Personal Protective Equipment (PPE) : A Comprehensive Guide

 

Personal Protective Equipment, also known as PPE, is clothing and equipment designed to protect the wearer from infection and injuries. According to the Ocupational Safety and Health Administration  (OSHA), personal protective equipment is “equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.” Personal protective equipment includes safety goggles/glasses, gloves, hard hats, respirators, body suits, coveralls, safety footwear, earplugs and muffs, high-visibility clothing, and vests designed to reduce injuries and illnesses that may result from exposure to chemical, electrical, mechanical, radiological, physical, and other workplace hazards.

In healthcare, PPE is used daily by healthcare workers to not only protect themselves but also protect patients and their caregivers when providing medical care. PPE must fit properly to ensure adequate protection and comfort for the wearer.

 

How to decide what PPE you need

According to the Advancement of Medical Instrumentation (AAMI) and the Center for Disease Control and Prevention (CDC), the first step to determining the appropriate PPE is to assess the risk of exposure, understand the hazard, and assess the source of transmission. The duration and type of task being completed by the wearer also determines the best PPE needed. In healthcare  settings  where PPE is primarily worn to reduce the risk of infections from pathogens, understanding the method of transmission for most microorganisms can help determine what PPE is needed within an organization. Typically, infections occur from:

  1. Direct or indirect contact – infectious pathogens can be directly transferred from person-to-person, through blood, body fluids like saliva, urine, and sweat, and via the eyes, nose, mouth, and skin.

 

  1. Airborne droplets – small infectious particles can linger in the air for some time, infecting people exposed to it.

 

  1. Respiratory droplets – infected droplets released by sneezing, coughing, breathing, talking, and singing can land on the mouth, nose, or eyes of someone nearby, thereby infecting them.

 

Understanding how infections and injuries occur within a specific workplace, evaluating possible hazards, determining the level of possible exposure to these hazards, and assessing the worst possible outcomes, is beneficial while making a decision on the best PPE to use.

 

 

Types of PPE

Gowns – also known as surgical gowns, procedural gowns, isolation gowns, surgical isolation gowns, nonsurgical gowns, and operating room gowns, gowns used in a medical setting are a critical part of personal protective equipment as they protect a wearer from spreading infections if they encounter potentially hazardous material, or infectious microorganisms. The FDA classifies medical gowns in 4 categories – level 1 (minimal risk), level 2 (low risk), level 3 (moderate risk), and level 4 (high risk) – based on their level of barrier protection. Examples of gowns include:

  • Surgical gowns – these are personal protective equipment intended to be worn during surgical procedures to protect healthcare personnel and patients from potentially infectious pathogens and bodily fluids.

 

  • Surgical isolation gowns – these are worn when there is a risk of contamination across a larger area. Surgical isolation  gowns like Airpro ISO gown PP-PE  and Airpro ISO gown PP provide full coverage, while being fluid-resistant, breathable, soft, durable, and lightweight. They are easy-to-wear and easy-to-take off, disposable, and one size fits all. Both of these types of gowns provide wrap-around protection and a comfortable fit.

 

  • Non-surgical gowns – these are used in minimal risk situations and protect the wearer from the transfer of bodily fluids and pathogens. Non-surgical gowns should not be worn for surgical procedures.

 

 

Regardless of which type of gown a wearer chooses, all gowns should cover as much of the body as possible for maximum protection.

 

 

Lab Coats – laboratory coats are critical for protecting workers against accidental spills in clinical settings, patient care areas, and the laboratory. They are designed to be easily removed in case of a spill or splash. When worn correctly, lab coats:

  • add another layer of protection for the skin
  • reduce the spread of contaminants outside the lab or work area
  • provide a removable barrier in case of a spill
  • protect the skin and personal clothing from contaminated surfaces
  • slow the penetration of contamination on the skin and clothing
  • protect parts of skin not covered by clothing

Lab Coats  can be worn in addition to other appropriate PPE like safety goggles, masks, and gloves when handling biological, radiological/radioactive, and chemical waste; working directly with patients; handling human blood and other infectious materials; handling clinical specimens; and, other medical situations. Laboratory Coats are made in different styles and fabrics including traditional white lab coats for everyday use, flame-resistant lab coats for protection against fire hazards, and fluid-resistance lab coats for protection against blood, bodily fluids, and infectious materials. Lab coats can also be washable or disposable like the Airpro white lab coat  which is durable, latex-free, soft, breathable, and comfortable.

 

Coveralls – also known as a PPE suit or protective suit, coveralls are essential personal protective equipment worn over other clothing to protect the body from potential injuries that can result from exposure to biological, chemical, airborne particles, electrical, electromagnetic, thermal/fire, and mechanical hazards. They are typically one-piece garments, disposable or useable, that cover most of the body including the torso, arms, legs, and chest area. Some coveralls are made with storm flaps, boots, hoods, elastic cuffs/wrists, and elastic ankles. Coversalls, especially those used in dark or busy areas, tend to be brightly colored to improve visibility and safety. These protective suits are also made from different fabrics, including lightweight, heavyweight, microporous, fire-resistant, and abrasion-resistant fabrics, so picking the appropriate material for the job is important to ensure comfortable and adequate protection for the wearer. Healthcare coveralls, known as medical coveralls, medical protective clothing, or medical protective suits, are worn by medical personnel to protect the wearer against biohazards, microbes, and pathogens that can cause injury or spread illness and infections.

 

 

Safety Goggles and Glasses – these are used for eye protection to reduce exposure to chemicals, heat, environmental, mechanical, and radiological hazards. Eye injury  accounts for a significant amount of workplace injuries and thousands of people are blinded each year from preventable eye injuries from various irritants including chemical splashes, laser radiation, and flyer debris. According to OSHA, one of the ten most cited workplace violations involves eye and face personal protection safety and health regulation. Eye injuries cost more than $300 millon per year  in workers’ compensation, medical expenses, and lost productivity. Safety goggles and glasses are the main PPE for the the eye. Selecting the right PPE significantly reduces exposure to potentially hazardous material.

  • Safety glasses – safety glasses, including general and laser safety glasses, are typically designed to allow air to circulate around the eye area. General safety glasses are the minimum personal protective equipment acceptable in a work situation that requires eye protection. Laser safety glasses offer some protection against lasers. Safety glasses can be worn over prescription glasses.

 

  • Safety goggles, such as chemical splash goggles and impact goggles, are made to fit more tightly around the face compared to safety glasses. Chemical splash goggles protect the eye against chemical splashes, infectious contaminants, and flying debris; impact goggles offer protection from flying debris. A well-designed safety goggle should be anti-fog and ergonomic since ergonomic safety googles are fully adjustable and can fit comfortably over most prescription glasses while still maintaining strength, durability, and flexibility.

 

 

  • Other eye protectants include face shields which can be worn with safety goggles as needed.

 

Disposable Protective Face Mask – a face mask covers the wearer’s mouth and nose in order to reduce the spread of pathogens. They are typically lightweight and designed to fit comfortably around the nose and under the chin. Most disposable face masks have a nose clip that can be adjusted to create a more comfortable seal, as well as elastic ear loops that stretch to fit the wearer. Disposable masks can be used at home or in clinical settings. The Airpro mask, a disposable mask for personal and medical use, combines three layers of non-woven fabric to keep more pathogens out. The CDC recommends that when selecting a mask to:

  • Wear a mask that completely covers the nose and mouth
  • Make sure the mask fits snuggly against your face without gaps
  • Verify that the mask has two or more layers of breathable fabric
  • Find the perfect comfortable fit

Where possible, wash or sanitize hands prior to putting on a mask to avoid cross-contamination. Avoid touching the mask while wearing it to reduce the spread of pathogens. And when taking off the mask, carefully remove by the ear loops, fold the outside corners together, avoid touching the eyes, nose, and mouth, discard, and wash hands immediately.

 

Disposable KN95 Protective Masks – KN95 masks are breathable masks that filter 95% or more of aerosol particulates, similar to the N95, hence the “95” in the name. Similar to N95, most KN95 masks have elastic loops for securing the mask, and a nose bridge clip for adjusting fit and comfort. These protective masks are typically ergonomic and widely accepted. Although both N95 and KN95 are regulated by different entities, they have a similar approval process, and to earn the designation of N95 or KN95, these masks must filter out at least 95% of particles that are 0.3 microns in size or larger. The National Institute of Occupational Safety and Health (NIOSH) regulates N95 masks in the United States while the Chinese government regulates KN95. Each of these masks undergoes a series of testing within their respective countries. Unfortunately, due to the existence of counterfeit masks, many protective masks in the market do not meet the NIOSH guidelines of a filter efficiency of at least 95%, thereby leaving wearers vulnerable to pathogens that should have otherwise been blocked. Wearing an authentic KN95 with multi-layers provides a powerful protective barrier and increases protection.

 

Gloves – these protect working hands from scrapes, cuts, scratches, cuts, chemicals and contaminants, and are considered one of the most important pieces of PPE in the workplace. It is important that the glove worn matches the project and work conditions of the wearer. There are different types of gloves including:

  • Surgical/exam gloves – disposable and protects against exposure to blood and bodily fluids in a medical setting
  • Light latex/vinyl or nitril gloves – disposable and protects the hands when working with biological and chemical hazards. Some surgical gloves are made of latex
  • Electrical insulation gloves – these are designed to protect users against energized conductors
  • Chemical-resistant gloves – these come in different lengths, thickness, and durability, and should be appropriate for the pH of the chemical involved.
  • Cut-resistant gloves – these include stainless steel mesh and other cut-resistant materials
  • Leather gloves – these are use for welding and other similar tasks
  • Cold-resistant gloves – many gloves can protect against the cold but extreme cold temperatures require cold-resistant gloves
  • Heat-resistant gloves – even though many gloves offer a degree of heat-protection, specialized gloves might be needed for work with hot materials or in extreme hot temperatures

 

 

Hard Hats – these are required in a work environment where employees are exposed to possible head injuries from impact, flying objects, falling objects, trips, slips, falls, electrical shocks, and burns. Even though hard hats have become symbolic for the construction industry, other work environments, including the health industry, have associated workplace risks that can potentially cause injuries to the head. For instance, objects stored on shelves and platforms might fall and cause a head injury within a hospital system. Or, a worker in any healthcare environment can slip, fall, and sustain a head injury. According to OSHA, the leading cause of fatality in the workplace is falls and the most common head injuries sustained from falls are:

  • skull fractures
  • heat contusions
  • brain hemorrhages
  • hematoma
  • concussions

Hard hats are made of polyethylene and can include accessories like shields, visors, lights, and hearing protection. Hard hats are categorized into different types and classes including type 1 and 2, and classes C, E, and F.

 

Respirators – sometimes workers are exposed to a work environment where they are at risk of inhaling substances that can lead to lung impairment, cancer, other serious respiratory-induced medical conditions and death. OSHA  requires that employers provide respirators to workers who are exposed to these harmful substances such smokes, gases, vapors, sprays, fogs, harmful inhalants, dust, and insufficient oxygen. There are different types of respirators:

  • Respirators that remove contaminants from the air like particulate respirators for filtering out airborne particles, as well as air-purifying respirators for filtering out gases and chemicals.

 

  • Respirators that supply clean respirable air to the wearer like airline respirators which supply compressed air from a remote location, as well as self-contained breathing apparatus (SCBA) with air supply.

 

  • Controlled air purifying respirator (CAPR) helmet – a battery-operated air handling system that draws in air through a HEPA filter and blows it out into a breathing chamber creating a flow of positive air pressure. Since a CAPR helmet constantly blows air away from the wearer’s face, exposure to contaminants and other biohazards is reduced within the breathing space of the respirator, thereby providing more protection to the wearer.

 

Regardless of what sort of respirator a worker needs, OSHA recommends that every wearer follows these seven simple steps to correctly wear and dispose of a respirator at work: wash hands, inspect the respirator, put on the respirator, adjust the respirator, wear the respirator, remove the respirator, and dispose of the respirator (if disposable).

 

Safety footwear – these are also known as safety shoes and safety boots. This personal protective equipment provides critical foot protection in workplaces that have increased risk of serious foot injury including jobs where the feet might be exposed to electrical hazards, or where a worker can come in contact with sharp objects that might puncture the feet. Safety footwear  is also required in situations where workers may be exposed to rolling or falling objects. It is also crucial in jobs that require carrying heaving items up and down the stairs, heavy lifting above the knee level, and mechanical lifting of materials. Since footwear is a significant part of health and safety programs in most workplaces, several considerations are typically made while choosing the appropriate foot protection including:

  • Safety shoes and boots should provide both compression and impact protection
  • Some special safety shoes also protect against punctures
  • Some safety footwear provides electrical insulation from foot contacts
  • Most PPE footwear is slip-resistant as well as water-resistant
  • Safety shoes should fit properly and comfortably

 

Earplugs and muffs – Exposure to loud noise damages the nerve endings in our inner ear and can lead to irreversible and permanent hearing loss. Hearing protectors like ear plugs and earmuffs are PPE that reduce the risk of noise-induced hearing loss by reducing the energy of the noise transmitted to the inner ear. The Centers for Disease Control and Prevention (CDC) estimates that about 22 million workers are exposed each year to noise that can potentially lead to hearing loss. NIOSH recommends that “employers shall make hearing protectors available to all employees exposed to an 8-hour time-weighted average of 85 decibels or greater at no cost to the employees” and that these hearing protectors  should be replaced when needed. NIOSH also recommends that workers who may be exposed to any single impulse noise level of more than 140 dBA or those who are subject to over 100 dBA while working, wear double protection such as earplugs and earmuffs simultaneously. Some recommended types of noise and hearing loss prevention devices and accessories include:

  • Expandable ear plugs – these soft, malleable plugs expand to fit to the shape of the wearer’s ear canals and seal against the walls of the ear. To use this, the wearer rolls the plug into a thin cylinder with clean hands, and then inserts about half the length into the ear canal. The advantage of an expandable ear plug is that it can adjust to the shape and size of most ear canals. Ear plugs can be disposable or reusable.

 

  • Pre-molded reusable plug – these are made from more durable material like silicon, plastic, or rubber, and are available in different sizes including small, medium, and large. These are ready-to-use and might take some trial and error to find the right size for each ear canal, especially for new users. When worn correctly, the plugs will fit comfortably and seal the ear canal. To wear this, simply reach over the head, pull up on the ear, then gently insert the plug with the other hand until the ear canal is sealed. Pre-molded ear pulgs are easy to clean, washable, hygienic, and come in different sizes.

 

  • Earmuffs – these come in different styles, and they block out noise by fitting against the head and physically covering most of the outer ears. Some earmuffs are lined with acoustic foam that can reduce the noise level by up to 30 decibels. Some earmuffs include electrical components to reduce certain types of noise or help users communicate with others while wearing it. Some muffs have small ear cups while others are made with larger earmuffs equipped with other noise-control accessories. Earmuffs can be limiting for workers that wear glasses or those with heavy beards. Earmuffs can also feel heavy due to their design. In a situation where earmuffs are not appropriate, earplugs can be a good alternative depending on the noise level.

 

  • Canal caps – these look like earplugs with a flexible metal or plastic band. These are available either as pre-modeled canal caps or moldable caps. When the earplug is being used, the headband can be worn under the chin, behind the neck, and over the head, but when not in use, it can be left hanging around the neck for quick use in hazardous noise conditions. Some canal caps also have jointed bands to ensure a better seal and protection.

 

  • Other devices – since hearing protection is essential PPE, many hybrid designs that eliminate the disadvantages of existing designs are under development.

 

While PPE falls into many general categories, some of the most commonly used PPE within the health sector include face masks, isolation gowns, eye protections, gloves, and lab coats. With the COVID-19 pandemic, more emphasis has been put on PPE because well-fitted PPE can make a difference in the morbidity and mortality of patients, caregivers, and healthcare personnel.