Personal Protective Equipment (PPE)
Personal Protective
Equipment (PPE)
Introduction
Personal protective equipment (PPE) involves use of protective barriers such as
gloves, gowns, aprons, masks, or protective eyewear, which can reduce the risk
of exposure of health care personnel (HCP) skin, mucous membranes, and
respiratory tract to potentially infective materials and certain airborne agents.
PPE also provides protection against other hazards in the health care facility
such as chemicals and physical injury. Employers and personnel share in the
responsibility for ensuring use of PPE. Employers need to provide PPE and
assure that it is accessible to all personnel. Personnel need to consistently use
PPE for their own protection. Some components of PPE, e.g. gloves and gowns,
are also used for protection of patients during invasive procedures such as
insertion of a central venous catheter or surgical operations where a sterile field
and aseptic technique are required. 46
The selection of PPE should be based on assessment of the risk of
contamination of HCP’s clothing and skin by blood, body fluids, secretions and
excretions and – if applicable- to minimize risk of exposure to splashes or sprays
of blood and body fluids or certain airborne microorganisms, e.g., Mycobacterium
tuberculosis. Use of PPE also should include assessment of the risk of
transmission of microorganisms from HCP or the environment to the patient.
Gloves
Types of Gloves
There are three main types of gloves used in the health care setting
1. Sterile gloves: Mostly used for surgery. They are
disposable, sterile, and individually wrapped items. They
are used whenever there will be a percutaneous or
permucosal contact with tissues (e.g. surgical procedures,
insertion of central venous catheter and urinary catheter). 46
Fig. 16: Sterile
Gloves
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Personal Protective Equipment (PPE)
2. Non-sterile gloves: Non-sterile disposable, single use
gloves (e.g. latex gloves) are usually not individually
wrapped. They are used to protect against direct skin
exposure to blood or other body fluids or for anticipated
contact with mucous membranes and prior to contact with
contaminated equipment or surfaces. Examples of
application include putting on gloves prior to insertion of a
Fig. 17: Nonperipheral IV catheter (except in high risk areas). These
sterile Gloves
types of gloves should be discarded after one use followed
by hand hygiene.
3. Utility or heavy-duty household gloves: Utility gloves
are used for handling contaminated items and waste and for
performing environmental cleaning activities. They can be
reused after decontamination, but they should be discarded
when punctured or torn.
General Indications for Gloves
Fig. 18: Utility
Gloves
Staff should wear gloves when they anticipate their hands will come into contact
with blood, body fluids, nonintact skin or tissue or equipment and surfaces that
are visibly contaminated with body fluids.
Indications for Sterile Gloves

Before surgery

Before any invasive procedure that require aseptic technique (e.g.
insertion of urinary catheter, insertion of central venous catheter, insertion
of canulas in immunocompromised patients and newborns).

Before wound dressing.

Mixing I.V. fluids and using multidose vials.
Indications for Disposable Non-sterile gloves

When starting intravenous (I.V.) lines or performing phlebotomy.

When changing dressings or handling soiled dressings.

When cleaning or handling soiled equipment, instruments, or other
items that may be contaminated with blood, urine, feces, or drainage.

When handling specimens and their containers.
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Personal Protective Equipment (PPE)

When suctioning the respiratory tract of a patient or performing oral
care in which fingers need to be placed inside the patient’s mouth.
Indications for Utility gloves:

When handling medical waste (red bag trash).

When cleaning up spills of blood or body fluids (As they are difficult to
be cleaned, it is preferable to use double non-sterile disposable
gloves).

When using chemicals such as cleaning products and disinfectants. 42
For most chemical disinfectants latex exam gloves that protect hands
and forearms are sufficient. Other glove materials such as nitrile offer
additional protection against certain chemicals if prolonged contact
with the chemical is anticipated.
Gloving tips
Washing utility gloves: Always wash utility gloves before you take the gloves
off your hands.
Washing hands: Hand hygiene is always recommended after removing gloves
because gloves may become perforated during use and bacteria can multiply
rapidly on gloved hands.
Reusing disposable gloves: Never reuse any type of disposable gloves (e.g.,
latex gloves, surgical gloves) as they are difficult to reprocess properly and the
protective integrity of the glove is usually compromised when attempting to
clean and reuse.
Latex allergy: If you or your patient has a latex allergy, wear nonlatex gloves,
e.g., vinyl or nitrile.
Changing gloves: Gloves must be changed:
 Between patients.
 Before each procedure if more than one procedure is done for the same
patient.
 If they become soiled, contaminated or perforated while caring for a single
patient.
Removing gloves: When removing gloves, you should not allow the outside
surface of the gloves to come into contact with your skin. Avoid letting the
gloves snap, as this may cause contaminates to splash into your eyes or mouth
or onto your skin or other people in the area. It is important to remove used
gloves before touching anything that can become contaminated through
contact, such as surfaces, faucets, or pens.
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Personal Protective Equipment (PPE)
Aprons and Gowns
Single use plastic aprons or gowns should be used during procedures that are
likely to generate splashes of blood or body fluids or during activities that may
contaminate clothing or uniforms with microorganisms or infectious material.
Most often, aprons can be used to minimize potential for contamination of HCP
uniforms or personal clothing. The neck strap and the waist tie should be torn
and the apron should be discarded into a clinical waste bag before it is carried
out of the room.11 More extensive coverage, such as a gown covering arms,
trunk, and upper thighs are only needed if the patient care might involve splashes
or sprays of blood or body fluids. Ideally gowns worn for such purposes should
be fluid resistant.
Note:
Cotton gowns are permeable to water and are no longer recommended.
Disinfection of heavy duty aprons
Heavier duty plastic aprons can be reused provided that they can be disinfected
by a wash with warm water and detergent and dried; followed by wiping the
apron with 70% isopropyl alcohol. Another option would be immersing the heavy
duty plastic aprons in water and chlorine. Cleaning and disinfection should be
done between each patient. 9
Headgear
Disposable caps, balaclavas, or scarves should be worn to confine and contain
hair during certain procedures such as surgical procedures performed in the
operating theater. They should be well-fitting and sealed.
Note:
Well fitting cotton caps and scarves may be recycled (by laundering at a high
temperature) if disposable ones are not available. Recycled caps must be
changed frequently (at least after every shift; in hot climates they should be
changed more frequently). 9
Face, Eye and Respiratory Protection
Face masks and eye protection should be worn when there is risk of splashes or
sprays of blood or body fluids into the face and eyes of HCP. Options for this
type of PPE include separate mask and eye protection or combination products
wherein an eye shield is bonded to a standard mask. Most masks are designed
to be used one time and then discarded. Another option however is a full-face
shield that protects the eyes and mouth. This can be disposable or reusable. If
reusable it should be cleaned and disinfected after contamination. Splashes of
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Personal Protective Equipment (PPE)
chemicals are additional examples of the need for face and eye protection of
HCP. 9
Respiratory Protection
Use a standard mask alone when there is risk of exposure to droplets that might
contain infectious agents. Examples of microorganisms that are transmitted by
exposure to droplets from patients with infection include Neisseria meningitidis,
Bordetella pertussis, and influenza virus. 9 Both disposable paper and cotton
masks offer less protection once they become moist; however, if resources are
limited these do provide some protection against large droplets. If available,
disposable paper masks with synthetic material for filtration are ideal for most
patient care needs. Most masks should be used once and then discarded;
reusable, cotton masks must be laundered. Cotton masks offer less protection
against airborne infectious agents such as M. tuberculosis but are better than no
respiratory protection if no alternative is available.
Airborne disease and respiratory protection
For airborne infectious agents such as M. tuberculosis a high filtration respiratory
protective device is ideal, and if available, should be used to care for patients
with suspected or proven active pulmonary tuberculosis. Such devices may be
labeled as high efficiency masks or respirators and are designed to capture high
percentages (>95%) of particles that are less than 1 micron in size. Instructions
for use of these devices are usually supplied by the manufacturer and are
designed to assure a good seal around the nose and mouth of the wearer. If
such devices are not available, a standard mask still offers some protection of
personnel and therefore should be worn. Other measures to prevent exposure to
airborne disease such as tuberculosis should be employed. These include asking
the patient to cough into a disposable tissue and, if tolerable, to have the patient
wear a mask when in corridors or in areas that do not have negative pressure
airflow and exhaust.
Overshoes and Footwear
Overshoes worn over the ordinary shoes are not
recommended, as it is an ideal way of transferring
microorganisms from floor and shoes to hands.
Closed footwears replacing the ordinary shoes are
not generally needed with the exception of some
special areas such as the Operating Theatre (OT).
The intent is to confine contaminants on footwear
prior to entering an OT. In addition, certain surgical
procedures, such as hip replacement, may result in
spills of blood around the patient table and onto the
floor. Fluid resistant shoe covers or boots are
recommended for this situation to protect operative
personnel from skin exposure to blood. 9
Fig. 19: Commonly used protective Barrier
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Personal Protective Equipment (PPE)
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