PPE is specialized clothing or equipment used to prevent contact with hazardous substances. Its use is an integral part of infection control and prevention measures that protect workers from exposure to blood, body fluids, and other potentially infectious materials. PPE such as gowns, gloves, masks, and goggles provide physical barriers that prevent the hands, skin, clothing, eyes, nose, and mouth from coming in contact with infectious agents. PPE is used to reduce transmission of communicable diseases when other measures such as engineering controls and work practices cannot completely eliminate exposure.

Employers are required to assess the workplace for hazards that necessitate the use of PPE and document that such an assessment has been done. They must also provide appropriate PPE in the workplace, store and maintain PPE in good working order, train employees on the proper use of PPE, and ensure that employees use PPE appropriately. The following PPE affords the protection of mucous membranes, skin, and clothing from infectious agents. Health facilities must have these items readily available at all times for use by employees with exposure to communicable diseases. Items such as uniforms, pants, blouses, and eyewear not intended to protect against communicable diseases are not considered PPE.

Gloves

Clean, disposable gloves are worn during direct contact with blood/body fluids, mucous membranes, non-intact skin, or any other potentially infectious material. They are also worn as a part of contact precautions (for persons infected with pathogens transmitted by the contact route, such as MRSA) while directly touching the patient or when in the immediate patient environment.

Disposable gloves are available in latex, vinyl, and nitrile materials. Since many individuals are allergic to latex, vinyl, or nitrile gloves are recommended alternatives. Vinyl gloves can be used for brief patient contact but nitrile gloves provide greater barrier protection for extended patient care activities or those requiring more manual dexterity. Local health agencies can select either vinyl or nitrile products for their clinical functions.

Discard gloves into covered waste bin with yellow liner at point of use and wash hands immediately after removing gloves.

Gowns

Isolation gowns are used as part of standard and contact precautions to protect the clothing and arms of health care workers. When used for standard precautions, gowns are worn only if contact with blood/body fluids is expected. Fluid resistant gowns should be used when splashes or sprays of blood/body fluids are expected. For contact precautions, gowns are worn during all patient contact and when in the patient’s environment. Gowns are always worn in combination with gloves, and with other PPE when indicated. Remove at point of use and discard disposable gowns or place cloth gowns in laundry containers. Wash hands immediately after removing all PPE.

Surgical masks

Surgical masks are used to protect the mouth and nose from splashes or sprays of blood/body fluids, or respiratory secretions, and to place on coughing patients to reduce the dissemination of respiratory secretions. They may have either ear loops or ties and can be either pleated or made of molded material.

Surgical masks are cleared by the FDA as having fluid-resistant properties.

Procedure masks

Procedure or isolation masks may also be used to protect the mouth and nose, but are not cleared by the FDA for fluid-resistant properties. There is no evidence to show that surgical masks are more protective than procedure masks, but there may be more variation in quality and performance among procedure masks. Many procedure masks have built-in eye protection and are available in pleated or molded styles.

Facility owners may select either surgical or procedure masks, depending on employees’ preference.

Eye protection

Goggles or face shields are used to protect eyes from splashes or sprays of blood/body fluids. Personal eyeglasses or contact lenses are not considered adequate eye protection. Goggles and face shields should wrap around the sides of the face to protect splashes from all angles.

Respiratory protection

PAPRs are battery-operated respirators that filter the air before it enters a hood worn over the head. Loose-fitting PAPRs do not require fit-testing but users must undergo a medical evaluation prior to wearing. Many users prefer PAPRs over an N-95 FFP as a more comfortable option for respiratory protection. Unlike N-95 FFPs, PAPRs require battery maintenance and cleaning procedures between uses.

Filtering facepieces (FFP) and respirators such as powered air-purifying respirators (PAPR) are used to filter the air of small infectious particles such as TB bacteria or the SARS virus before entering the respiratory tract. The type of FFP used to protect against infectious diseases is a NIOSH approved N-95 filtering facepiece, which is available in many styles, including pleated, molded, and duck-billed. Wearers must be fit-tested and receive a medical evaluation before they can use a FFP or a respirator.

Employees who share the same air space with suspect or known TB patient, patients infected with air-borne diseases such as COVID-19 or who will be in direct contact with pandemic influenza patients need to wear a fit-tested N-95 FFP or a PAPR until they are no longer in the air space shared by the infectious person.

Training

• Make sure anyone using PPE is aware of why it is needed when to use, repair or replace it, how to report it if there is a fault and its limitations.
• Train and instruct people on how to use PPE properly and make sure they are doing this. Include managers and supervisors in the training, they may not need to use the equipment personally, but they do need to ensure their staff is using it correctly.
• It is important that users wear PPE all the time they are exposed to the risk. Never allow exemptions for those jobs which take ‘just a few minutes’.
• Check regularly that PPE is being used and investigate incidents where it is not. Safety signs can be useful reminders to wear PPE, make sure that staff understand these signs, what they mean and where they can get equipment, eg for visitors.

Maintenance

Make sure:

• equipment is well looked after and properly stored when it is not being used, eg in a dry, clean cupboard, or for smaller items in a box or case;
• equipment is kept clean and in good repair – follow the manufacturer’s maintenance schedule (including recommended replacement periods and shelf lives);
• simple maintenance can be carried out by the trained wearer, but more intricate repairs should only be done by specialists;
• replacement parts match the original, eg respirator filters;
• you identify who is responsible for maintenance and how to do it;
• employees make proper use of PPE and report its loss or destruction or any fault in it.

Make sure suitable replacement PPE is always readily available. It may be useful to have a supply of disposable PPE, eg for visitors who need protective clothing.