disease (EVD) epidemics, the use of gloves, gowns and masks
each help to reduce the infection rate in healthcare personnel.
As Verbeck, et al. (2020) note, “More consistent use of
gloves, gowns, masks and goggles was each related to fewer
infections among healthcare workers. Also, theoretically,
protecting the skin and the mucous membranes of the mouth
nose and eyes will prevent transmission. We have therefore
little doubt that in a technical sense PPE will help and that
the minimum amount of PPE needed is gloves, gown, and
mouth, nose and eye protection, as recommended by WHO
and CDC. The guidance does not, however, indicate which
type or quality‐level of PPE is most protective.”
In their review, the researchers sought to identify which
PPE protects best by only including studies that compared
one type of PPE against an alternative type of PPE, such as
gowns against coveralls or goggles against face shields only
when used as part of full PPE. They explain, “There is still
uncertainty about the optimal type, composition, amount
and ways of using full‐body PPE to prevent skin and mucous
membrane contamination of healthcare workers while
treating patients infected with highly infectious diseases.
Since full‐body protection has mainly evolved as a direct
result of experiences gained from the recent outbreaks of
deadly viruses, there are still many types of PPE available with
varying types of components. The comparative effectiveness
of one type against another is still unknown. Regarding
the equipment, there is uncertainty whether face shields
protect as well as goggles, especially when goggles are
combined with a hood. There is uncertainty whether and
when double or triple gloves would be more protective
than single gloves. Regarding suits, it is unclear if gowns
are as protective as coveralls, and how breathable and
impermeable for liquids or viruses they should be. Some
argue that using more breathable material would decrease
the risk of contamination.”
When it comes to donning and doffing procedures for
pathogens such as EVD, the authors say “there is uncertainty
about the effect of integrity checks of gloves and other
equipment, and whether gloves should be changed when
highly contaminated. With doffing especially, it is unclear if
this should be done in pairs with a helper buddy removing
part of the PPE, or if this can be done alone. Another element
of the doffing procedure that is uncertain is if spraying with a
disinfectant such as chlorine spray is more protective than not
using spray. It is not clear which disinfectant is the best antiviral:
chlorine solution or alcohol gel, and at which concentration.
Also, for COVID‐19, different procedures for donning and
doffing PPE are recommended. Giwa (2020) proposes a
specific procedure of doffing PPE, but the procedure is not
consistent with the procedures proposed by CDC in 2020.
Others, including the CDC, have proposed that gown and
gloves should be doffed in a one‐step procedure (Osei‐Bonsu
2019), to minimize self‐contamination. It is also unclear what
are the best ways to train healthcare workers and how to best
maintain the skills needed for proper use of PPE.”
The challenge is that despite using proper articles of PPE,
the likely biggest risk of infection is associated with self‐con-
tamination by healthcare personnel inappropriately removing
the PPE, studies have found. Verbeck, et al. (2020) outline
an intervention that could help boost proper compliance:
www.healthcarehygienemagazine.com • may 2020
Despite problematic PPE use, we know from
studies conducted during the SARS and Ebola
virus disease (EVD) epidemics, the use of gloves,
gowns and masks each help to reduce the
infection rate in healthcare personnel.
“First, healthcare workers, their supervisors, or occupational
health professionals should choose the proper type of PPE,
as indicated in the guidance described above. Then, the
healthcare worker needs to know how to don and doff PPE
according to the guidelines provided. Next, the healthcare
worker needs to comply with established procedures for
correctly using, donning and doffing PPE. Education and
training are used to increase compliance. The emphasis in
teaching the correct use of PPE is on doing everything slowly
and carefully to minimize the risk of making a mistake. Often
an assistant or buddy, sometimes coupled with a mirror, is
used while donning PPE, while a hygienist supervises doffing.
Compliance can be increased by personal supervision and
instruction, checklists, audits of performance, by providing
feedback, and by allowing sufficient time for donning and
doffing. Education and training on uptake and compliance
with PPE should have an effect in both the short term and
the long term… Compliance with PPE can also be improved
by providing sufficient, comfortable, well‐fitting, and more
user‐ and patient‐friendly PPE.”
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