Overview of PPE

Personal Protective Equipment (PPE) is critical in reducing the risk of exposure to infections, particularly in healthcare settings. PPE serves as a barrier between healthcare workers (HCWs) and harmful pathogens, thus preventing healthcare-associated infections (HAIs). The use of PPE is an essential aspect of infection prevention and control (IPC) strategies to safeguard both patients and HCWs from cross-contamination.

Types of PPE

The primary categories of PPE used in healthcare include gloves, masks, gowns, and goggles. Each type of PPE is designed to protect healthcare workers from different transmission routes of infectious agents.

1. Gloves

• Purpose: Gloves are essential for preventing the direct contact of hands with potentially infectious materials, such as blood, bodily fluids, contaminated surfaces, or broken skin.
• Types of Gloves:
  • Disposable Gloves: Commonly made from latex, nitrile, or vinyl, these gloves are used once and discarded.
  • Non-Disposable Gloves: Often made from rubber, these are reusable but must be thoroughly disinfected after use.
• Glove Selection: The type of glove used depends on the situation. For example, nitrile gloves are preferred for protection against chemicals or other hazardous substances, while latex gloves are commonly used for general patient care.

Key Points to Remember:

• Always check for holes or tears before using gloves.
• Choose gloves based on the nature of the task and the risk of exposure.
• Replace gloves after each patient or procedure, and never reuse gloves.

2. Masks

• Purpose: Masks protect the wearer from inhaling airborne particles, droplets, or splashes that may contain infectious agents.
• Types of Masks:
  • Surgical Masks: These masks provide protection against large droplets but do not offer a tight seal around the face.
  • N95 Respirators: These masks provide a higher level of protection, filtering out at least 95% of airborne particles. They are used for airborne precautions, such as in cases of tuberculosis, COVID-19, or other airborne pathogens.
  • PAPR (Powered Air-Purifying Respirator): A more advanced mask with a battery-operated blower that forces air through a HEPA filter, providing both respiratory protection and comfort.

Key Points to Remember:

• Masks should be worn in situations where there is a risk of droplet or airborne transmission.
• N95 respirators and PAPRs are reserved for specific high-risk procedures or environments.
• Proper fit is essential for masks to function effectively.

3. Gowns

• Purpose: Gowns are used to protect the skin and clothing from contamination during patient care or when handling contaminated materials.
• Types of Gowns:
  • Disposable Gowns: These are made of non-woven materials and are used once before disposal.
  • Reusable Gowns: These are made of fabric that can be washed and disinfected for repeated use.
  • Isolation Gowns: These are used when caring for patients with known or suspected infectious diseases, particularly those with a high risk of transmission.

Key Points to Remember:

• Gowns should cover the arms, torso, and legs to prevent any exposed skin from coming into contact with infectious agents.
• Disposable gowns should be discarded after use, and reusable gowns must be cleaned and disinfected before reuse.
• Ensure that the gown is secured at the back, covering both the front and the sleeves.

4. Goggles and Face Shields

• Purpose: Goggles and face shields protect the eyes, face, and mucous membranes from splashes, droplets, and other potential exposures.
• Types of Eye Protection:
  • Goggles: Provide a tight seal around the eyes and protect against liquids and splashes. Some goggles also provide protection from harmful gases or vapors.
  • Face Shields: A clear plastic shield worn over the face to protect against splashes and airborne droplets.

Key Points to Remember:

• Goggles and face shields are crucial when there is a risk of exposure to blood, fluids, or potentially infectious airborne particles.
• Face shields are preferred when providing direct care to patients with contagious diseases transmitted through droplets.

Proper Donning and Doffing Techniques

The process of putting on (donning) and removing (doffing) PPE correctly is essential to ensure that exposure to infectious materials is minimized. Failure to follow these procedures can result in self-contamination.

Donning PPE (Putting on PPE)

1. Wash Hands: Thoroughly wash hands with soap and water or use hand sanitizer.
2. Gown:
   • Put on the gown first, ensuring it fully covers the torso, arms, and legs.
   • Tie the gown securely at the back, ensuring that it stays in place throughout the procedure.
3. Mask/Respirator:
   • Put on the mask or respirator, ensuring a snug fit. For N95 respirators, check for a proper seal.
   • For surgical masks, ensure the nose clip is adjusted to fit snugly over the nose.
4. Goggles/Face Shield:
   • Put on goggles or a face shield to cover the eyes and face.
   • Ensure that there is no gap between the goggles or shield and the face.
5. Gloves:
   • Put on gloves last, ensuring that they cover the cuffs of the gown to create a continuous barrier.

Key Points to Remember:

• Always follow the correct sequence to avoid contaminating yourself while donning PPE.
• Check the fit of each piece of PPE to ensure maximum protection.

Doffing PPE (Removing PPE)

1. Remove Gloves:
   • Grasp the outside of one glove with the opposite hand and pull it off, turning it inside out.
   • Use the gloved hand to remove the second glove by pulling it off from the inside, ensuring that the gloves are never touched on the outside.
2. Remove Goggles/Face Shield:
   • Remove goggles or a face shield by handling only the straps or ear pieces to avoid touching the front of the goggles.
3. Remove Gown:
   • Untie the gown and remove it by pulling it away from the body, rolling it inside out as it is removed.
   • Dispose of the gown appropriately in a designated waste container.
4. Remove Mask/Respirator:
   • If using a surgical mask, remove it by the ear loops or ties.
   • For N95 respirators, remove it by the straps, avoiding contact with the front of the mask.
5. Wash Hands: Immediately wash hands after doffing PPE.

Key Points to Remember:

• Do not touch the outside of any PPE during doffing.
• Doffing should always occur in a predetermined sequence to avoid cross-contamination.

Quiz: PPE Knowledge Check

1. What is the primary purpose of gloves in infection prevention? a. To protect the hands from heat
   b. To prevent the spread of infections through direct contact
   c. To keep the hands dry
   d. To provide comfort during long shifts

2. Which PPE is used to protect against airborne pathogens? a. Surgical Mask
   b. N95 Respirator
   c. Face Shield
   d. Gloves

3. What is the correct sequence for donning PPE? a. Gloves, gown, mask, goggles
   b. Mask, gown, gloves, goggles
   c. Gown, mask, goggles, gloves
   d. Gown, gloves, mask, goggles

4. Which of the following is true about doffing PPE? a. Gloves should be removed last
   b. Always remove goggles before gloves
   c. Wash your hands after doffing PPE
   d. Gown should be removed by touching the front

Practical Exercise: PPE Donning and Doffing

Objective: To demonstrate the proper techniques for donning and doffing PPE.

Materials: Gown, gloves, surgical mask, goggles, and face shield.

Instructions:

1. Practice donning the full set of PPE in the correct sequence.
2. After performing tasks (e.g., mock patient care), practice doffing PPE in the proper order.
3. Discuss the challenges you face while donning and doffing PPE and address any difficulties during feedback.

Online Resources for Further Learning

1. World Health Organization (WHO) – Infection Prevention and Control
   https://www.who.int/infection-prevention/en/

2. Centers for Disease Control and Prevention (CDC) – PPE Guidelines
   https://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html

3. CDC – PPE and Hand Hygiene Resources
   https://www.cdc.gov/handhygiene/index.html