Use of Personal Protective Equipment to Prevent Infectious Diseases in Medical Personnel in Facing the COVID-19 Pandemic
In this era of the COVID-19 pandemic, the use of personal protective equipment (PPE) is very important to reduce the risk of transmitting infectious diseases to medical personnel because it can avoid contact with pathogens. Things that medical personnel need to know regarding PPE are the types, how to remove them, and how to improve the compliance of medical personnel in using PPE.
There are various highly infectious diseases that can cause a pandemic, such as Ebola virus disease, severe acute respiratory syndrome (SARS), influenza, and Coronavirus Disease 2019 (COVID-19) due to the 2019-nCoV Coronavirus infection that is currently spreading. Contact with these highly infectious diseases with a high fatality rate has caused much medical personnel to die in pandemic areas. In Liberia, Sierra Leone, and Guinea, 869 medical personnel contracted Ebola, and more than half died.
These highly infectious diseases can be transmitted through contact with droplets from a patient’s cough or sneeze, contact with the patient’s blood and body fluids, needle stick injury, and even contact with objects that have been contaminated with pathogens. Doctors, nurses, and other medical personnel in health facilities have the opportunity to come into direct contact with these patients and are at high risk of contracting it. Diseases such as Ebola and SARS do not yet have effective vaccinations or treatments, therefore the use of PPE (personal protective equipment) plays an important role in protecting medical personnel.
Types of Personal Protective Equipment
Protective clothing, gloves, masks, hoodies, respirators, goggles, face shields, and boots are recommended personal protective equipment when handling patients suspected of cases of highly contagious infections. The selection of the type of personal protective equipment should be adjusted to the type of exposure (aerosol, splashes of blood or body fluids, contact with patients or body tissues), the type of procedure or activity carried out, and the size that is suitable for the user.
According to a Cochrane review published in July 2019, the use of a gown provides better protection against contamination than an apron. The study also found that more breathable protective clothing materials did not increase the risk of contamination compared to more water-resistant materials. This type of material can even increase user comfort. However, it should be noted that these conclusions were drawn from studies with low-quality evidence. Another principle of protective clothing is disposable, and the size is according to the user so that it does not hinder movement.
Personal protective equipment for the eyes can use goggles or a face shield. The attributes of the personal protective equipment are useful for protecting the eyes from contamination by pathogens in the form of droplets, splashes of blood, or patient body fluids. The face shield can be worn over the goggles to fully protect the face. Face shields and goggles are usually reusable but must be cleaned by immersing them in 1:49 diluted chlorine solution and then rinsing them with clean water.
In a study (low evidence) the use of masks with breathable materials got a better user satisfaction rate and did not cause significantly higher contamination. The use of a powered air-purify respirator (PAPR) provides better protection than the use of a respirator or other types of protective equipment (RR 0.27; 95% CI 0.17-0.43). PAPR is a type of respirator with an electric blower with a battery to filter the incoming air. PAPR is recommended to be used when the N95 mask does not fit the shape of the face or when performing procedures that produce aerosol gases.
Gloves and Boots
Gloves prevent hand skin contact with blood, body fluids, droplets, body tissues, and objects contaminated with pathogens. Gloves should be used once. The length of the glove should be past the wrist and the appropriate size so that the sleeve of the protective sleeve can be tucked into it. The results of the Cochrane review found that double gloving reduced contamination compared to single-use.
For the feet, the personal protective equipment used is in the form of boots made of rubber or other waterproof materials which can be added with the use of a boot cover on the outside.