What are the guidelines for personal protective equipment (PPE) management in a hospital setting?

Guidelines for PPE Management in Hospital Settings

Personal protective equipment (PPE) should be implemented as part of a comprehensive infection prevention system in hospital settings, with selection based on risk assessment of specific clinical scenarios and proper training for all healthcare workers. 1, 2

Core Components of PPE Management

• PPE forms only one part of a comprehensive system that includes environmental controls, decontamination of surfaces/equipment, minimizing unnecessary patient contact, and careful waste management 3, 2
• All components of PPE must work together as an integrated system to provide consistent protection 1, 2
• Strict safety measures should be implemented throughout the patient's healthcare pathway, including preoperative assessment, operating rooms, recovery rooms, and critical care units 3

PPE Selection Based on Risk Assessment

• Selection should be based on the type of pathogen and transmission route 1
• For confirmed or suspected COVID-19 patients, full precautions must be taken to cover all transmission types (contact, droplet, and airborne) 3
• Minimum respiratory protection for highly infectious airborne diseases should be N95/FFP2 respirators or equivalent 1, 2
• For high-risk procedures, healthcare workers should use gowns, gloves, fitted respirator masks, and eye protection or face shields 3

Training and Implementation

• All healthcare workers must be trained in proper donning and doffing procedures before patient management 3, 2
• Implement a "buddy system" with observers and checklists to ensure proper technique during donning and doffing 3, 1
• The most experienced staff should be responsible for procedures on infectious patients to reduce time and manage complications effectively 3
• Strict hand hygiene with alcohol-based hand rub is essential before and after patient contact 3

Environmental Controls and Zoning

• Implement specific circuits with color visual zone systems to distinguish contaminated (red), transition (yellow), and clean areas (green) 3
• Ideally, patients should be managed in single, negative pressure rooms with good air exchange rates (>12 exchanges per hour) 3, 2
• Allow enough time to ensure contaminated air is removed from the room before performing another procedure (at least 30 minutes) 3
• Establish clearly defined exposure zones with warning signs to minimize contamination risk 1

PPE Conservation Strategy

• Develop a strategy to conserve supplies of PPE in case of present or future shortages 3, 4
• Consider designating specific equipment for confirmed infectious patients (e.g., dedicated scanners) 3
• Reduce and prioritize allocation of human resources according to outbreak evolution and hospital needs 3

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
• Inadequate fit testing significantly reduces protection - perform proper fit testing initially and annually 2, 5
• Confusing surgical masks with respirators leads to inadequate protection - ensure proper selection based on risk 2
• Fogging of goggles/eyewear when using PPE is a practical problem - use anti-fog measures, iodophor, or liquid soap 3

Specimen and Equipment Management

• Samples from respiratory tract should be handled as Category 3 pathogens and double-bagged 3
• All specimens must be manually delivered with proper labeling 3
• Establish a pathway for contaminated equipment with adequate packaging to minimize exposure 3
• Proper cleaning and disinfection of equipment following manufacturer and CDC recommendations 3, 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
• Provide counseling and wellness interventions to address mental health and burnout 1
• Maintain physical distancing of at least 1-2 meters between staff members when not caring for patients 3

By implementing these comprehensive guidelines for PPE management, hospitals can significantly reduce the risk of infection transmission while ensuring the safety of both healthcare workers and patients.