Definition
PPE is clothing or equipment designed to reduce the user’s exposure to physical, chemical, and biological hazards at a healthcare setting, thereby decreasing the chance of adverse effects on health.
Purposes
- To protect healthcare workers who come in contact with body fluids when performing tasks.
- To reduce the potential spread of infection at a healthcare setting.
- To prevent cross-infection.
- To create a barrier to reduce or eliminate contact and droplet transmission.
Types of PPE
Common categories of PPE include:
- Eye & face protection
- Respiratory protection
- Head protection
- Skin & body protection
- Hand protection
- Foot protection
- Hearing protection
- Fall protection
Below is a summary of key PPE categories and their protective functions:
| PPE Category | Examples | Hazards Protected Against |
|---|---|---|
| Eye & Face | Safety glasses, goggles, face shields | Impact, dust, chemical splashes, UV/IR radiation |
| Respiratory | N95 masks, half- or full-face respirators, SCBA | Particulates, gases/vapors, oxygen-deficient atmospheres |
| Head | Hard hats, bump caps | Falling objects, electrical shock |
| Skin & Body | Coveralls, aprons, lab coats | Chemicals, heat, biological agents |
| Hand | Nitrile, latex, cut-resistant gloves | Cuts, abrasions, chemical exposure |
| Foot | Safety boots/shoes with steel toe, metatarsal guards | Impact, puncture, slips, electrical hazards |
| Hearing | Earplugs, earmuffs | Noise-induced hearing loss |
| Fall | Full-body harnesses, lanyards | Falls from height |
Principles
The below-mentioned principles prevent infectious materials from reaching the unprotected skin and mucous membrane when providing care at a healthcare setting:
- Ensure that healthcare workers are knowledgeable and skillful in donning and doffing PPE.
- Ensure that donning and doffing are done at a separate place away from the patient care area.
- Don the PPE in the right order and process before entering the patient care area.
- Do not adjust the PPE while caring for those required.
- Ensure that PPE remains in position during care.
- Perform frequent disinfection of gloved hands using alcohol-based hand rub especially before, between, and after caring for each patient and after contact with body fluids.
- In case of significant splash, move immediately to the doffing area to remove PPE.
- Confirm that the doffing area is large enough to allow movement for safe doffing.
- Use alcohol-based hand rub during the doffing process.
- Limit the surfaces touched.
Guidelines When Selecting and Using PPE
- Choose products that are suitable to the residual risk and are meeting the standards.
- Choose PPEs that suits the user-consider the size and fitness.
- When using more than one PPE, ensure that they can be used together.
- For example, wearing safety glasses may disturb the seal of a respirator causing air leaks.
- Store the PPEs properly in a clean, dry area when not in use.
Order of Wearing PPE
The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection, and isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of PPE.
Before wearing the mandated PPEs, shoe cover and head cap should be worn.
In case of using these to prevent communicable infectious diseases, the order of wearing PPEs is gown, mask or respirator, eye goggles or face shield as per need, and gloves.
For any sterile procedures including surgeries, the order of wearing PPEs is mask or respirator, eye goggles or face shield as per need, gown, and gloves.
1) Masking
Definition
Masking is defined as wearing a cloth or disposable mask over the nose and mouth to prevent dispersal of droplets.
Types of Masks
- Surgical mask.
- Respirator mask.
Purposes
- To prevent dispersal of droplets.
- To prevent cross-infection.
Articles
Preparation of Equipment
- Surgical mask or respirator.
Procedure
| Nursing actions | Rationale | |
| 1. | Perform sterile hand washing technique. | To prevent cross-infection. |
| 2. | Hold the top two strings of the mask; place the mask over the bridge of the nose and ensure that the metal clip or notch is snugly fit over the nose. | For correct placement. |
| 3. | Tie the two top strings at the back of the head above the ears and the two bottom strings snugly under the chin behind the neck. | To ensure full protection to nose and mouth. |
| 4. | Hold and pinch the mask at the bridge of the nose. | To prevent slipping of mask. |
| Removal of mask | ||
| 5. | Untie lower strings first, and then top strings and pull mask away from face. | Minimizes contaminated surface of mask coming into contact with face. |
| 6. | Hold the mask by strings and discard into the appropriate bin. | Reduces transmission of organisms and to follow waste management. |
2) Gowning
Gowns are part of an overall infection control strategy. At a healthcare setting, the various terms used for gowns include surgical gowns, isolation gowns, surgical isolation gowns, nonsurgical gowns, procedural gowns, and operating room gowns.
Definition
Gowning involves wearing a specially stitched gown to maintain asepsis and to protect the healthcare worker or nurse from contaminating self and others around.
Types of Gowns
The common types are the following:
- Surgical gown: A surgical gown is a one that is worn to protect the healthcare worker and the patient from cross-infection through microorganisms and droplet infection during surgical procedure.
- Surgical isolation gown: These are worn when the risk of contamination is medium to high. The seams of the gown should have liquid barrier similar to the other parts of the gown.
- Nonsurgical gowns: They are used to protect the healthcare personnel when there is a minimal risk for transfer of microorganisms and body fluids.
Purposes
- To prevent the contamination of one’s clothes by blood or body fluids.
- To protect both the patient and the healthcare personnel from the transfer of microorganisms, body fluids, and particulate matter.
- To ensure a sterile field throughout the care or procedure.
Indications
- When there is a chance of contact with body fluids or particulate matter.
- Assisting for any surgical procedure.
Articles
Preparation of Equipment
- Sterile gown, either separate or in a pack.
- Clean, flat, dry surface (table or Mayo stand) to open the gown.
Procedure
| Nursing actions | Rationale | |
| 1. | Perform sterile hand washing technique. | To prevent cross-infection. |
| 2. | Open the sterile gown package on a clean, dry, flat surface. | To prevent contamination. |
| 3. | Take the gown from sterile package, grasping the inside surface of the gown at the neck. | To maintain sterility of gown. |
| 4. | Unfold the gown slowly and ensure that it does not touch the lower surface. | In aseptic technique, lower surface is considered as unsterile. |
| 5. | Hold the gown at the shoulder level; place both the arms simultaneously into the arm sleeves of the gown and slide the arms into the sleeves till it reaches the wearer’s wrists. | To prevent sterile gown from touching unsterile area. |
| 6. | Ask the assistant to pull the gown from behind holding the inner surface and secure the ties at the neck and waist. | To avoid contamination and to prevent slipping of gown. |
| Removal of gown | ||
| 7. | Step back or away from the sterile field. | To prevent contaminating the sterile area. |
| 8. | Request the assistant to untie the knot at the neck and waist. | For easy removal. |
| 9. | Grasp the front surface of the gown and pull it off inside out away from the body. | Minimizes contaminated surface of gown coming into contact with face. |
| 10. | Dispose of the gown into its designated bin. | To follow biomedical waste management. |
3) Gloving
Definition
Gloving is the technique of donning the sterile gloves to maintain asepsis during the surgical procedure.
Purposes
- To handle the sterile equipment without contaminating them.
- To protect the operating personnel from being infected with body fluids/tissues.
- To prevent cross-infection.
Indications
- Any invasive/diagnostic procedure, for example, major and minor surgery, and endoscopy.
- Procedures involving contact with blood or body fluids.
Types
- Open gloving: It is a method of applying the gloves by oneself while the hands are exposed. This method is used for reapplying the gloves after the contaminated glove is removed by the circulating nurse.
- Closed gloving: It is a method of self-applying the gloves while the hands are concealed with the cuffs of a sterile gown.
- Open-assisted gloving: It is a method of applying sterile gloves to another person who has exposed his or her hands through the cuffs of a sterile gown.
- Double gloving: It is a method of applying two pairs of sterile gloves as an additional precaution.
Articles
Preparation of Equipment
- Appropriate-sized sterile gloves; two pairs in case of double gloving.
- Clean, flat, dry surface (table or Mayo stand) to open the glove.
Procedure
| Nursing actions | Rationale | |
| 1. | Open the outer wrapper of glove in case of nonassisted gloving technique. | To use the gloves. |
| 2. | Place the inner sterile labeled wrapper with cuff edge facing the wearer on a clean, flat, and dry surface above the waist level. | To wear easily. |
| 3. | Grasp the folded cuff of the dominant hand glove with the thumb and two fingers of the nondominant hand. | Dominant hand facilitates motor dexterity. |
| 4. | Slide the nondominant hand into the glove; simultaneously, pull the glove gently and firmly with the nondominant hand while placing the fingers into the proper spaces. | To prevent contamination and tearing of glove. |
| 5. | Insert the fingers of the gloved dominant hand under the cuff of the other glove while keeping the thumb of the gloved hand hyperextended; insert the glove into the nondominant hand while placing the nondominant fingers into the proper spaces. | Guiding the fingers into proper places facilitates gloving. |
| 6. | Straighten the cuffed edges, interlock the fingers of both hands to adjust the glove by touching only the sterile surface of the gloves. | To fit correctly. |
| Removal of gloves | ||
| 7. | Using the gloved fingers of the right hand, grasp the cuff of the left glove, and pull it off inside out. | Prevents contact with soiled surfaces. |
| 8. | Insert the ungloved fingers of the left hand under the cuff of the right glove, and pull it off inside out. | To prevent contamination. |
| 9. | Discard the gloves in the appropriate bin as per the biomedical waste management and perform hand washing. | To follow biomedical waste management. |
Special Consideration
- In case of gloving in theaters where a surgical gown is worn, pull the cuff of the glove above the arm cuff of the sterile surgical gown.
- In case of assisted gloving, simultaneously, slip both the hands into the gloves while placing the fingers into the proper spaces; interlock the fingers of both hands to adjust the glove by touching only the sterile surface of the gloves.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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