How do you manage Personal Protective Equipment (PPE) in a hospital setting?

Effective PPE Management in Hospital Settings

Proper PPE management in hospital settings requires a systematic approach with clear protocols for selection, donning, doffing, and disposal to minimize healthcare worker exposure to infectious agents and prevent cross-contamination.

Core Components of PPE Management

• PPE should be selected based on risk assessment of the specific clinical scenario, considering the type of pathogen and transmission route 1
• PPE forms only one part of a comprehensive infection prevention system that includes environmental controls, minimizing unnecessary patient contact, and waste management 1
• All components of PPE must work together as an integrated system to provide consistent protection 1

PPE Selection and Preparation

• Minimum respiratory protection for highly infectious airborne diseases should be NIOSH-certified N95 respirators or equivalent 1
• For suspected or confirmed COVID-19 cases, healthcare workers should use appropriate PPE including fitted respirator masks, eye protection, gowns, and gloves 2
• Identify one dedicated area (such as a catheterization lab) for treatment of suspected or confirmed infectious cases to minimize contamination risk 2
• Prepare a daily checklist to ensure adequate PPE is available in designated areas 2

Training and Education

• All healthcare workers must be trained in proper donning and doffing procedures before patient management 1
• Implement supervised donning/doffing procedures with a trained observer who reads the correct sequence to minimize contamination risk 2
• Use a "buddy system" with observers and checklists to ensure proper technique 1
• Face-to-face instruction is more effective in reducing noncompliance with doffing guidance compared to providing only written materials or videos 3

Tiered Response Based on Outbreak Severity

Conventional Care (Limited Cases)

• Use negative pressure rooms with anterooms when available 2
• Change PPE between patient contacts 2
• Minimize number of caregivers and restrict trainees from providing care 2
• Initiate staff exposure tracking 2

Contingency Care (Limited Outbreak)

• Designate specific isolation areas with controlled access 2
• Establish temporary anteroom/changing areas for PPE donning/doffing 2
• Use PPE continuously within infectious areas 2
• Modify ventilation systems to increase air exchange and exhaust 2

Crisis Care (Pandemic)

• Determine which patient care areas to use as infectious cohort care based on event scope 2
• Construct temporary anterooms for PPE changing adjacent to each cohort area 2
• Implement access control and staff screening/monitoring plans 2
• Use PPE continuously in infectious/cohort areas, potentially hospital-wide depending on scope 2

Proper Donning and Doffing Procedures

• Donning/doffing procedures should be supervised by a trained observer who reads the correct sequence 2
• Before patient arrival, notify receiving area of necessary precautions and ensure appropriate space around patient to reduce cross-contamination risk 2
• Consider outer gloves as heavily contaminated and remove them first during doffing 2
• Remove protective equipment in the correct sequence to minimize self-contamination 2
• Double-gloving may lead to less viral or bacterial contamination compared to single gloving 3

Environmental Controls and Waste Management

• Establish clearly defined exposure zones with warning signs to minimize contamination risk 1
• Set up dedicated containers for hazardous medical waste immediately outside patient care areas 2
• Containers should be closed and sealed before transfer to collection points 2
• All contaminated disposable material and PPE should be immediately disposed of in appropriate containers 2

Common Pitfalls and How to Avoid Them

• Improper doffing technique is a major source of self-contamination - ensure proper training and use the buddy system 1
• Inadequate fit testing significantly reduces protection - perform proper fit testing initially and annually 1
• Confusing surgical masks with respirators leads to inadequate protection - ensure proper selection based on risk 1
• Poor compliance with PPE use is linked to individual, environmental, and organizational factors - address these systematically 4

Linen and Equipment Management

• Disposable linen should be preferred when possible 2
• All linen should be handled wearing PPE during collection and placed directly inside dedicated containers 2
• Containers must be sealed and immediately sent for cleaning and sterilization 2
• Keep procedures as simple as possible while maintaining good clinical care to minimize hospital stay and readmission rates 2

Staff Considerations

• Separate healthcare workers into groups to reduce exposure and limit operators who may require quarantine simultaneously 2
• Limit work shift duration in full PPE to prevent physiological risks including dehydration and heat stress 1
• Implement proper decontamination procedures during breaks 1
• Provide counseling and wellness interventions to address mental health and burnout 2