A Beginner’s Guide to Protective Gear for Healthcare Workers
We've all seen healthcare workers in protective gear, but the coronavirus pandemic has called extra attention to items that keep medical professionals safe. If you’re wondering what protective wear doctors and nurses need, and the safest order to dress and undress, you’ve come to the right place. This ultimate guide will walk you through the 10 main types of protective gear and cover best practices for their use.
A note about protective gear before we begin: You’ve probably heard a lot about FDA Cleared PPE (personal protective equipment) since the pandemic started. This is a specific category of protective gear that has been cleared by the FDA and includes isolation gowns, safety glasses, respirators and more. Some protective gear — such as scrub caps — are not considered FDA Cleared PPE. If you’re wondering whether or not a piece of protective gear is considered FDA Cleared PPE or not, check the FDA website.
Surgical gowns are disposable coverings that are draped over scrubs or other clothing. They protect the healthcare worker from infectious diseases and materials, both liquid and solid. Several types of gowns are sold under different names, including surgical gowns, isolation gowns, surgical isolation gowns, non-surgical gowns, procedural gowns, and operating room gowns. Each gown corresponds to a level of risk. Risk levels start at level 1 and go up to level 4. Level 1 gowns are low-risk (such as a cover gown for visitors), and level 4 gowns are high-risk (such as a covering for surgery). These gowns are disposable, and workers should discard them properly after each use.
When workers need additional body protection, they might also wear a disposable apron over their gowns (most likely during surgery). Other healthcare workers, like janitors and caterers, might wear a disposable apron over their regular uniform for added protection. These aprons act as an additional barrier against splashing body fluids such as blood or urine, protecting the wearer from potential contagion. Like gowns, aprons are also disposable and should be discarded after each use.
Disposable gloves protect healthcare professionals and patients from transferring germs. Gloves are necessary whenever anybody touches blood, bodily fluids, bodily tissues, mucous membranes or broken skin. Wear gloves even if a patient seems healthy and doesn't show signs of sickness. Gloves come in different sizes, and choosing the right size is key for proper protection. If the gloves are too tight, they will restrict movement and might rip. If they're too loose, they won't provide a proper seal, and objects may be challenging to grip. There are many different types of gloves, including non-latex, sterile and surgical gloves. Make sure to choose the right type of glove for your clinical situation.
Disposable face masks cover the mouth and nose in an effort to protect patients from respiratory droplets. Face masks are not as tight as respirators, which provide a more secure seal. Face masks cannot filter smaller particles, such as those exhaled by other people, and as a result, they do not protect the wearer from other people’s germs. However, they do limit the number of respiratory particles that the wearer releases into the space around them. Face masks come in several different sizes, so make sure to choose the right one. If it’s too loose, it won’t provide enough of a barrier. Face masks are reviewed by the FDA, another difference that sets them apart from respirator masks. Like many other items on this list, you should throw them away after each use.
Respirators are face coverings that cover the mouth and nose, but they serve a different purpose than protective face masks: They protect the wearer from small particles exhaled by other people. Respirator masks are tested and certified by the National Institute for Occupational Health and Safety (NIOSH). Masks rated 95 collect at least 95% of aerosolized particles during tests. Those rated 99 collect at least 99% of particles and respirators rated 100 collect at least 99.97%. Respirators also have three-letter designations: "N" means they are not resistant to oil, "R" means they are somewhat resistant to oil and "P" means they are strongly resistant. "R" and "P" masks are more common in industrial environments, while "N" respirators are common in healthcare environments. Respirators should also be disposed of after every patient, ideally.
Infections can enter the body through the mucous membranes of the eye. These infections can occur through direct exposure (i.e., a fluid splashing in the eye) or by touching the eye with contaminated fingers. It’s important to note that regular eyeglasses do not count as eye protection. Safety glasses come in a couple of different designs. Some look like a pair of oversized eyeglasses with clear lenses that wrap partially around the sides. Others look a bit like scuba goggles with rubber edges surrounding the lenses. These safety glasses and goggles are not disposable and should be properly sanitized after each use.
Sometimes, goggles can’t provide enough protection on their own. If the risk of splatter is particularly high, healthcare workers can wear a face shield instead of eye protection or goggles. A face shield looks like a clear, curved piece of plastic that covers the forehead, extends below the chin and wraps all the way around the face. It’s important to note that face shields do not protect against particles exhaled by the wearer or others. They simply provide a waterproof barrier for liquids. If aerosolized particles are a concern, workers should wear a face mask or respirator under the face shield for additional protection.
Scrub Caps and Head Coverings
Scrub caps and other coverings keep hair from falling into the sterile field. They are most used in the operating room, but healthcare professionals wear them in other departments as well. Some medical professionals also use head coverings to keep hair out of their eyes. Scrub caps come in two basic designs: A sleek version that ties in the back and a large, bouffant style that sticks out from the head. Scrub caps come in reusable and disposable models.
Shoe covers protect shoes from contamination and prevent germs on shoes from entering a sterile space. Workers also wear them in operating rooms or other departments where the risk of liquid contamination is high. Shoe covers also help when the wearer’s shoes might carry possible contagion (i.e., when a visitor enters the hospital).
Other Disposable Gear
In highly contagious scenarios, healthcare professionals might reach for other disposable equipment, such as disposable stethoscopes. Disposable gear helps when the possibility of contagion is too great to risk sanitizing a device after being used. Your department or facility should provide guidelines for this type of clinical gear.
Protective gear won’t provide the full level of protection unless it is donned and doffed correctly. The Centers for Disease Control and Prevention provide the following examples for donning and doffing FDA Cleared PPE:
Donning Protective Gear
- First, put on your gown. Ensure that it fully covers your torso, including your neck, knees and arms (to the wrists). Fasten it in the back of the neck and at the waist.
- Next, put on your mask or respirator. Secure the ties or elastic bands in the middle of your head and at your neck's base. Shape the flexible nose bridge to mold to your face. Then, make sure the mask is snug across your cheeks and below your chin. If wearing a respirator, do a fit check to make sure a proper seal has been created.
- Now, it's time to put on goggles or a face shield. Place goggles over your face and eyes and adjust to fit. Make sure that you can see clearly through your face covering. If using goggles, check the seal.
- Put on your gloves and pull them up so that they cover the wrist of the isolation gown. Even while wearing gloves, you should still keep your hands away from your face and limit the surfaces you touch. Change out your gloves if they become torn or heavily contaminated.
The CDC also provides examples for removing protective gear. All FDA Cleared PPE should be removed before exiting a patient's room, except for the respirator. You should remove your respirator after exiting the patient's room and closing the door. When removing gear, remember that the outside is contaminated and should be treated as such. At any point in time, if your hands become contaminated during the removal process, you should stop immediately and perform hand hygiene.
Removing Protective Gear, Example 1
- Use one gloved hand to grasp the palm of the other gloved hand. Peel off the first glove. Hold the removed glove in your gloved hand. Slide the fingers of your ungloved hand under the wrist of your remaining glove. Peel the second glove over the first glove and discard both gloves in a waste container.
- Remove goggles or face shield from the back by lifting the headband or earpieces. If reusable, place the item in the designated bin for cleaning. Otherwise, throw used gear in a waste container.
- Unfasten your gown ties. Be careful that the sleeves don’t make contact with your body when you reach for the ties. Pull the gown away from your neck and shoulders, touching the inside of the gown to avoid contaminating your hands. Turn the gown inside out and roll or bundle it up. Dispose of it in a waste container.
- Grab the ties or elastic bands on your mask or respirator, first the bottom, then the top. Remove the mask without touching the front and discard the used gear in a waste container.
- Immediately wash your hands or clean them with alcohol-based hand sanitizer.
Removing Protective Gear, Example 2
- While your hands are still gloved, pull the gown away from your body so that the ties break. As you remove the gown, begin folding or rolling it inside out into a bundle.
- Peel off your gloves immediately after removing the gown. Only touch the insides of your gloves with your bare hands. Discard in a waste container
- Remove goggles and face shield from the back by lifting the headband or earpieces. If reusable, place the item in the designated bin for cleaning. Otherwise, dispose of it in a waste container.
- Pull the ties or elastic bands on your mask or respirator, first the bottom, then the top. Remove the mask without touching the front and throw it in a waste container.
- Immediately wash your hands or clean them with alcohol-based hand sanitizer.
Protective gear is essential to keeping our healthcare workers safe from coronavirus and other infectious diseases. Rebuilding the supply chain and ensuring that medical professionals have the gear they need is vital to the ongoing fight against coronavirus. We’re re-stocking our protective wear section as fast as possible, so check back regularly for the latest availability.