PPE in Healthcare

August 17, 2020

Personal protective equipment (PPE) refers to clothing, tools and gear that is intended to protect an individual from potential hazards that they may be exposed to at work or while engaging in other activities. Common job hazards that may necessitate the use of PPE include exposure to dangerous chemicals, bodily fluids or infectious germs. Some individuals may encounter these types of hazards several times during a typical workday, making the proper use of PPE even more important.

What is PPE in Healthcare?

For healthcare workers, PPE refers to protective clothing and tools that are designed to shield the user from potential biohazards. PPE is typically disposable and intended for one-time use [1,2]. The PPE used in healthcare settings is primarily intended to be used as a barrier between potential infectious agents found in bodily fluids and the user’s skin, mouth, nose and other ports of entry [1]. PPE intended for use in a medical setting must meet the regulations and standards as specified by Food and Drug Administration (FDA) [1]. These standards are set to maintain the safety and effectiveness of PPE in healthcare including sterility, fluid resistance, and biocompatibility.

Types of PPE in Healthcare

  • Gloves are used to protect the user’s hands when in contact with potentially infectious materials [2]. Wearing gloves is the most common PPE practice for infection control in healthcare.

    nurse putting on a glove

  • Masks are used as a protective barrier that covers the user’s mouth and nose. Surgical masks have specific standards for protecting the user from spreading or contracting infections [2,3].
  • Respirators such as N95 masks are further specialized masks that function by providing a tight seal around the healthcare worker’s mouth and nose to help prevent infections such as Streptococcus pneumoniae [2-4].
  • Goggles are a basic form of eye protection and are used to prevent infection-causing bacteria from entering the body through the mucous membranes in the eyes [2].
  • Face shields are often used with masks and goggles to provide an additional layer of protection for the face, where infection-causing bacteria are most likely to enter the body [2]. They are often used in cases of high infection rates or during times of limited PPE because in some cases, shields can be sterilized and allow for extended use of disposable masks [5].
  • Protective clothing such as gowns, aprons, head coverings, and shoe covers are typically disposable, one-time use garments that are worn on the outside of washable clothing, such as scrubs [2]. Gowns often have long sleeves and continue to below the knee.

 

It is important to remember that the different types of PPE in these categories have different uses. Special attention needs to be taken to ensure that the correct PPE is used for each patient and situation.

Why is PPE Important in Healthcare?

PPE is intended to create a barrier between patients and healthcare providers in order to reduce the risk of infection between people. This type of protection is particularly important in healthcare settings because of the close contact required to treat and care for patients. Proper PPE use in healthcare also refers to the proper removal and disposal PPE including appropriate hand hygiene [1]. Utilization of PPE requires proper fit, consistent and correct use and may be ineffective if used improperly [3].

When Should PPE be Used in Healthcare?

Any person who has the potential to come in contact with blood, body fluids, or airborne pathogens (e.g., respiratory secretions) should be equipped with the appropriate PPE [2]. All PPE should be properly donned before entering the patient’s room or beginning any tasks [6]. The Centers for Disease Control and Prevention (CDC) administers appropriate recommendations for use of PPE, specific to current scenarios including widespread outbreaks of disease [1].

Healthcare workers use gloves on a frequent basis for all aspects of patient care [6]. Protective clothing, such as gowns and masks, are typically utilized when an employee is involved in surgeries or if they are interacting with a highly contagious patient.

Gloves, gowns, and masks are used by staff conducting environmental services or disposing of contaminated PPE that have been in contact with bodily fluids [6,7]. During times of widespread disease outbreaks, all staff may be required to wear masks or face coverings while at work [3].

Patients also utilize PPE if they are at a greater risk for contracting an infection during a surgical procedure [1]. Additionally, some patients that are diagnosed with infections or diseases such as HIV or cancer and have a compromised immune system will have a greater need for PPE use. PPE is often utilized more frequently in these situations to protect high-risk patients from infections that may be acquired during a hospital stay [1].

Visitors will be required to wear full disposable clothing PPE if they are visiting a patient that is in isolation with a highly infectious disease [2]. They will also be required to dress fully if they will be present during surgery [2]. This is most common for companions during cesarean delivery.

Impact of PPE on the Environment

In the vast majority of cases, gloves and other disposable PPE should not be washed or reused between patients or for repeat contacts with the same patient [7]. However, in situations where PPE is limited, procedures can be conducted to reuse or sterilize PPE such as respirators and eye protection [5,9-11].

Single use PPE products are typically composed of synthetic materials and are not biodegradable [8]. Most hospital-associated PPE is sent to landfills or incinerated, if deemed potentially infectious [8]. This poses a significant environmental threat as the demand for single-use PPE continues to grow. The environmental burden of single-use items has led to the consideration of methods to provide safe and reusable PPE for use in the healthcare field.

How You Can Safely Reduce PPE in Healthcare

Mounting clinical evidence demonstrates nasal decolonization as a component to infection prevention programs that increases patient safety while reducing isolation days and use of PPE [12]. Among the CDC’s recommended guidelines for preventing the transmission of S. aureus, is the utilization of intranasal decolonization treatments [13]. Focusing on reducing hospital acquired infections (HAIs) such as Staphylococcus aureus (S. aureus) by using nasal antiseptics such as Nozin® Nasal Sanitizer® antiseptic may aid in the reduction of PPE by limiting patient isolation days.

Alternatives to PPE use in healthcare are extremely limited. One modern solution to reducing PPE is through the use telemedicine in consultations. In situations where the patient must be seen in person, the CDC recommends reducing the number of healthcare workers and eliminating visitors in the cohorts requiring the most PPE [3]. This will help to conserve resources, reduce waste and limit the amount of personnel exposed to high risk infections.

Summary

PPE is a critical component to the safety of healthcare workers and patients. The types of PPE used in healthcare vary according to the setting and current disease climate. The FDA maintains the guidelines for safety and certification of manufacturing PPE for use in medical settings, while the CDC updates the recommended protocols for PPE use. PPE provides an important protective barrier for healthcare personnel and its effectiveness is directly linked to proper use. Ultimately, effective infection prevention programs that include appropriate PPE use and focus on reducing HAIs are vital to maintain the safety of healthcare workers and patients.

 

References:

  1. Center for Devices and Radiological Health. (2020). Personal Protective Equipment for Infection Control. Retrieved June 03, 2020, from https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/personal-protective-equipment-infection-control
  2. Bainbridge, L. (2019, May 14). When Should Personal Protective Equipment (PPE) Be Used in Healthcare? Retrieved June 03, 2020, from https://www.beaucare.com/blog/personal-protective-equipment-ppe-used-healthcare/
  3. Centers for Disease Control and Prevention. (2020, April 12). Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Retrieved June 04, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
  4. Hebden, J., Diamond, F., Saskia, & Popescu. (2016, October 17). The Role of Personal Protective Equipment in Infection Prevention History. Retrieved June 03, 2020, from https://www.infectioncontroltoday.com/personal-protective-equipment/role-personal-protective-equipment-infection-prevention-history
  5. Centers for Disease Control and Prevention. (2020, April 30). COVID-19 Decontamination and Reuse of Filtering Facepiece Respirators. Retrieved June 04, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
  6. Centers for Disease Control and Prevention. (2020) Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved June 03, 2020, from https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf
  7. Centers for Disease Control and Prevention. (2019, July 22). Isolation Precautions. Retrieved June 04, 2020, from https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
  8. Corina, T. (2020, May 27). Protecting public health and the environment: Addressing the dual crisis of PPE. Retrieved June 04, 2020, from https://www.politicshome.com/members/article/protecting-public-health-and-the-environment-addressing-the-dual-crisis-of-ppe
  9. Centers for Disease Control and Prevention. (2020, March 17). Strategies for Optimizing the Supply of Eye Protection: COVID-19. Retrieved June 04, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/eye-protection.html
  10. Centers for Disease Control and Prevention. (2020, March 17). Strategies for Optimizing the Supply of Isolation Gowns. Retrieved June 04, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html
  11. Centers for Disease Control and Prevention. (2020, April 30). Strategies for Optimizing the Supply of Disposable Medical Gloves. Retrieved June 04, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/gloves.html
  12. Nozin. (2020, April 21). Staph aureus: Learn About It and How to Help Reduce Risk of Infection. Retrieved June 04, 2020, from https://www.nozin.com/staph-aureus/
  13. Centers for Disease Control and Prevention. (2019, December 16). Strategies to Prevent S. aureus BSIs in Acute Care Facilities. Retrieved June 04, 2020, from https://www.cdc.gov/hai/prevent/staph-prevention-strategies.html


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