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Personal protective equipment

Author: Yan Ling Apollonia Tay, Medical Student, University of Otago, Wellington, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. April 2020.


What is personal protective equipment?

Personal protective equipment (PPE) generally consists of wearable items that are designed to shield users from environmental hazards. These hazards may be physical, chemical, biological, radiological, or nuclear in nature. PPE can be used in a variety of situations and configurations depending on the type of exposure.

A commonly held misconception is that PPE will fully protect users from harm. There will always be an element of risk when working in a hazardous environment. The purpose of properly used PPE is to reduce this risk of harm.

Personal protective equipment

Who uses personal protective equipment?

PPE is mainly used by those who have workplace exposure to occupational hazards. Occupations that require this hazard protection can include:

Certain forms of PPE like gloves and dust masks may also be used at home.

  • Gloves can protect hands from irritants while performing tasks such as washing, gardening, and cooking.
  • A dust mask may be used while cleaning or doing woodwork.

Examples of personal protective equipment

Different types of PPE have been designed to protect specific parts of the body.

Full-body protection

A hazmat suit can provide comprehensive full-body protection.

  • A hazmat or decontamination suit can be made with a variety of materials.
  • Most hazmat suits include built-in air purifying and circulation systems.
  • They are most frequently used in decontamination procedures involving dangerous chemicals, pathogens, chemical waste, and nuclear waste.

Head protection

Helmets and hair coverings are worn on the head.

  • A helmet made with a light, strong material like fibreglass can be used to protect the head from physical trauma.
  • A hair covering can be used to prevent splashes from contaminating the hair.

Face protection

Face shields, goggles, and masks are used to protect the eyes and face.

A face shield can be used to protect the user from injury or infection.

  • A metal shield may prevent welding burns to the eyes and face.
  • A clear plastic shield can prevent bio-hazardous fluid from spraying onto the user’s face.

Goggles prevent foreign bodies or hazardous liquids from entering the user’s eyes.

  • Ordinary spectacles do not have the same protective capabilities and should not be used as a substitute [1].
  • Special safety goggles can be used over spectacles.

A mask or a respirator can prevent dust and infectious particles from being inhaled.

  • A mask may also trap respiratory droplets produced by coughing or sneezing.
  • Masks are available in different filter sizes.
  • A mask with the appropriate filter size should be selected based on the size of the hazardous particles involved [2].

Body protection

An apron, a gown, or a coverall can be used for body protection.

  • An apron can be used when there is less risk of hazardous exposure to the limbs.
  • A gown or a coverall is used when additional limb protection is required.

Hand protection

Gloves made of a wide range of materials can be used as a protective barrier to shield users from hazards.

Foot protection

Boots made of different materials are used to protect the feet.

  • Rubber boots guard against fluid splashes and prevent slips.
  • Steel-toe boots prevent traumatic foot injuries.

Healthcare PPE

How to use personal protective equipment effectively

PPE needs to be selected and sized carefully to best reduce exposure to specific hazards [3]. Professional organisations usually have specific guidelines for PPE selection within particular workplace settings.

PPE needs to be put on (donned) and removed (doffed) according to proper protocol [4].

  • If PPE is not donned correctly, you may not be protected due to improper fit.
  • Improper doffing may cause your body to become contaminated after the exposure.

Studies in healthcare workers have shown that the rate of contamination is greatly reduced if the workers had completed a structured PPE training course [5]. Hence, PPE education sessions are highly recommended for all users. There is also evidence that supervised PPE use can decrease the rate of PPE protocol deviations and improve the quality of protection [6].

What are the side effects and risks of personal protective equipment?

While PPE is extremely useful, some people may experience an unwanted side effect from PPE use, such as [7]:

Up to 99% of cutaneous side effects caused by PPE are due to gloves, especially in healthcare workers [8]. Non-glove related dermatoses are more common in manufacturing and military personnel [7].

Overheating

Overheating due to PPE is very common [9]. PPE may cause an increase in body temperature by preventing heat from being lost via sweat evaporation [10]. Heavier forms of PPE may also increase body heat production due to the increased work of carrying the PPE.

Sweat loss and dehydration from overheating can cause heat illness, ranging from a mild heat rash (miliaria) to a life-threatening heat stroke [11]. Cooling measures should be undertaken immediately if there are any signs of heat illness [11].

Contact irritant dermatitis

Most contact dermatitis due to PPE is classified as irritant contact dermatitis, where dermatitis is not due to the development of a hypersensitivity type of immune reaction. Examples of irritant reactions associated with PPE include:

  • Hand dermatitis due to sweating inside a glove
  • Gloves and other forms of PPE may directly cause irritant contact dermatitis when they rub on the skin
  • Rough clothing such as seams or woollen fibres rubbing on sensitive skin
  • Chemicals penetrating through leaks in coveralls

Skin hypersensitivity reactions

Some people may develop type I and type IV hypersensitivity reactions to specific materials or chemicals used to make PPE.

Allergens causing allergic contact dermatitis due to PPE include [12,13]:

Once an allergen is identified, contact with it should be avoided as much as possible.

Mechanical skin damage

Facial ulcers and acne have been reported in those who wear goggles or a mask for a long period of time due to pressure effects. 

An ulcer is an open defect in the skin barrier. Prolonged pressure on the skin from a mask or a pair of goggles can cause a disruption in blood supply and subsequently, the death of overlying skin. This results in the formation of a pressure ulcer.

Acne mechanica is a complication of acne vulgaris. Pressure and friction on existing acne vulgaris can cause micro-abrasions that exacerbate inflammation [14]. The pustules may become deeper and more enlarged with continued pressure [15].

Irritant contact dermatitis occurs when the skin is directly exposed to soap and water, alcohol (in a sanitiser), or a harsh physical or chemical irritant. The irritant damages the skin barrier, enabling other irritants to enter the skin. This leads to local inflammation, pain, and itching.

Damaged skin is also more likely to develop a secondary bacterial infection [14]. Hence, measures should be taken to prevent skin damage such as removing the source of irritation and limiting the number of hours spent in PPE [14–16].

Regular face washing with a gentle cleanser may help with acne mechanica [15]. A lubricant or moisturiser may be applied at pressure areas [14].

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Related information

 

References

  1. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35: S65–164. DOI: 10.1016/j.ajic.2007.10.007. PubMed
  2. Lepelletier D, Keita-Perse O, Parneix P, Baron R, Glélé LSA, Grandbastien B; French Society for Hospital Hygiene working group. Respiratory protective equipment at work: good practices for filtering facepiece (FFP) mask. Eur J Clin Microbiol Infect Dis 2019; 38: 2193–5. DOI: 10.1007/s10096-019-03642-8. PubMed
  3. Canadian Centre for Occupational Health and Safety. Designing an effective PPE program. 2020. Available at: https://www.ccohs.ca/oshanswers/prevention/ppe/designin.html [accessed 9 Apr 2020]
  4. Mumma JM, Durso FT, Ferguson AN, Gipson CL, Casanova L, Erukunuakpor K, Kraft CS, Walsh VL, Zimring C, DuBose J, Jacob JT; Centers for Disease Control and Prevention Epicenters Program, Division of Healthcare Quality Promotion. Human Factors Risk Analyses of a Doffing Protocol for Ebola-Level Personal Protective Equipment: Mapping Errors to Contamination. Clin Infect Dis 2018; 66: 950–8. DOI: 10.1093/cid/cix957. PubMed
  5. Doll M, Feldman M, Hartigan S, Sanogo K, Stevens M, McReynolds M, Masroor N, Cooper K, Bearman G. Acceptability and Necessity of Training for Optimal Personal Protective Equipment Use. Infect Control Hosp Epidemiol 2017; 38: 226–9. DOI: 10.1017/ice.2016.252. PubMed
  6. Tomas ME, Kundrapu S, Thota P, Sunkesula VC, Cadnum JL, Mana TS, Jencson A, O'Donnell M, Zabarsky TF, Hecker MT, Ray AJ, Wilson BM, Donskey CJ. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med 2015; 175: 1904–10. DOI: 10.1001/jamainternmed.2015.4535. PubMed
  7. Bhoyrul B, Lecamwasam K, Wilkinson M, Latheef F, Stocks SJ, Agius R, Carder M. A review of non-glove personal protective equipment-related occupational dermatoses reported to EPIDERM between 1993 and 2013. Contact Dermatitis 2019; 80: 217–21. DOI: 10.1111/cod.13177. PubMed
  8. Geier J, Lessmann H, Mahler V, Pohrt U, Uter W, Schnuch A. Occupational contact allergy caused by rubber gloves--nothing has changed. Contact Dermatitis 2012; 67: 149–56. DOI: 10.1111/j.1600-0536.2012.02139.x. PubMed
  9. Herlihey TA, Gelmi S, Flewwelling CJ, Hall TN, Bañez C, Morita PP, Beverley P, Cafazzo JA, Hota S. Personal Protective Equipment for Infectious Disease Preparedness: A Human Factors Evaluation. Infect Control Hosp Epidemiol 2016; 37: 1022–8. DOI: 10.1017/ice.2016.124. PubMed
  10. Tharion WJ, Potter AW, Duhamel CM, Karis AJ, Buller MJ, Hoyt RW. Real-time physiological monitoring while encapsulated in personal protective equipment. J Sport Hum Perf 2013; 1: 14–21. DOI: 10.12922/jshp.0030.2013. Journal
  11. Centers for Disease Control and Prevention. Warning signs and symptoms of heat-related illness. 2017. Available from: https://www.cdc.gov/disasters/extremeheat/warning.html#text [cited 9 Apr 2020]
  12. Sasaki M, Kanda K. Glove selection as personal protective equipment and occupational dermatitis among Japanese midwives. J Occup Health 2006; 48: 35–43. DOI: 10.1539/joh.48.35. PubMed
  13. Warshaw EM, Schlarbaum JP, Silverberg JI, DeKoven JG, Maibach HI, et al. Safety equipment: When protection becomes a problem. Contact Dermatitis 2019; 81: 130–2. DOI: 10.1111/cod.13254. PubMed
  14. Yan Y, Chen H, Chen L, Cheng B, Diao P, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther 2020: e13310. DOI: 10.1111/dth.13310. PubMed
  15. Wattanakrai P, Taylor JS. Kanerva’s Occupational Dermatology. 3rd ed. Cham (Switzerland): Springer Nature Switzerland; c2020. Chapter 31, Occupational and Environmental Acne. p. 435–59.
  16. World Health Organisation. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19) [Internet]. 2020 Mar 19. Available from: https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf [accessed 9 Apr 2020]

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