PPEs are barriers that help prevent the spread of microorganisms from person-to-person (patients, clients or health care provider) and equipment, instruments and environmental surfaces to people.

PPEs include: caps, eyewear, masks, aprons, gowns, eye-protectors, gloves, respirators, scrub suits, drapes and boots or closed shoes.

Health care workers must wear PPEs whenever they are at risk of contact with contaminated materials or blood and body fluids.

Managers must ensure adequate PPEs are available for the staff.

Gloves

Gloves are the most important physical barriers for preventing the spread of infection. They:

are worn when there is a chance of contact with mucous membranes, blood, body fluids, secretions or excretions during patient/client contact.

are worn when handling contaminated wastes or cleaning or disinfecting instruments, equipment and surfaces.

protect hands from infectious materials.

protect patients from microorganisms on staff members’ hands.

There are three categories of gloves

Surgical (sterile, single use)

Examination (non-sterile)

Heavy duty/utility/household

When to Use Gloves and Types of Procedures

Gloves should be worn when contact with body and blood fluids is anticipated.

Gloves should be worn as an additional measure, not as a substitute for hand washing.

Examination gloves shall be worn

For examination and non-surgical procedures

For contact with blood, bodily fluids, secretions and excretions, mucous membranes, draining wounds, or non-intact skin (open skin lesions or oxidative rash)

For handling items visibly soiled with blood, bodily fluids, secretions, or excretions

When the HCW has non-intact skin on his/her hands o When inserting an IV line

Surgical gloves shall be worn for surgical and invasive procedures.

Utility gloves are used for cleaning equipment, floors, walls, furniture (such as beds), handling waste, etc.

Gloves shall be changed between care activities and procedures for the same patient after contact with materials that may contain high concentrations of microorganisms.

Gloves shall be removed before moving to another patient or after completion of a specific task.

Hands shall be washed and dried immediately after removing gloves.

With the exception of utility gloves, other gloves shall not be washed, decontaminated, and reused.

Gloves shall not be worn while walking in corridors and traveling in elevators, unless in special circumstances, e.g., transporting laboratory specimens.

Gloves are not required for routine care activities in which contact is limited to a patient’s skin.

Double Gloving

Decreases the risk of blood-hand contact

When to double glove

If the procedure involves coming in contact with large amounts of blood or other body fluids (e.g., vaginal deliveries and caesarean sections).

For orthopaedic procedures in which sharp bone fragments, wire sutures, and other sharps are likely to be encountered

For short surgical procedures (30 minutes or less) that involve minimal exposure to blood or mucous secretions (e.g., laparoscopy or minilaparotomy), double gloving is not necessary.

Consider whether to double glove or not depending on the situation.

Use gauntlet gloves or modified surgical gloves if protection of forearms is needed.

Elbow-Length Gloves for Obstetrical Procedures

Blood contact with the skin and mucous membranes of providers occurs in 25% of vaginal deliveries and 35% of caesarean sections (Davis, 2001) hence the hand and forearm need to be inserted into the vagina (manual removal of a retained placenta) or deep into the uterus to deliver the infant’s head (caesarean section), elbow-length, so-called “gauntlet”/gynaecological gloves help protect the provider from significant blood and amniotic fluid contamination.

Orthopaedic Surgical Gloves

These are designed for tough

orthopaedic procedures and offer

increased thickness and hydrogel

coating.

Eyewear

Eyewear protect staff from splashes of blood and other body fluids by covering the eyes.

They include clear plastic goggles, safety glasses, face shields and visors.

Glasses with plain lenses are also acceptable if they have side shields attached.

Masks and eyewear should be worn whenever there is a risk of splashes into the face e.g., when performing caesarean section or vaginal delivery or when cleaning instruments) and when patients are on droplet precautions.

Masks

Are worn to protect others by containing moisture droplets expelled by health care providers through nose and mouth during procedures.

Protect health care workers by preventing splashes from entering their noses or mouths.

Qualities of masks

Should be large enough to cover the nose, lower face, jaw and all facial hair (to contain it).

The most effective masks are fluid-resistant

There are four types of masks

The tieback mask, which has four ties to fasten the mask around the mouth and nose. The side of the mask with the flexible metal tab is worn away from the face with the metal tab placed above the bridge of the nose to help secure the mask and minimize air escaping from the sides (venting).

The ear-loop mask is similar to the tieback mask except that it has two elastic bands used for fastening.

Surgical masks have attached faced shields to provide a protective barrier against splashes and spatters of blood or other infectious material. These masks are fluid resistant, lightweight, and adequate for most procedures and isolation precautions.

An N95 respirator is a protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. N95 means that the respirator blocks at least 95% of very small (0.3 microns) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.

Respirators

Particulate respirators are specialized types of masks, such as N-95, which are recommended for situations in which filtering inhaled air is considered important (e.g., for the care of a person on airborne precautions).

Scrub Suits

A scrub suit consists of drawstring pants and a shirt worn during procedures to protect health care workers from splashes.

They are worn over or instead of street clothes.

The V-neck shirt must fit well enough so that it doesn’t slide off the wearer’s shoulders or expose the chest.

The main use of cover gowns is to protect the health care providers clothing.

Surgical gowns

These are outer sterile garments worn during surgery by scrubbed staff. Sleeves should be long and cuffed; the gown should be tied in the back and should be long enough to reach boots.

Surgical gowns made of fluid-resistant materials help keep blood and other body fluids off the skin of personnel, particularly in operating, delivery and emergency rooms.

Cloth gowns should be heavy enough to provide an effective barrier.

Jeans material (denim) or canvas is too dense to autoclave, is difficult to wash and takes too long to dry.

The health care provider should wear a plastic or rubber apron underneath the gown to prevent contact of the skin with blood and body fluids.

If a large spill occurs, the best thing to do is shower or bathe as soon as possible after completing the procedure.

Aprons

Aprons are macintoshes or plastic coverings used to protect clothing or skin from contamination.

Aprons made of rubber or plastic provide a waterproof barrier along the front of the health care provider body, and

Should also be worn during procedures where the likelihood of splashes or spillage of blood, body fluids, secretions or excretions is likely (e.g., when conducting deliveries).

Footwear

Footwear is protective, rigid or semi-rigid coverings for the feet.

It is worn to protect feet from injury by sharp or heavy items or fluids that may accidentally fall or trip on them.

Rubber boots or closed shoes or leather shoes are acceptable and must be kept clean and free of contamination from blood or other body fluid spills.

Sandals, “thongs” or shoes made of soft materials (cloth) are not acceptable.

Drapes

Drapes are cloths placed around a prepared surgical incision and used to create a work area.

Although this area is often called the “sterile field,” it is NOT sterile because cloth drapes allow moisture to soak through and can help to spread infection from skin.

Neither sterile gloved hands nor sterile or high-level disinfected instruments and other items should touch drapes once they are in place because cloth drapes allow moisture to soak through and can help to spread organisms into the incision.

Caps

Caps are used to keep the hair and scalp covered so that flakes of skin and hair are not shed into the wound during surgery.

Caps should be large enough to cover all hair.

While caps provide some protection to the patient, their primary purpose is to protect the wearer from blood and bodily fluid splashes and sprays.

Hoods

A hood is a covering for

head and neck with an

opening for the face, typically

forming part of a coat or cloak.

The material should be plastic

or waterproof.

Protects healthcare workers from exposure to infectious agents

Prevents the transmission of infections from patient to patient, healthcare worker to patient, and patient to healthcare worker

Reduces the risk of healthcare-associated infections (HAls)

Essential for safe injection practices and proper handling of medical waste.

A key component of standard precautions and infection prevention and control strategies.

Roles of PPE

Control hazards at the source.

Eliminate hazards from work places.

Isolate hazards from workers.

Addition of safety feature to the existing equipment.

Facilitates redesigning of the work processes or purchasing new equipment.

The World Health Organization (WHO) recommends that PPE should be donned and removed in the following order to minimize environmental and self‐contamination.

Good practice guide: donning protective equipment

Perform hand hygiene

Plastic apron (or fluid‐repellent gown)

Surgical mask (or respirator mask)

Protective eyewear

Gloves

Good practice guide: removing protective equipment

Gloves

Plastic apron or gown

Protective eyewear

Mask or respirator mask

Perform hand hygiene

STEP 1: Grasp the outside edge near the wrist.

STEP 2: Peel the glove away from the hand, turning the glove inside out.

STEP 3: Hold it in the opposite gloved hand.

STEP 4: Slide an ungloved finger under the wrist of the remaining glove, then peel it off from the inside, creating a “bag” for both used gloves.

STEP 5: Discard in designated receptacle.