Basics of PPE, Where & when & how to use it

1. RATIONAL USE OF PPE IN
COVID-19 ERA
Dr Sravan Kumar
D.MCardiology
SCTIMST

2. OUTLINE OF DISCUSSION
 Components of PPE
 Principles behind use of Face masks & Respirators
 Where to use what PPE
 Sequence of Donning & Doffing

3. MODE OFTRANSMISSION
 Respiratory droplets
 Cough, sneeze, or exhalation
 Touching
 Direct touch of patient/infectious materials
 Contaminated surfaces or objects
 and then touching their own mouth, nose, or possibly their eyes
 Airborne transmission
 aerosol-generating procedures and support treatments (e.g.
tracheal intubation, non-invasive ventilation, tracheotomy,
cardiopulmonary resuscitation, manual ventilation before
intubation, bronchoscopy)

5. MOST EFFECTIVE PREVENTIVE
MEASURES INCLUDE
 Maintaining physical distance (a minimum of 1 metre) from other
individuals;
 Performing hand hygiene frequently with an alcohol-based hand rub if
available and if your hands are not visibly dirty or with soap and water
if hands are dirty
 Avoiding touching your eyes, nose, and mouth;
 Practicing respiratory hygiene by coughing or sneezing into a bent
elbow or tissue and then immediately disposing of the tissue;
 Wearing a medical mask if you have respiratory symptoms and
performing hand hygiene after disposing of the mask;
 Routine cleaning and disinfection of environmental and other
frequently touched surfaces

7. VIRUSCAN REMAINVIABLE UPTO
72 hours on plastic and stainless
steel
24 hours on cardboard
4 hours on copper
In Aerosol Form upto 3 hours
during study period after
nebulisation

8. N van Doremalen et al. N Engl J Med 2020;382:1564-1567.
Viability of SARS-CoV-1 and SARS-CoV-2 in Aerosols and on
Various Surfaces.

9. COMPONENTS OF PPE
 Goggles
 Face-shield
 Mask
 Gloves
 Coverall/gowns
 Head cover
 Shoe cover

10. FACE SHIELD AND GOGGLES
 Contamination of mucous membranes of the eyes, nose and
mouth
 droplets generated by cough, sneeze of an infected person or during
aerosol generating procedures
 Inadvertently touching the eyes/nose/mouth with a contaminated
hand
 Protection of the mucous membranes of the eyes/nose/mouth
by using face shields/ goggles is an integral part of standard and
contact precautions.

11. GOOGLES
 Specifications:
 Transparent glasses, zero power, well fitting, covered from all sides
with elastic band/or adjustable holder.
 Good seal with the skin of the face
 Flexible frame to easily fit all face contours without too much
pressure
 Covers the eyes and the surrounding areas and accommodates for
prescription glasses
 Fog and scratch resistant
 Adjustable band to secure firmly so as not to become loose during
clinical activity
 Indirect venting to reduce fogging
 May be re-usable (provided appropriate arrangements for
decontamination are in place) or disposable

12. FACE SHIELD
 Specifications
 Made of clear plastic and provides good visibility to both the wearer
and the patient
 Adjustable band to attach firmly around the head and fits snuggly
against the forehead
 Fog resistant (preferable)
 Completely covers the sides and length of the face
 May be re-usable (made of material which can be cleaned and
disinfected) or disposable

13. (0.1 – 0.8 µm)
0.1 µm

14. MASKS
1.Triple layer medical mask
 Disposable mask, fluid-resistant, provide protection to the wearer
from droplets of infectious material emitted during
coughing/sneezing/talking.
2. N-95 Respirator mask
 Respiratory protective device with high filtration efficiency to
airborne particles.
 High fluid resistance, good breathability, clearly identifiable internal
and external faces, duckbill/cup-shaped structured design that does
not collapse against the mouth.
 Protect the wearer from inhaling airborne particles

16. 3-PLYVS 2-PLY FACE MASK
3-ply Mask 2-ply mask
Surgical mask or medical mask Hygienic face mask
Outer layer: Non-woven fabric
Fluid repellent- hydrophobic layer
that can repel water, blood and body
fluids
Two layers (outer and inner)-
Same material fabric, polypropylene
or another non-woven kind of
material
No middle layer
Middle layer- melt-blown material
Filter bacteria/viruses and also filters
out the water droplets
Use
Sanitary and hygienic purposes
• Restaurant (for food handlers,
catering staff, food processing
workers)
• Spa setting
• Factory workers,,
• Pharmaceuticals employees
Inner layer: Non-woven fabric
hydrophilic layer- For Moisture
absorption- which can absorb water,
sweat and spit.
filter efficiency of 99% for 3
micron particle size.

17. FFP:Filtering face piece score
P1,p2,p3-European standards
N 95, 99, 100 – NIOSH, US

18. N95 MASKS- FILTER OUT AT LEAST
95% OFVERY SMALL (0.3 MICRON)
PARTICLES
 Specifications
 Shape that will not collapse easily
 High filtration efficiency
 Good breathability
 Quality compliant with standards for medical N95respirator: a.
NIOSH N95, EN 149FFP2, or equivalent
 Fluid resistance: minimum 80 mmHg pressure based on ASTM
F1862, ISO 22609, or equivalent
 Quality compliant with standards for particulate respirator that can
be worn with full- face shield

19. • Performance of a respirator or medical mask depends on
1) efficiency of the filter (how well it is able to collect airborne particles)
2) fit (how well it prevents leakage around the facepiece).
• Material
nonwoven fibrous material – polypropylene
• Mechanism
1) Inertial impaction – aerosols 1 µm or larger, Instead of flowing through
the filter material, the large particles deviate from the air streamlines and
collide with the fibers and may stick to or be caught in them.
2) Diffusion – 1 µm or smaller, Brownian motion—the process by which
the constant motion of oxygen/nitrogen molecules causes collisions
between particles—results in a “wandering” pathway.The complex path
that is followed by the small particles increases the chance that they will
collide with the filter fiber and remain there.
3) Electrostatic attraction : resins added to polypropylene attract opposite
charge particles

21.  Over time mask gets loaded with particles and makes it difficult
to breath, & loaded particles may get dislodged
 Negative pressure during half the time mask is worn, sucks in
particles from sides if adequately not fit
 Clean shave
 Fit tested
 Most of the contaminants enter through faceseal leakage rather
than filter penetration
 Longer the respirator is worn, the more particulate loading and
moisture buildup from exhaled air occurs, with possible
obstruction of breathing

28. GLOVES
 Nitrile gloves are preferred over latex gloves because they resist
chemicals, including certain disinfectants such as chlorine
 Nonpowdered gloves are preferred to powdered gloves.
 Specifications:
 Nitrile
 Non-sterile
 Powder free
 Outer gloves preferably reach mid-forearm (minimum 280 mm total
length)

29. COVERALLS
 Coveralls typically provide 360-degree protection because they
are designed to cover the whole body, including back and lower
legs and sometimes head and feet as well
 Medical/isolation gowns do not provide continuous whole-body
protection (e.g., possible openings in the back, coverage to the
mid-calf only).
 Specifications:
 Impermeable to blood and body fluids
 Single use
 Light colors are preferable to better detect possible contamination
 Thumb/finger loops to anchor sleeves in place

30.  Shoe covers
 Shoe covers should be made up of impermeable fabric to be used
over shoes to facilitate personal protection and decontamination
 Made up of the same fabric as of coverall
 Should cover the entire shoe and reach above ankles
 Head covers
 Coveralls usually cover the head.Those using gowns, should use a
head cover that covers the head and neck while providing clinical
care for patients. Hair and hair extensions should fit inside the head
cover

31. 24/03/2020

41. DONNING

48. DOFFING

54. EXTENDED USE AND LIMITED REUSE

55.  Extended use refers to the practice of wearing the same N95 respirator for repeated
close contact encounters with several patients, without removing the respirator
between patient encounters
 8 -12 hours of continuous or intermittent use
 Discard N95 mask when contaminated with blood, respiratory or nasal secretions etc
 Reuse refers to the practice of using the same N95 respirator for multiple encounters
with patients but removing it (‘doffing’) after each encounter.
 5 reuses for device
 Virus survives 72 hours on plastic
 Issue 5 N95 masks , Mark 1, 2, 3, 4, 5 start reusing the masks in same sequence as 1, 2,
3, 4, 5
 discarded if:
 Following use during aerosol generating procedures.
 If N95 respirators contaminated with blood, respiratory or nasal secretions
 If patient requires contact precautions in addition to droplet/airborne precaution.
Perform HH before and after touching or adjusting the N95 mask
CDC

56. FOR COVID 19 COHORTS
Medical
masks
N 95 Gowns Goggles Face
shields
Gloves
Extended
use
Use without
removing
for 6 hours
Use without
removing
for 6 hours
Can be used
till shit
If MDR-
change
between pt
Till shift Till shift No
Reprocessin
g
Not advised •vapor of
hydrogen
peroxide
• ethylene
oxide
• UV
radiation
lamp
Cotton
gowns
Yes Yes
The reuse of masks, gowns, or eye protection without appropriate decontamination
/sterilization is strongly discouraged.The removal, storage, re-donning, and reuse of the same,
potentially contaminated PPE items without adequate reprocessing is one of the principal
sources of risk to health care workers.

57. SANITIZE YOUR PHONE
 Use antibacterial wipes or alcohol swabs (typically 70 % alcohol)
to clean phone and other items

58. CONCLUSION
 Always make all patients entering hospital wearTriple layer
facemask
 Doctors, Nurses, Staff in triage area, Emergency, OPD wear N 95
masks
 Full PPE if handling suspected COVID 19 or SARI patients in
Triage area, OPD, Emergency or in ICU
 When reusing N 95, be careful in not transmitting the virus
yourself by haphazardly handling the mask