What personal protective equipment (PPE) should I wear?

Site: ISRRT e-Learning
Course: International Covid-19 support for Radiographers and Radiological Technologists
Book: What personal protective equipment (PPE) should I wear?
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Date: Monday, 29 November 2021, 3:06 AM

1. Patients case definitions

As reported by Zanardo et al.1, the WHO defined a suspect, probable, and confirmed COVID-19 case as follows:

Suspected case:

  • A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness of breath), and with no other aetiology that fully explains the clinical presentation and a history of travel to or residence in a country/area or territory reporting local transmission of COVID-19 disease during the 14 days prior to symptom onset;
  • A patient with any acute respiratory illness and having been in contact with a confirmed or probable COVID-19 case in the 14 days prior to onset of symptoms;
  • A patient with a severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness breath) and requiring hospitalization and with no other aetiology that fully explains the clinical presentation.

Probable case:

  • A suspect case for whom testing for COVID-19 is inconclusive.

Confirmed case:

  • A patient with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

Three different conditions may be identified

  1. Patients with no respiratory symptoms
  2. Patients with suspected or confirmed COVID-19
  3. Patients with suspected or confirmed COVID-19 undergoing procedures at high risk of generating aerosol

1.1. Patients with no respiratory symptoms

While indications from the World Health Organization (WHO) do not suggest wearing any additional personal protective equipment (PPE) compared to standard precautions1, the Italian novel coronavirus disease (COVID-19) experience taught us that it is often difficult to identify asymptomatic patients with certainty. Therefore, it has often been prudently decided to have each patient and healthcare worker wear a surgical mask, paying special attention whenever maintaining a distance of at least 1 m (3 ft) is impossible.

1.2. 2. Patients with suspected or confirmed COVID-19

When providing direct care to suspected positive or positive COVID-19 patients, each healthcare worker should utilize: a surgical mask1 or N95, FFP2 or FFP3 respirator,2 gown,1, 2 gloves,1, 2 and eye protection (goggles or face shield).1, 2 In Italy, the set is often completed with overshoes, surgical caps and a double pair of gloves.

1.3. Patients with suspected or confirmed COVID-19 undergoing procedures at high risk of generating aerosol

In case of aerosol-generating procedures performed on COVID-19 patients, each healthcare worker should utilise: N95, FFP2 or FFP3 respirator,1,2 gown,1,2 gloves,1,2 eye protection (goggles or face shield),1,2 apron.1,2 As previously mentioned, in Italy, the set is often completed with overshoes, surgical caps and a double pair of gloves. The use of a powered air-purifying respirator (PAPR), if available, should be used to further reduce the chances of transmission which can occur despite N95 or equivalent mask protection.4


2. note that:

It should be noted that particular attention should be posed at whether PPEs are labelled as single-patient or single-use. Thus, it may be advisable to check the indications given on intact packaging for each PPE.

3. References

1. Zanardo M, Martini C, Monti CB, et al.Management of patients with suspected or confirmed COVID-19, in the radiology department. Radiography 2020 [Accepted and in press]

https://www.radiographyonline.com/article/S1078-8174(20)30062-6/pdf

2. WHO (27 febraury 2020)Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)

https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf

3. ECDC (february 2020)Personal protective equipment (PPE) needs in healthcare settings for the care of patients with suspected or confirmed novel coronavirus (2019-nCoV)

https://www.ecdc.europa.eu/sites/default/files/documents/novel-coronavirus-personal-protective-equipment-needs-healthcare-settings.pdf

4.Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore [published online ahead of print, 2020 Mar 11] Can J Anaesth. 2020;1-14. doi:10.1007/s12630-020-01620-9