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

Effective PPE Management in Hospital Settings

PPE management in hospital settings requires a comprehensive system including proper selection, training, and implementation of protocols to minimize infection risk and protect healthcare workers.

Core Components of PPE Management

• PPE forms 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, 2
• PPE selection should be based on risk assessment of the specific clinical scenario, considering the type of pathogen and transmission route 1

PPE Selection and Preparation

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

Training and Education

• All healthcare workers must be trained in proper donning and doffing procedures before patient management 1, 2
• Implement supervised donning/doffing procedures with a trained observer who reads the correct sequence to minimize contamination risk 1
• Use a "buddy system" with observers and checklists to ensure proper technique 1, 2
• Virtual simulation training can be effective for teaching proper PPE use when in-person training is not possible 3

Proper Donning and Doffing Procedures

• Donning/doffing procedures should be supervised by a trained observer who reads the correct sequence 1
• Before patient arrival, notify receiving area of necessary precautions and ensure appropriate space around patient to reduce cross-contamination risk 1
• Consider outer gloves as heavily contaminated and remove them first during doffing 1
• Remove protective equipment in the correct sequence to minimize self-contamination 1
• Following CDC doffing guidance may lead to less contamination compared to no guidance 4
• Double-gloving may reduce viral or bacterial contamination compared to single gloving 4

Environmental Controls and Zoning

• Establish clearly defined exposure zones with warning signs to minimize contamination risk 1, 2
• High-risk zones must be clearly demarcated with warning signs 2
• Ideally, patients should be managed in single, negative pressure rooms with good air exchange rates (>12 exchanges per hour) 2
• Maintain physical separation of at least 2 meters (6 feet) between workers whenever possible 2

Tiered Response Based on Outbreak Severity

• Use negative pressure rooms with anterooms when available 1
• Change PPE between patient contacts 1
• Minimize number of caregivers and restrict trainees from providing care 1
• Initiate staff exposure tracking 1
• Designate specific isolation areas with controlled access 1
• Establish temporary anteroom/changing areas for PPE donning/doffing 1

Waste Management

• Set up dedicated containers for hazardous medical waste immediately outside patient care areas 1
• Containers should be closed and sealed before transfer to collection points 1
• All contaminated disposable material and PPE should be immediately disposed of in appropriate containers 1

Staff Considerations

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

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, 2, 5
• Inadequate fit testing significantly reduces protection - perform proper fit testing initially and annually 1, 2
• Confusing surgical masks with respirators leads to inadequate protection - ensure proper selection based on risk 1, 2
• Studies show that without proper training, contamination rates can be as high as 100%, but can be significantly reduced with active training 5
• During high-risk procedures like CPR, healthcare workers should use appropriate PPE: gown + gloves + powered air-purifying respirator or N95 mask + goggles or a face shield 6