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Equip yourself: Understanding the basics of PPE

04 Jun 2020

Personal protective equipment, or PPE, is a part of the standard precautions that every healthcare worker takes to mitigate the risk of exposure to pathogens in everyday practice. Significantly, the correct use of PPE protects not only the healthcare worker but also the patient and the environment, helping to keep everyone safe from pathogens that might otherwise spread with ease. 

The emergence of severe acute respiratory syndrome coronavirus 2, the novel coronavirus causing the disease COVID-19, has thrown into sharp relief the importance of protective equipment. Globally there has been a catastrophic failure to ensure enough PPE for frontline workers, and in many countries this has already had an impact on care for patients with COVID-19 and continuity of other essential medical services.   

Some elements of PPE have also moved out of healthcare settings and onto the city streets, worn by the general public. 

So what exactly is PPE, and what do we all need to know about how it should be used, and the impact of shortages? 

A member of MSF's hygiene team hangs disinfected scrubs and googles on a clothesline at MSF's Ebola treatment centre in Freetown, Sierra Leone. © Anna Surinyach / MSF

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.

An MSF medical team member dons personal protective equipment in the designated “blue zone” of MSF’s paediatric clinic on Lesbos island, Greece. © Anna Pantelia/MSF

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.

The members of the operating theatre nursing team in MSF's hospital in Dagahaley, northern Kenya, are dressed in surgical uniform. © Paul Odongo

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.

Can you reuse PPE?

Some PPE can be reused after cleaning or sterilisation, such as goggles, some types of gowns and plastic aprons.
 
Single-use gloves must never be reused or cleaned and must be disposed of immediately after wearing to avoid cross-contamination.
 
Surgical and respirator masks are also single-use and must be changed if they become moist or soiled.

What PPE should I use to protect myself from coronavirus? 

If you are not a healthcare worker, and do not have direct contact with people that you know have coronavirus, in most situations you do not need to wear PPE.
 
Gloves, for example, if not used correctly, can easily be a factor in transmitting a virus, instead of protecting against one. Gloves can also give a false sense of protection. Washing or sanitising your hands after possible contact with a contaminated surface is much more effective and safer than wearing gloves.
 
Face masks, however, are currently recommended or mandated for use by the general public as an additional precaution in a number of countries. Even non-medical masks can offer some supplementary protection, as well as help preserve supplies of medical masks (surgical masks and respirators) for healthcare workers and carers. As long as they cover the nose, mouth and chin, and are handled hygienically, including cleaned daily, manufactured or homemade cloth masks can complement the fundamental rules of hand hygiene and physical distancing and help reduce the spread of the COVID-19 virus. 
 
MSF is encouraging the local production of cloth masks for patients and the community in places where physical distancing and hand hygiene are difficult, if not impossible, to follow, including in Democratic Republic of Congo (DRC), Mali and Afghanistan. In Kinshasa and Goma in DRC, production is underway in 20 small sewing shops, generating masks that can protect non-medical staff, patients and the people who accompany them in health facilities that MSF supports.

Should we be worried about a global shortage of PPE?

Globally, there has been a catastrophic failure to ensure enough PPE for frontline workers, and this has already had an impact on the continuity of essential medical services in a number of countries.   Our teams too have been grappling with maintaining reliable supply and monitoring the very tense and volatile market. MSF is also concerned that while the highest-bidding countries may have more access to crucial PPE, countries with fewer resources miss out. If health workers cannot be kept safe, and health facilities themselves become transmission centres of the disease, then there will be a breakdown in care that will be very difficult to reestablish. 

These effects are already being felt in Mathare, one of Kenya’s largest slums. More than half a million people living here already had limited access to healthcare, and this has only been compounded by the arrival of COVID-19. 

“Many private health facilities closed because of the risk of contamination and the lack of PPE, and at least one public health centre has been closed and its staff quarantined after some of them tested positive,” says Dr Hajir Elyas, Project Coordinator for MSF in Mathare. “Some hospitals are refusing to admit patients with respiratory issues even when the novel coronavirus has been ruled out. As a consequence, many people with tuberculosis, asthma and pneumonia end up in COVID-19 isolation facilities, resulting in delayed care and increased exposure to these patients and their families”.

While the number of reported COVID-19 cases has remained relatively low so far, it is expected to increase, along with the number of indirect victims – those who couldn’t access essential medical care for other types of medical issues.

 

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Right now, Médecins Sans Frontières is providing much needed support and medical care in over 30 countries to counter the COVID-19 pandemic.
 
Our teams are also gearing up to confront potential outbreaks in the hundreds of areas we were already working before the pandemic struck. We are deploying medical staff, sending supplies and applying nearly 50 years of experience fighting epidemics to protect the most vulnerable and save lives.
 
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