PERSONAL PROTECTIVE EQUIPMENT (PPE)

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Posted by Helen Wood on behalf of Pressure Pump Solutions Ltd on 7th Dec 2021

PERSONAL PROTECTIVE EQUIPMENT (PPE) is used in healthcare settings to create a barrier between healthcare workers and an infectious agent, from the patient and to reduce the risk of Personal Protective Equipment (PPE) use in Standard Infection Control Precautions:

• Gloves, aprons, long sleeved gowns, surgical masks, eye goggles, face visors and respirator masks are all examples of PPE that may be worn in the provision of healthcare.


• PPE is used in healthcare settings to create a barrier between healthcare workers and an infectious agent from the patient and to reduce the risk of transmitting micro-organisms from healthcare workers to patient(s). In addition, PPE may sometimes be used by the patient’s family / visitors, particularly if they are providing direct patient care e.g., aiding patients with toileting. In these circumstances carers must be fully inducted in the use of PPE and Hand Hygiene.

• The selection of personal protective equipment (PPE) should be based on a risk assessment of potential exposure to blood, bodily fluids, or infectious agents.

• Personal protective equipment (PPE) should be available at the point of use in both community and acute care settings, and employees should be trained on how to use and dispose of PPE properly.

• If worn incorrectly, personal protective equipment (PPE) can increase the risk of infection transmission and put individuals at risk of infection.

Legislative obligation

• Employers must provide suitable personal protective equipment (PPE) to safeguard employees from infection risks linked with their jobs. Employees are responsible for ensuring that they are using the necessary personal protective equipment (PPE) to protect themselves from infectious pathogens (refer to local COSHH guidelines - Control of Substances Hazardous to Health).

• Employers should give and keep accurate records of training on the proper use of personal protective equipment. Employees should receive mandatory IPC training and know how to use personal protective equipment.

Examples of PPE use in healthcare are:


Disposable Gloves
• Aprons
• Long-sleeved gowns
Goggles
• Fluid-repellent surgical masks
Face visors
Respirator masks

The level of risk of transmission to and from the patient is used to determine whether or not personal protective equipment (PPE) is required. All healthcare professionals are obligated to follow standard IPC precautions when caring for patients and their surroundings. Additional transmission-based precautions suited to the mode of spread are recommended if these measures alone are insufficient to prevent transmission.

Gloves

When handling contaminated equipment or handling blood, body fluids, secretions, or excretions, gloves should be used.
When patients require transmission-based measures, gloves should also be used. A rising use of gloves in health care has resulted from increased knowledge among healthcare professionals of the potential for gloves to give protection against certain harmful bacteria.


Gloves, on the other hand, can be misused, and failure to remove them at the proper time and perform effective hand washing might raise the risk of infection transmission to susceptible patients. Each healthcare worker should be aware of the justification for wearing gloves and analyse the risk associated with each task.

However:
o Gloves do not replace the requirement for good hand hygiene
o Gloves should be changed when they have become contaminated, ie: between patients and different procedures on the same patient.
o Hands should always be decontaminate following the removal of gloves
o Gloves are single-use items and should not be washed or reused.

How do sterile gloves and non-sterile gloves differ?

STERILE GLOVES


When a gloved hand must touch a vulnerable site/sterile field, sterile gloves are used.
NON-STERILE GLOVES

Wearing non-sterile gloves protects the wearer's hands from becoming infected with microorganisms. When there is a risk of contact with blood/body fluids, secretions, or excretions, or when handling contaminated equipment, non-sterile gloves should be worn. Gloves may not provide total protection against microbiological contamination, so non-intact skin should be protected with a waterproof dressing.

Gloves of Various Types

Polythene is thin and prone to tearing. They are not suitable for use in healthcare settings.
Vinyl gloves have been showed to be less successful at providing an impermeable barrier against microorganisms than latex gloves. They're also ill-fitting, making them unsuitable for tasks that demand manual dexterity. Vinyl gloves have a limited application in healthcare.

• Latex, particularly DPNRL (De Proteinase Natural Rubber Latex): Supplies a more effective barrier against bacteria than vinyl. They should be non-powdered and have the smallest amount of extractable protein. Latex gloves should not be worn by healthcare workers who have a latex allergy. A latex-free alternative should also be accessible when caring for a patient who is known to be sensitive to latex. Because of the allergic risk to patients and workers, most healthcare environments are now latex-free.

• Nitrile (acrylonitrile): Provides a biological barrier similar to natural rubber latex, but with less flexibility. When a latex-free workplace is necessary, nitrile gloves are the most typical choice. However, there have been cases of nitrile-induced allergic responses in healthcare personnel.


• Neoprene: Has qualities similar to natural rubber latex and is a common substitute in instances where a latex-free glove is required and manual dexterity is required, such as surgery. Natural rubber latex gloves are more expensive than these gloves.

• Gloves should be stored in their original package on a clean, dry surface or in a wall-mounted container, and healthcare personnel should avoid carrying gloves in their pockets.

• Gloves should be worn as soon as a task begins and removed as soon as it is finished.
• Before putting on gloves, make sure your hands are clean and dry, and cover any cuts or broken skin with a waterproof dressing.

• Gloves should never be reused after being decontaminated. They are one-time-use items that should only be worn once before being thrown.

• Hands should be cleansed and dried after removing gloves or decontaminated with alcohol hand rub.
• Immediately after usage, gloves should be disposed of in the designated waste receptacle.
• If gloves irritate your skin, get medical attention.
• Limit the risk of "touch contamination" by avoiding unnecessary contact with your face/environmental surfaces while wearing infected gloves.

Aprons/Gowns

Disposable Plastic aprons and gowns are used to keep uniforms and apparel dry and clean while supplying direct patient care.

Plastic aprons will suffice in most circumstances for conventional precautions. Long sleeved fluid repellent gowns may be more proper in some situations where extensive contamination of blood / body fluids is expected, such as maternity units, ED units, or when the patient needs a significant amount of direct care with close skin-to-skin contact, such as maternity units, ED units, or when the patient requires a significant amount of direct care with close skin-to-skin contact.
Unless used for an aseptic procedure such as central line insertion or in an operating room, gowns do not need to be sterile.

• Store aprons and gowns in a clean area. Storage that is installed on the wall
• Store aprons and gowns in a clean area. PPE can be stored in wall-mounted storage units, which should be cleaned on a regular basis.
• Aprons/gowns must be changed between patients and should not be worn on a regular basis during shifts. It's also possible that they'll need to be swapped out between surgeries on the same patient.
• Aprons and gowns should be removed with care, using ties and being cautious not to contact the outer surface
• Used aprons / gowns should be discarded at once after usage and folded / rolled into a ball before disposal into a waste receptacle.
• After removing the apron/gown and gloves, properly sanitise your hands.
• When wearing colour-coded aprons, the colour must be appropriate for the task at hand, such as green aprons for serving meals.

Eye protection, visors, and full-face protection are all options.

When there is a possibility of splashing body fluids onto mucous membranes, such as the eyes or nose, eye and face protection must be used. Goggles or a visor can be worn to protect the eyes. Personal glasses will not suffice as a substitute. If you're using reusable eye/face protection, make sure to clean it according to the manufacturer's instructions. After removing the apparatus, thoroughly disinfect your hands.

Suitable protective eye/face equipment should:

• cover the entire face area (e.g., face shield) if protection of the mouth and nose area is also needed
• be changed if visibly soiled
• be removed using the earpieces / headband to avoid touching potentially contaminated surfaces
• be disposed of after use if single-use or placed into a receptacle for reprocessing
• fit over personal glasses and anti-fog properties should be considered

Masks

Surgical masks (Fluid Repellent)

o Provide a barrier between the wearer's nose, mouth, and respiratory tract and splashes and droplets. They are not categorised as Respiratory Protective Equipment since they do not provide protection against aerosolized particles.
o All members of the theatre surgical team should wear it properly (covering their nose and mouth). If splashes of blood or body fluids are expected, a full-face visor can be used instead.

o Should be worn when performing procedures such as lumbar puncture / spinal anaesthesia.
o Must be compliant with the Medical Devices Directive (MDD 93/42/EEC) and be “CE” marked.
o Single-use items should be discarded as soon as they become soiled or after usage. They should not be reused if they are left fastened around the wearer's neck after use.
o Prior to usage, they should be stored in their original packing with caution to avoid contamination.
o Using the ties/strings, remove the item and dispose of it in the appropriate waste stream (e.g., clinical waste).
o Fluid-repellent masks with eye visors attached are also available for use.

FFP3 respirator masks

Respiratory protection is used to protect people from viruses transferred by the air, such as measles, chickenpox, and tuberculosis, as well as when performing aerosol-generating operations on patients with suspected or confirmed influenza or other respiratory tract infections. The IPC Team can provide guidance on how to use them, and healthcare personnel and visitors may be obliged to use them in specific situations.

All healthcare personnel who may need to use an FFP3 respirator mask should be fit-tested before using it and given training on how to use it; the Occupational Health Department will assist with this.
Before each use, each person is responsible for inspecting the seal on their individual mask.
After each use or when noticeably soiled, FFP3 respirator masks should be replaced. If breathing becomes problematic, they should be replaced as well.

References
Coia, J.E. Ritchie, L. Adisesh, A. Makison-Booth, C.Bradley, C. Bunyan, D. Carson, G. Fry, C. Hoffman, P. Jenkins, D. Phin, N. Taylor, B. Nguyen-Van-Tam, Zuckerman, M. (2013) Guidance on the use of respiratory and facial protection equipment Journal of Hospital Infection 85: 170-182
FRAISE, A . and BRADLEY, C. (2009) Ayliffe’s Control of Healthcare-Associated Infection: A Practical Handbook Fifth Ed. CRC Press, Croydon
Guidance for the selection of PPE https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04...
Health Protection Scotland (2015) Standard Infection Control Precautions Literature Review available at
https://www.hps.scot.nhs.uk/

HSE (2005) Personal Protective Equipment at work 2nd ed. HSE Books, Norwich
HSENI: Health & Safety at Work (Amendment) (Northern Ireland) Regulations 2006.
NICE TB Guidelines https://www.nice.org.uk/guidance/cg117
RCN (2012) Essential practice for infection prevention and control: Guidance for nursing staff 2nd ed. RCN, London

Pressure Pump Solutions Ltd. of Penistone, Barnsley. South Yorkshire are Authorised Distributors of Portwest Workwear and Protective Safety Clothing & Accessorie


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