Equip yourself: Understanding the basics of PPE

What is PPE?

PPE stands for Personal Protective Equipment, which covers a range of items that physically protect healthcare and other workers from causes of harm. Without the physical barrier of PPE, the worker has a greater risk of being injured or becoming ill. 

PPE can include a uniform, gloves, mask, face shield, goggles, apron, gown, cap and boots. Some elements will be more appropriate than others depending on the pathogen of concern, its mode of transmission, the level of risk, and the procedure being undertaken. 

Gloves are the most commonly used PPE. 

Here is a list of select PPE and their key use in healthcare, head to toe.

Uniform

The uniform replaces street clothes and street shoes inside the workplace, to avoid infection transmission from outside into health facilities and, equally, from inside to out. In specific areas such as the delivery room or the operating room staff must don a fresh uniform, to avoid infection being transmitted in childbirth or during surgical operations for example.

Caps

Caps are a common PPE to prevent hair falling and causing contamination, and as part of the uniform in some sterile situations, especially for surgery.

Goggles

There are also two types of goggles: protective googles and safety glasses. Amongst their specific uses, both offer protection from body fluid splashes such as due to haemorrhagic fever, like Marburg or Ebola. Protective googles are wraparound. They also protect from dust. Safety glasses are advised for activities such as medical and surgical procedures, in a laboratory, and for handling waste that will be incinerated. 

Mask

The two types of mask, the surgical mask and respirator, filter the air and provide protection in different ways. The surgical mask filters the particles of air exhaled by the person wearing it, thus protecting the people that the wearer comes in close contact with, for example patients in the operating theatre. It also provides some protection for the wearer, from pathogens spread by droplets such as the common cold or influenza.The respirator, or FFP2 and N95 mask, filters inhaled particles of air. This is mandatory PPE when the wearer will be in contact with someone suspected or confirmed to have an infectious disease that is spread by airborne transmission, such as tuberculosis.

Face shield

A face shield, commonly made of clear plastic, covers the whole face. It can protect from flying debris and from body fluid splashes for example, but it is also useful as additional protection when a healthcare worker must use their surgical mask or respirator for an extended period, or need to re-use either. A face shield can also be used in place of goggles.

Gloves

Gloves can be divided into protective work gloves and single-use medical gloves. Protective work gloves are suitable for cleaning tasks and waste management, for example. Single-use medical gloves come in two types: sterile gloves and examination gloves. They protect in case of contact with a patient’s bodily fluids, mucous membranes, wounds, or any skin lesions. They also protect the patient if the healthcare worker themself has any lesions, such as a cut, on their hands.

Gowns 

Gowns also come in two types: surgical (sterile) and isolation (non-sterile) gowns. The isolation gown, or fluid-resistant gown, can protect against the risk of splashes from body fluids and should also be worn, as per its name, when attending to patients who have been placed in isolation. 

Apron

The protective apron is made of plastic. It protects the healthcare worker’s uniform or other clothing underneath when there is a risk of getting wet or contaminated and can be layered over a gown to provide additional protection. Boots Boots protect feet and legs when there is a risk of contact with liquids or bodily fluids.

Why is PPE important? 

The most common cause of harm for a healthcare worker is contamination by infectious microorganisms, typically transmitted through bodily fluids. PPE is designed to stop the microorganisms from reaching the healthcare worker’s skin, mucous membranes such as the mouth, the nose and the eyes, or their clothes. The correct use of PPE protects the healthcare worker, the patient, and the environment.

How do you use PPE properly? 

The choice of PPE depends on the specific pathogen, its mode of transmission, and the care being provided. The healthcare organisation and its workers need to assess this risk, and be sure that their choice of PPE will fully cover the parts of the body they want to protect. At the same time, in any setting there will be healthcare workers who do not need full PPE or any PPE, and respecting this will help ensure that PPE resources are allocated in the most efficient way.

Donning and doffing are the two terms for putting on and taking off PPE. Both need to be done very carefully and in strict order to achieve maximum coverage in the wearing, and minimum risk of contamination at any stage of wearing or removal. Hands must be washed before donning and at key moments in the doffing process to avoid any cross-contamination.

PPE is a protective barrier, but it must be worn mindfully. Touching the patient or patient’s environment will contaminate the PPE, and anything touched subsequently will then become contaminated. Equally, touching something else before touching the patient risks their contamination.  

As the name suggests, single-use gloves should be replaced between each new procedure and each new patient and disposed of immediately after use. Because gloves cannot guarantee total protection from contaminants, hands must be also washed after every wearing. Gloves must never be used as a replacement for good hand hygiene.