Pandemics and Personal Protective Equipment

Personal Protective Equipment is very important when working in healthcare. There are many precautions to take when caring for a person infected with a contagious virus or disease. Taking precautions not only protects the patient, the healthcare worker but will prevent further spreading of the disease or virus. Personal Protective Equipment is only useful when it is worn correctly. Monkey pox, The Plague, HIV, H1N1, and Zika virus is a few pandemics that require various types of personal protective equipment.

CDC mandated standard precaution in the 1980s, these were design to prevent transmission of microorganism from one patient to the other, as well as protect the health care worker from unnecessary exposure to infection. These are to be used on all patients because potential for being infectious is not always known. Standard precautions include barrier precautions such as gloves, gown, face mask, and protective eyewear. These will protect you from unnecessary exposure or possibly passing on an infection to your patient.

Airborne precautions are required for patients having small pox, severe acute respiratory syndrome (SARS), measles, varicella, disseminated zoster, pulmonary or laryngeal tuberculosis, draining tuberculosis skin lesions, and viral hemorrhagic some of the common infections. They require the patient’s door to remain closed at all times. A special mask must be worn when entering the patient’s room. A NIOSH-approved N95 respirator is used to protect the wearer from airborne particles. N95 mask must pass a Fit Test to make sure is correctly fitted, even then it does not eliminate the risk of infection. According to OSHA Fit Testing is mandatory, and the employer must provide. To research further the proper OSHA N95 Fit Testing follow this link provided. There are several methods that are OSHA approved. N95 masks are not recommended for use in people with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their healthcare provider before use. Airborne precautions do not require you to wear gowns or gloves unless there is an open wound draining then a gown and gloves are required.

Contact precautions are guidelines recommended by the CDC for reducing the risk of transmission of organism by direct or indirect contact. Common types of infections include open and draining wounds, history of MRSA (methicillin resistant staphylococcus aureus), VRE (vancomycin-resistant enterococci), ESBL positive (extended spectrum beta (ß) lactamase), diarrhea and MDRO (multidrug-resistant organisms) infections. Contact precaution is patient specific, you may not always need a gown, mask with or without eye protection, hair, and shoe covers. In case you need to wear personal protective equipment such as a gown, mask, hair cover, shoe covers, gloves or eye protection there is a proper way to put it on as well as take it off.

First perform hand hygiene. If there is a chance of your hair falling onto the patient during the procedure you will be required to put the hair cover on first. Second, hold the gown by the neck area, allowing it to unfold with the opening to the back towards you. This will allow entry to the gown keeping the gown clean or sterile. A clean gown must be used every time entering a patient room and the same gown not used for two separate patients. Third, slip your arms into the sleeves and tie the ties at the back of the neck first then at the waist. Tying the gown will prevent contaminants from coming in contact with your clothing. Fourth, the face mask if required. Place the mask with the metal band on the outside of the nose, make sure it covers your mouth and nose. Securely tie the mask at the back of your head starting with ties above the ears first then adjust the mask so that the bottom of the mask covers the mouth and chin then tie around the neck. To make sure the mask fits correctly it should fit close to the face with no gaps. This mask does not require any special fit testing as mentioned above. If there is a risk of your shoes or feet getting contaminated put on shoe covers now. Also put on eye protection if not attached to the mask.

After the gown is tied, mask is on, then time to put on your gloves. When putting on gloves make sure the gloves cuffs are pulled up over the gown cuff to prevent any contaminants getting on your skin.

After you finished with wearing the personal protective equipment there is also a proper way to take it off and dispose of it. To remove PPE first you will want to remove your gloves without contaminating your hands, to do this grasp the cuff of one hand, slide the glove off the hand folding the contaminated glove to the inside. Then hold the glove that you removed in the hand that still has the glove on, grasp the cuff of the remaining glove and roll the glove down over the other contaminated glove, turning it inside out over the first glove. Touch only the inside surface of the rolled-up glove and drop them in the correct waste container. Next, if wearing eye protection, it will need to be removed without touching your face and properly disposed of. Also, hair cover should be removed as well. Next, untie the waist tie of the gown, then the neck put your hands on the inside of the neckline and pull down the gown off your shoulders, making sure not to let any contaminates from the outside touch you or your clothing. After the gown is off your shoulder, slip your hands inside each sleeve. Then pull out your arms and hands while putting the gown outside surfaces together, making sure the gown is inside out. Do not handle the inside of the gown or shake it around. Dispose of the contaminated gown in the proper waste container. After your gown is off you can remove your mask. Untie the strings around your neck first then the upper ones, discard in the proper receptacle. Then perform hand hygiene after everything is removed.

Droplet precautions requires wearing a mask when entering the room and if the patient is being transported anywhere outside their room. Common infections of droplet precautions include Pneumonia, influenza, streptococcal pharyngitis and pertussis.

Ebola precautions require someone to help put on the personal protective equipment and taking it off as well as observing care being given to the patient, making sure there is no contamination or exposure has occurred. It is required to wear a N95 mask with full face shield and mask. In the Ebola and Quarantine article it is stated that quarantine is unfair and unwise, does more harm than good. I disagree with that. I believe whoever is returning from working with Ebola infected patients should be quarantine for 21 days just as precaution. I understand how the effects of being in quarantine could affect a person mentally and an inconvenience but it’s not worth infecting the US. Even though it has been learned transmission is passed when symptoms arise, fever, malaise, vomiting and diarrhea. What if the virus mutated and then it was able to be passed on before any symptoms? If this happens and the person was not in quarantine, then the US is in trouble. The healthcare workers should be honored for traveling to an infected area, but when returning to the states should be in quarantine to protect the public.

The Plague is thought to be originated from Asia, and is a bacterial infection caused by Yersinia pestis. This bacterium is found to be carried by rats and mice and spread by flea bites. The plague is rare in the United States but has been found in California, Colorado, New Mexico, and Arizona. There are 3 different types of the plague, bubonic is an infection of the lymph nodes, pneumonic is an infection of the lungs and septicemic plague which is an infection of the blood. Some of the sign and symptoms include fever, muscle pain, lymph node swelling, abdominal pain and bleeding into organs. There is no vaccine for the plague available in the USA, but you can prevent it by environmental control. Treat dogs and cats for fleas, use approved insecticides to kill fleas during an outbreak. Try to eliminate food and shelter for rodents in and around the home. If you have been exposed to an infected flea bite, notify your health care provider.

Typical antibiotics used are tetracyclines, chloramphenicol or sulfonamides. For healthcare workers that encounter the plague should use Droplet Precautions. Health care facilities should try to limit the number of persons coming in direct contact with the patient. A mask should be provided to the symptomatic patient. People that come in direct contact with the infected person should wear gloves, gown, goggles, and N95 mask. Health care workers must practice good hand hygiene, washing well with soap and water or use alcohol-based hand rubs. Another type of pandemic is Monkeypox. Monkeypox is found in remote parts of Central and West Africa, near tropical rainforest. Monkeypox is a virus transmitted from infected monkeys to humans or eating or touching a dead animal infected with the virus. This virus has emerged as the most significant orthopoxvirus in humans and is similar to Small Pox virus. A combination of standard and droplet precaution should be used. Avoid contact with animals that could harbor the virussuch as monkey and rodents, avoid sick animals or dead animals that have been found in an area where monkeypox has occurred. Recently this year 16 people in Cameroon was diagnosed. Since it’s in a remote area of the world, the risk of spreading the virus is limited. To prevent the spread of infection, isolate the infected individual. Healthcare personal should practice good hand hygiene. Anyone who is encountering this virus should use a disposable gown and gloves, eye protection, N95 mask and call the local or state health department for further instruction on disposing of items that has been in contact with this virus. Do not throw any items away in regular trash to prevent spreading the virus further. When changing the linens use chlorine bleach with hot water, and linen should not be shaken.

In the US, H1N1 also known as the swine flu was pandemic in 2009. The best way to avoid transmitting or becoming infected with the swine flu is vaccinated yearly for the flu, 6 months and older. Other ways are wash your hands with soap and water, do not cough or sneeze on anyone, avoid crowds, and if you’re feeling sick stay home.

Healthcare professionals should use droplet precautions for infected individuals, since it passed from human to human thru sneezing and coughing. Also, the patient that is infected should wear a mask when outside of their room or in public. H1N1 may spread before symptoms arise. HIV, human immunodeficiency virus, weakens a person’s immune system by destroying white blood cells which puts the person at risk for infection and diseases. HIV can be controlled but not cured. HIV cannot be passed thru water, air, salvia, sweat, tears, using a toilet or sharing food. HIV is only transmitted thru body fluids such as blood, semen, sex, or breast milk. Fluids must enter the mucous membranes fluids, damaged tissue or directly injected into the blood. To prevent the infection do not have sex, do not share needles. If you do have sex, make sure to use protection even that may not prevent contracting the disease. Healthcare providers should use extra caution when handling needles and sharps with a person infected with HIV. Be sure to wear gloves when encountering any body fluids. A disposable gown and eye protection should be worn if there is chance of the infected person bodily fluids splashing on the uninfected person. Zika Virus is another common pandemic in the US. The Zika Virus is transmitted through a bite of a mosquito, sex, and possibly thru blood transfusion. The virus is passed on the unborn baby causing microcephaly and possibly other birth defects. There are many ways to prevent contracting the virus wear long sleeve shirts outside, use insect spray, and using barrier protection while when having sex. While treating a person with the Zika Virus the healthcare professional should use standard precautions such as washing hands with soap and water, wear a mask, and gloves while treating the infected person.

All healthcare workers not only need to know what type of personal protective equipment is needed but in compliance in using it every time the correct way. Some ways to encourage the use of PPE is provide proper training, make sure it is conveniently available, have all the correct sizes, and attempt to make it comfortable for the individual wearing it.