Personal Protective

Personal Protective
Equipment
Dr. Fatima Khurshid
Define Personal protective equipment.
Personal protective equipment (PPE) is defined as ‘all equipment that is
intended to be worn or held by a person at work and which protects
them against one or more risks to health or safety’.
What is the main purpose of wearing PPE?
With regard to infection prevention and control, the main purpose of
wearing PPE (gloves, aprons, masks and eye protection) is to protect
healthcare workers from blood-borne pathogens and prevent the
transmission of microorganisms to both patients and staff.
Personal protective equipment: Risk
assessment
The selection of personal protective equipment (PPE) must be based on
a risk assessment of the risk of transmission of microorganisms to the
patient or healthcare worker, and the risk of contamination with blood,
body fluids, secretions and excretions or exposure to chemicals.
Therefore, two simple questions need to be asked:
• What is the task that the healthcare worker is about to undertake?
• What is the risk of exposure to blood, body fluids, chemicals (e.g.
when making up solutions) and infection?
Gloves
The introduction of standard precautions in the 1980s led to a high
demand for latex examination gloves to protect against blood-borne
viruses. This increase in glove use led to more healthcare workers
developing latex allergies, with half of all cases now seen in healthcare
professionals.
• Disposable gloves are manufactured from both natural and synthetic
materials, such as NRL (natural rubber latex), vinyl (polyvinyl chloride)
and nitrile (acrylonite). While the protection offered by all gloves has
the potential to fail if they are damaged or torn during use, polythene
gloves can leak, and for this reason they are no longer used in
healthcare.
• Latex gloves are popular because they are strong, stretchy, and
protect against viruses in blood. However, using them too much can
lead to skin problems. Powdered latex gloves are not used anymore
because the powder can carry proteins that cause allergies when
inhaled. Now, latex gloves are used only when necessary and for tasks
where other gloves don’t work as well. This change helps to keep staff
and patients safe from latex exposure.
Indications for the use of sterile or
non-sterile gloves
Healthcare workers wear gloves to protect themselves and/or to
protect the patient. Gloves:
• Provide a physical, protective barrier, protecting the healthcare
worker’s hands (skin) from coming into direct contact with blood, body
fluids (e.g. urine, feces or vomit) and microorganisms.
• Provide protection for healthcare workers’ hands when they come
into contact with chemicals(e.g. when making up cleaning solutions,
decontaminating endoscopes, or preparing cytotoxic drugs).
• Prevent the transmission of microorganisms from healthcare workers
to patients during invasive procedures.
• Protect the healthcare worker from injury resulting from exposure to
chemicals as part of Control of Substances Hazardous to Health
(COSHH) measures.
Continued:
This means that they must be worn (either on their own or in conjunction
with other PPE):
• for invasive procedures
• for contact with sterile body sites
• for contact with non-intact skin
• for contact with mucous membranes
• where there is a risk of exposure to or contact with blood and/or body fluids
• where there is a risk of exposure to or contact with microorganisms
• when handling sharp or contaminated instruments
• when handling chemicals or drugs where the COSHH certificate states that
gloves must be worn.
When to wear sterile gloves?
• Any type of surgical procedure
• Taking biopsies
• Lumbar puncture
• Insertion of central lines
• Urinary catheterization
• Vaginal examination in obstetric patients and vaginal delivery
When to wear nonsterile gloves?
Contact with blood, body fluids, chemicals or infection: For example, with patients known
or suspected to be colonized or infected (e.g. in a cohort bay or isolation side room); for
• Cannulation
• Venipuncture
• Removal of vascular access devices,
• Vaginal examination in non-obstetric patients
• Rectal examinations,
• Urinary catheter removal
• Taking a catheter specimen of urine (CSU)
• Obtaining a clinical specimen or IV drug administration; as part of wound care
procedures or endotracheal suctioning
• During insertion, aspiration or removal of a nasogastric tube
• When administering suppositories and enemas
• When emptying urinals, bed pans and vomit bowls
• When changing incontinence pads and nappies, emptying or changing
stoma bags
• handling or cleaning instruments
• handling clinical waste bags, cleaning up blood or
• body fluid spills and handling soiled bed linen or clothing; and
• during eye care (if infection present)
Aprons and Gowns
Purpose of aprons and gowns?
Uniforms can get very dirty from direct contact, but there isn't much
proof that they lead to infections. Disposable plastic aprons shield the
parts of a healthcare worker's uniform that touch patients the most.
Full-length fluid-repellent gowns provide even more protection from
blood and body fluids
• Aprons must not be worn folded down at the waist.
• They must be worn as single-use items for one procedure or one
episode of care. Therefore, they may need to be changed in between
interventions on the same patient.
• They must be removed as soon as the patient care or intervention has
been completed and before leaving the side room or bay unless the
healthcare worker is taking a commode, a bedpan, a urinal or dirty
equipment to the sluice.
• They must be disposed of as clinical waste.
Indications for wearing aprons and gowns
Wear disposable plastic aprons when:
• Close contact with a patient, materials, or equipment is expected.
• There's a risk of clothing contamination from microorganisms, blood,
body fluids, secretions, or excretions (except sweat).
• They can be used alone or with other PPE.
 Wear full-body fluid-repellent gowns when:
• There's a risk of heavy splashing of blood, body fluids, secretions, or
excretions onto the skin or clothing of healthcare personnel.
When to wear disposable plastic aprons?
• Wear aprons in isolated areas.
• During procedures like venipuncture or cannulation.
• Assisting with washing or bathing patients.
• Changing dressings.
• Helping patients use commodes or bed pans.
• Cleaning commodes.
• Emptying catheter drainage bags.
• Cleaning or decontaminating equipment.
• Changing soiled or contaminated linen.
• Cleaning bathrooms, toilets, or general ward areas.
• Working in ward kitchens or serving patient food.
When to wear full-length fluid-repellent
gowns?
Any situation or intervention where there is a risk of extensive
contamination of the arms and uniform from blood and/or body fluids,
such as surgery or invasive procedures, and childbirth
Respiratory and
facial protection:
masks,
goggles and visors
(face shields)
While masks, goggles and visors are the less commonly used
components of PPE, they are just as important in certain situations as
aprons and gloves but they are not always worn appropriately.
The eyes, nose, and mouth can easily be entered by microorganisms,

and during some patient care activities, they might be exposed to
splashes of blood, body fluids, or secretions.
Respiratory and facial protection shields against airborne
microorganisms, which can be present in several forms:
• Aerosols: Tiny particles in the air that can travel different distances,
influenced by their size and the environment. Healthcare procedures
can create aerosols.
• Droplets: Larger than aerosols, these can stay in the air briefly before
settling down. Smaller droplets can evaporate into even tinier droplet
nuclei.
• Splash particles: These are larger than droplets and can become
airborne mists during surgical procedures or if a patient vomits blood
forcefully.
Masks
• Surgical face masks
Surgical face masks protect against blood and fluid splashes but aren't
for full respiratory protection. They are recommended for close contact
with patients with respiratory infections like seasonal flu and during
norovirus outbreaks to avoid splashes from spills. These masks are
single-use, should not be worn for extended periods, and must be
replaced if wet or damaged. They have a metal strip to adjust over the
nose but don't fit tightly and need to be securely fastened around the
head.
• Respiratory Protection:
Masks for respiratory protection must comply with the European
Standard EN149:2001. This standard applies to disposable respirators
covering the nose, mouth, and chin that filter out harmful particles
such as bacteria and viruses. Class 3 filtering face piece (FFP3) masks,
offering the highest level of protection, reduce exposure to infectious
particles significantly when properly fitted
• Fit testing:
Healthcare workers must undergo fit testing for FFP3 masks to
confirm that the mask fits closely to their face shape without gaps,
allowing unfiltered air to pass. This testing is conducted by trained
personnel, typically in the Occupational Health Department. Each
time an FFP3 mask is worn, it requires a fit check to make sure it seals
effectively and there are no leaks.
DO’s And DON’T’s of Masks and
Respirators
• Put on masks right before they are needed.
• Dispose of masks as clinical waste right in the room where they were
used. If the patient has a respiratory infection, remove the mask after
leaving the room and dispose of it in the nearest clinical waste bin.
• Secure surgical masks tightly using head straps and adjust the metal
strip to fit snugly over the nose.
• Check the fit of FFP3 respirators each time they're worn after the
initial fitting.
• Change masks as needed. Replace surgical masks if they get wet. FFP3
masks can be used for up to eight continuous hours.
• Masks must not be reused.
• Masks must not be worn outside of the side room, procedure room,
or bay. If the patient has a respiratory infection, remove the mask
after leaving the room.
• Masks must not be worn dangling around the neck.
Goggles and visors
• Wrap-around goggles and visors or face shields protect the eyes from
splashes of blood, body fluids, and chemicals.
• Wear them when there's a risk of splashing, such as during
hemodialysis or manual cleaning of endoscopes.
• Regular glasses, safety glasses, or contact lenses do not offer
adequate protection as substitutes.
The order of donning and removing PPE
Donning full PPE
• Apron
• Mask
• Eye protection
• Gloves
Removing full PPE
• Gloves
• Apron
• Eye protection
• Mask
MCQs
1.What standard must masks for respiratory protection comply with?
A) EN149:2001
B) EN135:1998
C) EN150:2003
D) EN148:2000
2.FFP3 masks should be used by healthcare workers when dealing with:
A) Routine check-ups
B) High-risk aerosol-generating procedures
C) Administrative work
D) Light cleaning
3. What is the primary reason for wearing gloves in a healthcare
setting?
A) Comfort
B) Protection from chemicals and infections
C) To keep hands clean
D) For handling food
4. Which one is NOT a suitable substitute for proper facial
protection?
A) Safety goggles
B) Contact lenses
C) Face shields
D) Wrap-around goggles
5. What does the fit testing for FFP3 masks ensure?
A) Comfort of the mask
B) Suitability and closeness of the fit
C) Color of the mask
D) Style of the mask
6. Surgical masks must be replaced if they become:
A) Famous
B) Dyed a different color
C) Wet or damaged
D) Too tight
7. What should healthcare workers do if a patient has a respiratory
infection?
A) Remove the mask before leaving the room
B) Keep the mask on always
C) Remove the mask after leaving the room
D) Never wear a mask
8. How often can FFP3 masks be worn?
A) Up to eight continuous hours
B) Indefinitely
C) Only for 30 minutes
D) Once a week
9. What is the main purpose of wearing PPE in healthcare?
A) To look professional
B) To protect against blood-borne pathogens and prevent transmission of
microorganisms
C) Because it is fashionable
D) None of the above
10. When should disposable plastic aprons be used?
A) When close contact with patients is expected
B) Every time a healthcare worker is at the hospital
C) Only during lunch breaks
D) Never
11. Which is NOT a true statement about the removal of PPE?
A) Masks should be the first item removed
B) Gloves should be the first item removed
C) PPE should be disposed of as clinical waste
D) Aprons should be folded and reused
12. What should NOT be done with masks?
A) Reuse them
B) Dispose of them properly
C) Wear them tightly
D) Check their fit
13. Which type of PPE is necessary when there is a risk of heavy
blood or fluid splashes?
A) Cotton gloves
B) Paper masks
C) Fluid-repellent gowns
D) Loose-fitting sweaters
14. When are goggles necessary in healthcare?
A) When reading patient files
B) During procedures likely to cause splashes
C) When walking in the hospital hallways
D) All the time
15. Why are powdered latex gloves no longer used?
A) They are too expensive
B) They can carry proteins that cause allergies
C) They come in limited sizes
D) They are less effective
KEY
1.A) 9.B)
2.B) 10.A)
3.B) 11.D)
4.B) 12.A)
5.B) 13.C)
6.C) 14.B)
7.C) 15.B)
8.A)

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