive triple layer surgical masks.
- Respirators(N95, FFP2 or equivalent standard) should be reserved for aerosol generating procedures (Tracheal intubation, non-invasive ventilation, tracheostomy, bronchoscopy and cardio pulmonary resuscitation) along with other personal protective equipments (PPE).
- Health care workers who are involved in direct care of COVID -19 patients should use three layered surgical mask/ Respirator (only if available in sufficient quantity) and other PPE (eye protection, gloves and gowns/fluid resistant aprons)
- Medical and Nursing staff involved in Intensive care unit should use Respirators( N95/FFP2 or an equivalent)
- During the present pandemic situation respirators (e.g., N95, FFP2 or equivalent standard) can be used for an extended time, especially while caring for multiple patients who have the same diagnosis without removing it. Evidence shows that respirators maintain their protection when it is been used for extended periods.
- Always prioritize the use of N95 respirators for those personnel at the highest risk of contracting infections.
- Most often an N95 mask can be used for up to 8hours on a continuous or intermittent basis and ideally it needs to be removed after that.
- Avoid touching the inside of the respirator. If inadvertent contact is made with the inside of the respirator, perform hand hygiene.
- Used mask should be considered as a potentially infected material and it should be disposed separately in an infectious waste disposable bag.
- Health care system at every locality should adopt appropriate steps for disposal of used masks. [63]
3. Scrubs, tops
- Tunic/tops, woven, scrubs, reusable or single use, short sleeved (tunic/tops), worn underneath the coveralls or gown.
4. Scrubs, pants
- Trouser/pants, woven, scrubs, reusable or single use, short sleeved (tunic/tops), worn underneath the coveralls or gown.
5. Apron, heavy duty
- Straight apron with bib, Fabric: 100% polyester with PVC coating, or 100% PVC, or 100% rubber, or other fluid resistant coated material, Waterproof, Sewn strap for neck and back fastening.
- Minimum basis weight: 300g/m2, covering size: 70-90 cm (width) X 120-150cm (height)
- Reusable (provided appropriate arrangements for decontamination are in place)
6. Gown
- Single use, disposable, length mid-calf.
7. Shoe cover, hood
8. Goggles, protective
- Good seal with the skin of the face, Flexible PVC frame to easily fit with all face contours with even pressure, Enclose eyes and the surrounding areas, Accomodate wearers with prescription glasses, Clear plastic lens with fog and scratch resistant treatments, Adjustable band to secure firmly so as not to become loose during clinical activity, Indirect venting to avoid fogging, May be re-usable (provided appropriate arrangements for decontamination are in place) or disposable.
