What is effective Personal Protective Equipment (PPE) management?

Effective Personal Protective Equipment (PPE) Management

Effective PPE management requires implementing a comprehensive system that includes proper selection based on risk assessment, training in correct use procedures, establishing environmental controls, and maintaining an integrated approach where all components work together to provide consistent protection. 1, 2, 3

Core Components of PPE Management

• PPE forms only one part of a comprehensive infection prevention system that includes environmental controls, decontamination procedures, minimizing unnecessary exposure, and waste management 1, 2
• All components of PPE must work together as an integrated system to provide consistent protection across different scenarios 3
• PPE selection should be based on risk assessment of the specific clinical scenario, considering the type of pathogen and transmission route 2
• PPE serves as the last line of defense in the hierarchy of safety controls after engineering and administrative controls 4

Proper PPE Selection

• Minimum respiratory protection for highly infectious airborne diseases should be NIOSH-certified N95 respirators or equivalent that filter 95% of airborne particulates with a diameter of 0.3 microns 5
• For suspected or confirmed infectious cases, healthcare workers should use appropriate PPE including fitted respirator masks, eye protection, gowns, and gloves 5
• Many respirators claim to provide 95% or greater filtration, but when tested rigorously may be much less effective, highlighting the importance of certified equipment 5
• PPE selection should be tiered based on risk level, with different protection grades for different exposure scenarios 5

Risk-Based PPE Levels

• Primary protection: Surgical mask or N95 mask for those performing exams using a 'no physical touch' technique with non-suspect patients 5
• Secondary protection: Surgical mask or N95 mask + goggles + 1 layer of long-sleeved gown + 1 layer of gloves for those performing exams using 'physical touch' with non-suspect patients 5
• Tertiary protection: Head cover + N95 mask + goggles & face shield + 2 layers of protective gown + 2 layers of gloves + shoe covers for those performing exams of suspect/confirmed patients 5

Training and Implementation

• All workers must be trained in proper donning (applying) and doffing (removing) procedures before patient management 1, 3
• Implement a "buddy system" with observers and checklists to ensure proper technique during donning and doffing 2, 3
• All respirator use must be administered as part of a comprehensive Respiratory Protection Program (RPP) with provisions for training, selection, sizing, and maintenance 5
• Training should include practice sessions and regular refreshers to maintain competency 3

Environmental Controls and Zoning

• Establish clearly defined exposure zones with warning signs to minimize contamination risk 5
• High-risk zones must be clearly demarcated with appropriate signage 5
• In healthcare settings, zones at high risk of exposure must be carefully defined and identified 5
• Maintain physical separation of at least 2 meters (6 feet) between workers whenever possible 5, 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 2, 3
• Inadequate fit testing significantly reduces protection - perform proper fit testing initially and annually 5, 3
• Confusing surgical masks with respirators leads to inadequate protection - ensure proper selection based on risk 5
• Poor compliance with PPE use is linked to many individual, environmental, and organizational factors including availability, quality, and institutional policy 6

Physiological Considerations

• Working in full PPE poses physiological risks to workers and increases risk of dehydration and heat stress 5, 2
• Limit work shift duration in full PPE and implement proper decontamination procedures during breaks 5, 2
• Allow sufficient time at the beginning and end of each shift for donning, doffing, and decontaminating PPE 5

Disposal and Decontamination

• PPE should be disposed of appropriately immediately after removal (doffing) 3
• Follow established disinfection recommendations for surfaces and reusable equipment 3
• Set up dedicated containers for hazardous medical waste immediately outside patient care areas 1
• All contaminated disposable material and PPE should be immediately disposed of in appropriate containers 1

Organizational Factors

• Institutional policies significantly impact PPE compliance among healthcare workers 6
• Quality, availability, and proper sizing of PPE are critical factors affecting compliance 6
• A systematic risk-based approach to PPE selection requires a team with expertise in infectious diseases, occupational health, and related disciplines 7
• Differences in professional roles and competing priorities can affect PPE compliance, highlighting the need for collaborative development of guidelines 8