Experiences of wearing Personal Protection Equipment (PPE) from a medical practitioner's professional perspective

1. Context

I currently work as a medical registrar in a district general hospital in southwest London, covering both acute medical admissions and general medical wards.  The patient population is varied including young adults to the elderly, coth COVID and non-COVID patients. The protection measures I need to take vary depending on the type of review or procedure I am undertaking.  For example. for patient reviews on a general ward (weather COVID positive or not) I have to wear scrubs, protective glasses, a surgical mask, gloves, and disposable apron. In contrast, when entering a patient area where there are aerosol-generating procedures (AGPs) such as ventilators or non-invasive ventilation (BI-PAP or CRAP) is underway, I must wear full protective gear including a long-sleeved apron, FFP3 mask, and full-face visor. Regular hand washing of course is also a regular  measure including entry and exit to any patient area or patient contact.

2. Interactions with patients

Developing a relationship with the patient through the PPE involves often having to lean in closer to the patient despite the risk of infection, as it is often difficult to hear through the masks which act as a muffler and can be very tricky with elderly and hard of hearing patients.  Speaking slower and louder is also frequently required, as well as clarifying if the patient would like anything repeated. Such interactions can be time consuming but necessary to ensure the patient is given every opportunity to understand what is happening. In some circumstances, writing on paper instead can also be helpful if time permits. I also regularly employ touch to reassure or comfort patients where I place a hand on theirs or similar (when it is deemed appropriate) and I’ve found that patients frequently use hand squeezing to answer questions when verbal communication is a struggle.  

Communication with both patients and relatives alike (over telephone or video calls) has certainly become more time and energy consuming, and as a consequence can be emotionally draining although always rewarding and essential to keep patients and relatives informed.

3. Personal Impact of PPE

Wearing the PPE each day has given me both positive and negative feelings. On a positive note, the wider multidisciplinary team (MDT) has felt much closer and a tight-knit community as we are all dressed alike and on an equal footing. This can make it harder for patients to recognise the job role of individuals however, as we are no longer identifiable by “uniform” and often name badges are hidden under PPE. It can also be very hot, sweaty and claustrophobic particularly over the face when wearing a mask almost all the time. It has led to my colleagues and me suffering from greasier skin and acne, and at the end of the day you certainly feel like you need a good scrub in the shower as soon as you get home!

 I would recommend having a name badge and ideally photo visible over the top of PPE where possible (if plastic or similar it can be cleaned as required) to help patients and colleagues identify you and your role, as it adds a nice personal touch. Also, ensure you and your colleagues have regular breaks to go to the toilet and at the same time always have a large gulp of water/refreshments. It can also be nice to carry some facial wipes in your bag to allow you to freshen up at break times.

When in close proximity to patients with known or suspected COVID, once in the adequate PPE, it gives you a sense of confidence treating them with the same thorough approach as you normally would when not having to wear PPE. I also think that as a healthcare professional, there is an innate sense of invincibility when your natural gut kicks in to rush and help patients, without second thought for your own protection. Most of us have to be reminded by colleagues regularly to gown up appropriately or wait until we are fully equipped before rushing to help a patient when they are acutely unwell if they have suspected COVID, as it goes against our instincts and training to protect ourselves above our patients' needs.

 A final practical tip: if you’re wearing a tie mask then try to wear a hair cap to protect your hair and then tie the mask over the top, otherwise your hair will constantly get caught/pulled out each time you try to remove the tie masks! (Maybe more appropriate for those with longer hair.)