With the shortage of Personal Protective Equipment (PPE) in the wake of Coronavirus pandemic in the country – and worldwide – a focused attempt in making sure of proper and efficient utilization of PPE while minimizing unnecessary usage of the equipment becomes imperative.
The following guidance on the types of PPE required as well as how to use, clean, and dispose of the equipment is intended for healthcare personnel (HCP) in the United States, although it is also most likely applicable to healthcare settings in most other countries too. A fundamental method of protecting HCP from occupational Coronavirus infections is by controlling exposures to sources of the infections in the first place.
Hand Hygiene
Practicing consistent hand hygiene is the first line of defense against Coronavirus infection. Many cases of infection occurs because a person is unknowingly exposed to respiratory droplets (such as from a cough or sneeze), after which the person touches the mouth, nose, or eyes with the exposed hand. Therefore:
· HCP must perform hand hygiene before and after making contact with potentially infectious materials, surfaces, and patients. Also make sure of proper hand hygiene before putting on and after removing PPE including masks and gloves. After removing PPE, it is especially important to perform hand hygiene because the removal process itself might transfer pathogens to bare hands.
· Washing hands with soap and water for at least 20 seconds as often as possible helps maintain hygiene, although it is always better to follow the step by applying moderate amount of Alcohol-Based Hand Rub (ABHR) that contains 60 – 90% alcohol afterward. When the hands are visibly soiled, practice both methods in the aforementioned order.
Healthcare facilities must make sure that hand hygiene supplies are readily available at all times to all HCP and placed in all appropriate locations including entrances to rooms, at the bedside, and work stations.
Personal Protective Equipment
Fit, correct, and consistent use of PPE is indispensable in preventing HCP exposure to viral infection. A simple checklist of the types of PPE along with proper methods of using, removing, cleaning, and disposing of the equipment is as follows.
1. Respirator or Facemask
Wear an N95 respirator (or other types that have higher level of protection) before entering patient room, care area, or other places within close proximity to patients known or suspected to have been infected with Coronavirus. Higher level respirators include disposable filtering facepiece respirators, elastomeric respirators, and Power Air Purifying Respirators (PAPRs). Facemask should be used only when a respirator is not readily available, although the former will not provide adequate protection against infection when HCP is performing or present for aerosol generating procedures (AGPs) such as bronchoscopy, manual ventilation, and non-invasive ventilation, among others.
Disposable respirators and facemasks must be removed and discarded after exiting care area, unless the protective gears are parts of extended use approach, for example when HCP has to enter multiple care areas. All reusable respirators must be disinfected according to manufacturers’ instructions before reuse.
NOTE: cloth face coverings are not categorized as PPE. They should not be worn for the care of patients with suspected or known COVID-19.
2. Eye Protection
Respiratory droplets from a COVID-19 patient may enter HCP’s system not only through typical air passageways (nose and mouth), but also through the eyes. The most ideal eye protection includes goggles or face shield that covers the front and side of the face.
HCP must wear adequate eye protection before entering patient room, care area, or other places within close proximity to patients known or suspected to have been infected with Coronavirus. Extended use of eye protection is possibly implemented in case HCP has to make repeated close contact encounters with several different COVID-19 patients.
Eye protection is a priority during care activities in which sprays and splashes are anticipated for example in AGPs. It is also indispensable in the event prolonged face-to-face contact with COVID-19 patients is unavoidable.
Do not touch eye protection; if it is necessary to adjust the equipment during work, perform hand hygiene immediately afterward. HCP must leave care area before removing eye protection. Reusable goggles and face shields must be disinfected according to manufacturers’ instructions before reuse. Disposable or damaged eye protection equipment must be discarded after every use.
NOTE: contact lenses and personal eye glasses are not categorized as PPE. They should not be worn for the care of patients with suspected or known COVID-19.
3. Gloves
Among all mandatory PPE for HCP when providing care and treatment to patients with COVID-19, gloves are almost certainly the only gears available in abundance. There is no shortage of supply of gloves so far.
HCP are required to put on clean disposable patient examination (although not necessarily sterile) gloves before entering patient room, care area, or other places within close proximity to patients known or suspected to have been infected with Coronavirus.
Change gloves as soon as they appear damaged, torn, or heavily contaminated; HCP should not wait until after the next routine examination of COVID-19 before changing gloves. Leave care area before changing gloves. Remove and discard gloves when leaving care area, and perform hand hygiene immediately.
NOTE: non-sterile disposable patient examination gloves, which are most commonly used for routine patient care in healthcare settings are appropriate for the care of COVID-19 patients.
4. Isolation Gowns
HCP must wear disposable patient isolation gown before entering patient room, care area, or other places within close proximity to patients known or suspected to have been infected with Coronavirus. In case of shortages of isolation gown, the PPE must be prioritized for AGPs and other care activities during which the transfer of pathogens to the clothing and hands of HCP is likely to occur for examples grooming, changing linens, assisting with toileting, wound care, etc.
Disposable isolation gown must be discarded after use in a dedicated container before leaving care area. Reusable cloth gowns must be laundered and disinfected before re-use.
Limitation of PPE
Bear in mind that PPE is the least effective control of occupational infection (after elimination, substitution, engineering and administrative approaches) because it entirely depends on the way the equipment are used.
In other words, even the “theoretically” most reliable protective equipment has all the likelihood to be rendered useless given improper, incorrect, and inconsistent usage. Be that as it may, PPE is indispensable as patients rely on HCP to help manage symptoms of infection. HCP must stay safe and protected throughout the entire time they are positioned in direct vicinity of potential sources of infections including patients in isolation or under treatment.