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CHAPTER 2 Review of Related Literature and Studies Personal Protective Equipment (PPE) Personal Protective Equipment at Work Regulations

(1992) defined PPE as all equipment which is intended to be worn or held by a person who is at work and which protects him or her against one or more risks to his or her health and safety. PPE, therefore, includes items such as the following when they are worn for purposes of health and safety: apron, gloves, protective clothing for adverse wether conditions, safety shoes, hard hats, high visibility waistcoats, eye protection, lab coats, and facemasks (NHS Trust and School of Medicine as cited in PPE at Work Regulations, 1992). Many authors have emphasized the advantages in using PPE. Nevertheless, several studies have shown that the efficacy of these PPEs still depends on the management of the person wearing it. It is important to assess the right type of PPE. This can be done by considering the different hazards that may be in the workplace. The hazards and types of PPE to be used should be checked: (1) Eyes chemical or metal splashes, dust, projectiles, gas, and vapour, radiation. The possible PPE options are safety spectacles, goggles, facesheilds, and visors; (2) Head- impact from falling or flying objects, risk of head bumping, hair entanglement. The possible PPE of choice are helmets and bump caps; (3) Breathing- dust, vapour, gas, and oxygen deficient atmospheres. The PPE of choice are disposable filtering facepiece or respirator, half or full respirators, air-fed

helmets, and breathing apparatus; (4) Protecing the body- extreme temperature, adverse weather, chemical or metal splash, spray from pressure leaks or spray guns, impact or penetration, contaminated dust, excessive wear or entanglement of own clothing. Options for PPE include disposable overalls, boiler suits, and specialist protective clothing; (5) Hands and arms- abrasion, temperature extremes, cuts, puntures, impact, chemicals, electric shock, skin infection, disease or

contamination. Possible options for PPE include gloves, gauntlets, mitts, wristcuffs, armlets; and (6) Feet and legs- wet, electrostatic build-up, slipping, cuts and punctures, falling objects, metal and chemical splash, abrasion. Options for PPE include safety boots, leggings and spats (PPE at Work Regulations, 1992). Among these PPE, mask is considered to be the most widely available. Aside from this, choices or types of mask are being offered locally. Mask is an important tool in terms of convenience to safeguarding one's health especially if the event deals with the infectious hazards. Mask (specifically face mask), according to Kozier et.al (2008), are used to reduce the chances of transmission of microorganisms both by droplet contact and airborne routes, and likewise to prevent contactracting splatters of body substances that may contain infectious organisms. Moreover, the CDC suggested circumstances to which the mask must be worn (Kozier et.al, 2008). These following circumstances must be strictly observed: (1) to those clients who has infectious disease and transmits large particle aerosols (droplets). Examples of these are measles, mumps, or acute respiratory disease in children; (2) another is for the persons entering a room with clients having certain infections

which are transmitted by small aerosols (droplet nuclei). Examples of these as reviewed by Kozier et. Al (2008) are pulmonary tuberculosis and SARS. For these kinds of infections, tighter face seal and better filtration must be used. Brouhard (2009) stated that surgical face masks provide protection from large blood splashes. Aerosolized blood and body fluids require special particulate masks. For most first aid applications, surgical masks or painting masks would be sufficient. He added that it is an economical option for PPE. Technological advancements in PPE give convenience to many especially the healthcare personnels. Disposable pieces of equipment are being widely used in the clinical settings especially in the Philippines where cheaper wears are sought after by those who seek immediate PPE. Mask for example had gained popularity since it is the cheapest PPE available in the country. Abundant choices of masks are being technologically made primarily to improve its quality. Facemasks are made from spun bond PP Fabric, ear loops, and non woven material sterilize for single use (Brouhard, 2009). The FDA (Food and Drug Administration) and CDC (Center for Disease Control) have only defined 2 types of masks - facemasks and respirators. The main purpose of a facemask is to help prevent particles (droplets) being expelled into the environment by the wearer. Masks are also resistant to fluids, and help protect the wearer from splashes of blood or other potentially infectious substances. They are not necessarily designed for filtration efficiency, or to seal tightly to the face. Respirators are intended to help reduce the wearer's exposure to airborne particles (HPA, 2009). As cited by HPA (2009), masks and respirators are components of a number

of infection control measures intended to protect healthcare workers, and prevent the spread of infectious agents. However, according to WHO (2009), wearing a mask or respirator is not a guarantee of protection against infectious diseases. These two are just part or component to a safer interaction. According to Edwards (2010), facemasks are barriers which can further be classified as surgical, laser, isolation, dental or medical procedure masks and may include a face shield. They can be held in place by fabric ties or with elastic straps. Surgical masks are a form of barrier protection worn by health-care workers during surgical procedures, and in settings where bacteria or viruses may be present. Surgical masks are loose-fitting barriers that cover the nose and mouth. It generally reduces the chances of contamination and contracting infectious disease (Edwards, 2010). Moreover, it acts as barrier to protect the user from inhaling fluids that can contain bacteria or viruses, or from transmitting oral or nasal fluids. Surgical masks are made of disposable material, such as paper, and do not serve as complete barriers for airborne particles (Edwards, 2010). As cited by Edwards (2010), surgical masks are disposable and are available in three general configurations: a paper shield that may be pleated, which has two ties for around the head and a flexible nose bridge; a flat or pleated shied that has ear loops; and a molded cup shape held in place by an elastic cord around the head. However, surgical masks are not regulated by health authorities and are not officially tested for filtering levels. Size and flexibility for easy and frequent use are

key factors in choosing a surgical mask (Edwards, 2010). Edwards (2010) added that surgical masks should not be reused, and frequent changing is recommended. In the first place, surgical masks are often times disposable. Although disposable masks are highly accessible and are much cheaper, washable mask is another option for general protection. Unlike disposable masks, washable masks are very practical since it can repeatedly be used as long as proper maintenance is observed. Foster (2009) mentioned that some washable masks are made of activated carbon that protects against indoor and outdoor pollutants and allergens. They effectively capture exhaust and diesel fumes, fragrances, household chemicals, formaldehyde, cigarette smoke, smog and industrial air pollution, new car smells, printer ink and toner, germs and the recycled air on aeroplanes. Similarly, according to Foster (2009), airborne particulates such as dustmite and pet allergen, pollen, mould spores and acrylic dust are also efficiently filtered out. The mask is consists of layers of porous dimpled "honeycomb" polyester which holds the coal-based activated carbon filter. It can filter particulate air pollution of 1-5microns by 99-100% and captures chemicals harmful to health, reducing exposure by 50-95% depending on the substance. It is also recommended for asthma, COPD, multiple chemical sensitivity.

Colorful Mask As the air becomes more polluted different organizations try to find ways on how to maximize the resources available and to encourage their citizens to actively

participate in health promotion and disease prevention specifically respiratory illnesses. But according to Ahmid (2010),although the masks cannot completely prevent all of the adverse effects of air pollution, at least they can reduce the risk. According to The Jakarta Post (2010), colorful fabric masks covering the mouths and noses of people in public places are seen more and more often as a new fashion has swept the city. Regardless of the inconvenience, the trend is a simple measure taken by many people to protect themselves from air pollution on the citys streets, public buses and trains. The wearing of a colorful mask is not just to protect ourselves against communicable disease but also to promote a comfortable mask that is suited for anyone by choosing different colors that they prefer therefore making it a good trend for the hospital workers and to promote a supportive aid for the clients that is well made and also gives them an option to choose any color which they desire (Jakarta Post, 2010). In our present day, where there is great pollution and increase production of harmful gases, one of the things that can protect the health of an individual is through a barrier by just using a simple device, the mask and the now color enhanced masks for anyone in different areas of the world. However, some articles arose in terms of qualifying colorful mask as an effective barrier to prevent communicable disease specifically airborne ones. Controversies placed that the dyes used in these masks allegedly cause harmful

effects on the ones wearing it. Risanti (2010) stated that the compliance in wearing colorful mask is basically

in accordance with the government's advice on efforts to prevent the spread of swine flu. The citizens and government of Indonesia stated that wearing colorful mask is an effective and trendy campaign in terms of minimizing airborne-diseases (The Jakarta Post, 2010). However an exerpt from Brosseau and Ann (2009) stated that NIOSH-approved respirators go through a rigorous testing and certification process. Alterations to a respirator, including decorating with ink or paint, can be detrimental to the respirators performance and may void the NIOSH certification. the risk from major

Communicable Disease Communicable disease is defined simply by Kozier et.al (2008) as a disease that can spread from one person to another. While this definition seems to be as simple as it is, Navales (2007) expounded communicable disease as an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agency, and a vector or an inanimate object. Furthermore, both authors state that this infection follows only a specific track or chain. This chain always starts and succeeds with the following: causative agent or microorganisms, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Given this cycle of infection Navales (2007) emphasized that of all these chains, mode of transmission is considered to be the weakest and the easiest link to break. Mode or method of transmissions are mechanisms which require the leave of microorganisms from its reservoir to another host via the portal of entry (Kozier et.

Al 2008). There are three (3) mechanisms invlove as cited by Kozier et. Al (2008) direct transmission, indirect transmission (vehicle and vector-borne) and airborne transmission. Airborne transmission is where the microorganisms about less than five (5) microns small remain suspended in the atmosphere for long periods of time (Navales 2007). According to the Department of Health (2007), the leading causes of morbidity from communicable diseases are diarrhoea, pneumonia, bronchitis, tuberculosis, malaria, and sometimes, measles and dengue outbreaks. The Department of Health (2007) added that among these communicable diseases, pneumonia, tuberculosis, and diarrhoea still remain in the top 10 causes of mortality in the Philippines. It is alarming to know that despite the government's effort to erradicate these kinds of communicable diseases, airborne carrying pathogens such as pneumonia and tuberculosis still continue to dwell within the localities of the Philippines. World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) noted that pneumonia and tuberculosis are two diseases that can either be caused by virus or bacteria and can also be prevented through proper disease management and vaccines. Pneumonia , as reviewed by CDC (2011), is an infection of the lungs that is usually caused by bacteria or viruses. Globally, pneumonia causes more deaths than any other infectious disease. However, it can often be prevented with vaccines and can usually be treated with antibiotics or antiviral drugs. Furthermore, it is classified to several types namely Community-Acquired Pneumonia (CAP), HospitalAcquired Pneumonia (HAP), Healthcare Associated Pneumonia (HCAP) and

Ventilator-Associated Pneumonia (CDC, 2011). Moreover, in 2007, 1.2 million people in the U.S. were hospitalized with pneumonia and more than 52,000 people died from the disease. Tuberculosis, on the other hand is caused by bacteria that spreads through the air and breathed into the lungs (WHO, 2007 ). It is highly contagious but

definitely curable. It was approximated that two billion people are infected [worldwide] with TB bacteria and one out of 10 infected develops active Tuberculosis. According to CDC (2011), over 70% of the 6,854 foreign-born TB

cases reported in the United States in 2009 were in persons born in only 12 countries including Philippines with a partial case of 806 persons. Pandemic cases of respiratory-borne diseases in the past years had affected many countries not only in Asia but also in the West. Another airborne-disease [Influenza] review and citation was made by the WHO (2009). At present, evidence suggests that the main route of human-to-human transmission of the new Influenza A (H1N1) virus is via respiratory droplets, which are expelled by speaking, sneezing or coughing. Because of this, according to Steckelberg (2010), people who live in community housing - such as college dorms, nursing homes or military barracks - are at higher risk of influenza infection because they're in contact with more potentially infected people. Snider (2004) noted that the potential for pandemic influenza is a tremendous concern due to the persistence of and extreme difficulty in controlling the H5N1 Epizootic strain in Asia. H5N1 is established as enzootic and is unprecedented in its scope and complexity. H5N1 has an extremely high case fatality rate, but the majority of cases have occurred in young and healthy persons with no sustained

person-to-person transmission. Another group of viruses known as coronaviruses which sometimes cause mild respiratory illness in humans were also implicated in the outbreak of Severe Acute Respiratory Syndrome (SARS) in Southeast Asia (CDC, 2011). Like influenza, according to Science Daily (2009), the disease can also be transmitted through inhalation. CDC learned several lessons about the key epidemiologic features of SARS. Snider (2004) said a fairly high proportion of cases occurred in healthcare workers (HCWs). In the majority of countries, most cases were spread person-to-person. The disease rapidly spread around the world, but healthcare facilities played a central role in the epidemic Snider (2004) added that the epidemic [influenza and SARS] emphasized the critical importance of preparedness planning and strong partnerships at national and international levels . Hence, CDCs concern for respiratory protection extends to patients, visitors and other persons in healthcare settings in addition to HCWs. Challenges related to global infectious diseases over the past decade include airborne transmission of influenza, severe acute respiratory syndrome (SARS) and more traditional diseases (Airborne Infectious Agents [AIAs] Workshop Report, 2004). Snider (2004) mentioned that CDC is currently being reorganized under the Futures Initiative with a stronger focus on health impact, customers, public health research, leadership, performance improvement and global health impact. According to Cole (2004) in his discussion on Basics of AIAs Control, the aerobiology and physics of infectious agents plays a significant role in disease

prevention or control. Cole also said an aerosol of bacterial, viral or fungal origin is typically capable of initiating an infectious process in a susceptible host. These aerosols generally consist of a mixture of mono-dispersed and aggregate cells, spores or viruses carried by respiratory secretions, inert particles or other materials. Smaller aerosols, according to Cole's (2004) discussion on Basics of AIAs Control, can remain airborne for a longer period of time with rapid desiccation, while larger aerosols may initially fall out and then resuspend after desiccation. It was also mentioned that respiratory disease agents that are expelled from the respiratory tract within a matrix of mucus and other secretions typically begin to desiccate upon expulsion by coughing, sneezing, talking or singing. Particles up to 100 m in diameter are generally considered to be capable of remaining airborne for a sufficient period of time to be observed or measured as aerosols or droplets that are able to transmit infectious agents. A sneeze can generate as many as 40,000 droplets, but most will evaporate to particles or droplet nuclei ( dried residuals of large aerosols) in the range of 0.5-12 m (Cole, 2004). Cole (2004) explained that infectious microbes within droplets will survive radiation, oxygen, as well as other pollutants and additional stressors following aerosolization, transport, desiccation and landing or deposition. He added that the capacity of an infectious microbe to initiate and spread disease depends on its ability to survive or reproduce and maintain infectivity or cause infection. Furthermore, he pointed out that the infectious disease process is a function of microorganism concentration or infective dose and virulence or disease-promoting

factors that enable an agent to overcome physical and immunological defenses of the host. However, the initiation of signs and symptoms may vary from the susceptibility of host. The initiation of some diseases requires only small infective doses for humans because the agents have an affinity for specific tissue and possess one or more potent virulence factors that facilitate resistance to inactivation (Basics of AIAs Control, 2004). The citation was further clarified by Cole (2004) through an example. He

mentioned that only a few cells of M. tuberculosis (M.tb) are required to overcome normal lung clearance and inactivation mechanisms in a susceptible host and the deposition within the respiratory tract is inherent in the infection process that is initiated by the inhalation of infectious droplet nuclei. Transmission of infectious disease by the airborne route is dependent upon the interplay of several critical aerosol factor identified by Cole (2004). First is the particle size and shape or aerodynamic diameter of the microbe. Second is the survival of microbes. Third is the microbe's virulence. Fourth is the host susceptibility. All of these factors accordingly are significant in identifying ways to prevent and control the transmission mechanisms of all microorganisms.

Efficacy of PPE (Mask) against Communicable Disease Center for Disease Control and Prevention (2007) and the World Health Organization (2009) have advised that wearing a mask is a "first line of defense" and advise that "in a highly contagious environment, wearing any mask is far better than wearing no mask at all".

According to Kozier et.al (2008), mask is worn to reduce the risk for transmission of organisms by the droplet contact and airborne routes and by the splatters of body substance. The author added that small particle aerosols remain suspended in the air and thus travel greather distance by air. Special masks that provide a tighter face seal and better filtration maybe used for these infections Maxillo (1987) stated that the use of surgical face masks has been advocated to protect clinicians from inhalation of aerosols containing organic and inorganic particulates. This study examined the ability of a 22 micron tracer particle to bypass the filtering capability of face mask material by peripheral marginal leakage of inspired air. According to CDC (2009) early surgical masks were constructed from layers of cotton gauze. They were first worn by surgery staff in the early 1900s to prevent contamination of open surgical wounds. With time their design, function, and use have expanded. Today surgical masks are worn in a wide range of healthcare settings to protect patients from the wearers respiratory emissions. A surgical mask is a loose-fitting, disposable device that prevents the release of potential contaminants from the user into their immediate environment. In the U.S., as added by CDC (2009), surgical masks are cleared for marketing by the U.S. Food and Drug Administration (FDA). They may be labeled as surgical, laser, isolation, dental, or medical procedure masks. They may come with or without a face shield. Since OSHA issued the Bloodborne Pathogens Standard (29 CFR 1910.1030) in 1991, surgical masks have been recommended as part of universal precautions to protect the wearer from direct splashes and sprays of infectious blood or body fluids.

CDC (2009) noted that the use of surgical masks in healthcare settings dates to the 1990s in response to concerns about employee exposures to drug-resistant tuberculosis. Healthcare worker illnesses and deaths during outbreaks of severe acute respiratory syndrome (SARS) in the early 2000s led to renewed attention to the use of respirators for some infectious respiratory diseases. Most recently, planning efforts for pandemic influenza in 2006-07 led to considerable discussion about the role of small particle inhalation in disease transmission and the use of respirators to protect healthcare personnel from airborne influenza particles. A listing of all NIOSH-approved disposable, or filtering facepiece, respirators is available. NIOSH also maintains a database of all NIOSH-approved respirators regardless of respirator type - the Certified Equipment List (CDC, 2009). Furthermore, CDC (2009) emphasized that whether the goal is to prevent the outward escape of user-generated aerosols or the inward transport of hazardous airborne particles, there are two important aspects of performance. First, the filter must be able to capture the full range of hazardous particles, typically within a wide range of sizes (<1 to >100 m) over a range of airflow (approximately 10 to 100 L/min). One column of CDC (2009) explained that the filters used in modern surgical masks and respirators are considered fibrous in natureconstructed from flat, nonwoven mats of fine fibers. Fiber diameter, porosity (the ratio of open space to fibers) and filter thickness all play a role in how well a filter collects particles. In all fibrous filters, three mechanical collection mechanisms operate to capture particles: inertial impaction, interception, and diffusion. Inertial impaction and interception are the mechanisms responsible for collecting larger particles, while

diffusion is the mechanism responsible for collecting smaller particles. In some fibrous filters constructed from charged fibers, an additional mechanism of electrostatic attraction also operates. This mechanism aids in the collection of both larger and smaller particle sizes. This latter mechanism is very important to filtering facepiece respirator filters that meet the stringent NIOSH filter efficiency and breathing resistance requirements because it enhances particle collection without increasing breathing resistance. The CDC (2009) deviced a flow of the filtering performance of an efficient surgical mask. They explained it through these various principles: Inertial impaction. With this mechanism, particles having too much inertia due to size or mass cannot follow the airstream as it is diverted around a filter fiber. This mechanism is responsible for collecting larger particles. Interception. As particles pass close to a filter fiber, they may be intercepted by the fiber. Again, this mechanism is responsible for collecting larger particles. Diffusion. Small particles are constantly bombarded by air molecules,

which causes them to deviate from the airstream and come into contact with a filter fiber. This mechanism is responsible for collecting smaller particles. Electrostatic attraction. Oppositely charged particles are attracted to a charged fiber. This collection mechanism does not favor a certain particle size. According to Kozier et.al (2008), single-use disposable surgical masks are effective for use with the nurse who provide care to most clients but should be changed if they become wet or soiled. The author also added that disposable particulate respirators of different types maybe effective for droplet transmission, splatters and airborne microorganisms.

Many researchers stated that although it is helpful to wear mask in terms of preventing airborne infections it is not always the PPE of choice. Similarly, many authors stated that there are different modes of transmissions involved in contactracting communicable diseases. An example would be sexually transmitted diseases. Ofcoures, mask can do nothing to prevent the spread of this kind of disease. Hence, mask can only be limited to prevent and reduce the risk of aquiring airborne diseases. According to Kozier et.al (2008), all health care providers must apply clean or sterile gloves, gown, facemask, and protective eyewear according to the risk of exposure to potentially infective materials. Langmuir (2009) stated, to treat the subject of the control airborne infection in some systematic manner, one turns logically to Theobald Smiths concept of the chain of infection. According to Navales (2007), suggested control measures for primary care clinics in the community setting emphasizes the use of barrier apparel, personal hygiene, and environmental cleaning in addition to universal precautions. He emphasized the four important links of infection; the microorganism, entrance to tissue, exit to host, and the mode of transmission. He also mentioned that specific control measures should be practiced to break or weaken one link at a time. An important practice which he cited in his article was to wear an effective mask to prevent the organism's entry to the host. Healthcare workers are often at risk from contracting these infections. Hence, many authors claimed that they must have the awareness on the proper usage of mask.

Taylor (2010) he mentioned, Securing your mask as a practising nurse or midwife is akin to taking all adequate measures to ensure you are best equipped to provide care for your patient, client or consumer...it is important for everyone in your professional and personal life that you take the time to secure your mask on a regular basis. While it is necessary to look out for the safety and comfort of the client it is also, nonetheless, important to consider the nurse's or healthcare provider's safety whenever interacting with them. McIntyre (2009) said that masks are important means of protection for the community in cases where vaccines and drugs for particular diseases are likely to be delayed. Moreover, McIntyre added that reducing transmission if they are properly worn. Donning mask - either a surgical mask or a P2/N95 respirator mask (high particulate filter mask) helps protect the person from severe respiratory illnesses such as influenza and SARS (Live Science, 2009 as cited in UNSW, 2007). Alvarez-Dardet and Ashton (2004) explained in their study that as influenza and SARS CoV, alike, has been suggested to travel via aerosol droplet wearing masks play an important role in

surgical mask may significantly increase the preventive and control level mechanism. The same goes with Mycobacterium tuberculosis to which they

identified that wearing mask increases the protection rate from TB to almost three percent. Evidences from the research gathered by the Scientists of the University of Michigan School of Public Health (2007) showed that wearing mask and washing hands (hand hygiene), alike, bears great potential in terms of preventing respiratory

diseases. According to 3M Health Care Respirators (2005), masks prevent the particles being expelled by the wearer from getting into the environment or contaminating people. Futhermore, they mentioned that the European Standard for Surgical Mask- Requirements and Test Methods defines a strict guideline in ensuring the consistent level on quality of the mask being manufactured. The following properties must be met: bacterial filter efficiency (BFE), differential pressure (breathability), and splash resistance. McIntyre (2009) stated that the problem arises when non-compliance on wearing masks by the client or even by the healthcare providers during close interaction. This was further justified by the Preliminary work in Australia (Sydney's Westmead Hospital) in 2007 to which it showed a very low acceptance of and compliance with mask used by hospital doctors and nurses. Bonabente (2009) cited in her column on The Philippine Daily Inquirer that wearing mask, according to WHO, although proven effective in preventing influenza, it is unlikely to be beneficial in community setting more so in 'open areas'. The article also concluded that improper usage of mask might even increase the spread of certain virus which ironically are being expelled through sneezing, coughing, or speaking. On the other hand, Harrison (2011) attributed the drawback from the abundant choices of mask, nowadays. He stated that because of the abundance of mask choices clinicians may feel overwhelmed and may also compromise the need for selecting mask that is appropriate to a specific situation. Mood

Mood is defined by Merriam-Webster (2011) as a conscious state of mind or predominant emotion. With this definition mood can be differentiated to feelings in a sense that the latter is the expression of the mood. On the other hand, Stuart and Sundeen (1988) identified mood as that patient's self-report of prevailing emotional state and is a reflection of the patient's life situation. Color and mood are inextricably linked together as stated by Bender (2011). She further stated that There are several reasons why colors are able to influence how we feel. Likewise, Harrington (2011) explained We react on multiple levels of association with colors - there are social or culture levels as well as personal relationships with particular colors. Alongside these, Serene Interiors (2010) stated in their column that color has a profound effect on our mood. In clothing, interiors, landscape and even natural light, a color can change mood from sad to happy, from confusion to intelligence, from fear to confidence. Particular colors have different effects on each individual . Response to a color may be influenced by a number of factors such as the bodys need for a specific color, a sad or happy memory associated with a color. Serene Interiors (2010) enumerated some of the most typical responses to various color groups. Neutral Colors. These colors create a sense of peace and well being. They foster quiet conversation with family and friends and can dispel loneliness. Examples of these colors are green and blue. Intellectual Colors. These are the sharp, witty and unique colors which convey a message that the person has travelled, is well read and has something to say. Furthermore, these colors command respect. Examples of these colors are

grey, red and navy blue. Playful Colors. These colors are exiting and used for a fun providing environment. These playful, whimsical palettes create their own kind of music, like the sounds of children playing. Moreover,the foundation of this palette is white. Examples are bubble gum pink, wintergreen, berry colors and all other colors found in crayon colors. Healing Colors. This palette includes the colors which are very refreshing and rejuvenating.Like nurturing colors, healing colors also begin by getting in touch with nature. Colors under these are in the pallete of green. Romantic Colors. Many species including the human beings attempt to attract the opposite sex with colors. These colors are believed to induce passionate feelings. Examples of these colors are red, purple, paler tone of orange and even blue. Serene Interiors (2010) added that the effects of color on mood will vary from individual to individual. Color schemes have emotional messages too. An awareness of the emotions generated by different colors is helpful in planning personal palettes that will be pleasant to live with, but it must be understood that this information is not absolute. Subtle changes in tone can increase or decrease the emotions evoked by a particular color, allowing it to be included in many diverse palettes. According to Siemer (2009), the core feature that distinguishes moods from emotions is that moods, in contrast to emotions, are diffuse and global. His study outlines a Dispositional Theory of Moods (DTM) that accounts for other features of mood experience. DTM holds that moods are temporary dispositions to

have or to generate particular kinds of emotion-relevant appraisals. Moreover, the author stated that DTM recognizes the cognitions and appraisals one is disposed to have in a given mood partly constitute the experience of mood. As nurses it is significant to know the 'mood' of their clients for it affects their dispostion in terms of rendering care. There are abundant studies on moods. Many of the researchers focused on the factors that affect moods. Some of the studies showcased the effects given by the colors to the moods with that of the client. According to Cherry (2010) perceptions on colors may be viewed by others as subjective. However, some of these colors have actually universal meanings as far as psychology is concerned. She also mentioned in her article about the Egyptian's and Chinese's practice on 'chromotherapy'. This practice involoves colors and light as a treatment of choice during the ancient period. Moreover, chromotherapy as elaborated by Cherry (2010) is still being used today but only as an alternative or holistic treatment. While some articles hold positive attributes to colors most psychologist view color therapy as an exaggeration. Researchers claimed that the mood-altering effects of color are rather temporary and hence should not often times be the basis of treatment. Stuart and Sundeen (1988) explained that mood can be evaluated by asking a simple non-leading question such as How are you feeling today?. Moreover, the authors suggest that a rating scale of one to 10 can help provide immediate reading of patient's mood.

The researchers seek to find the following inquiries:

The profile of the respondents (age, gender, profession, and area of assignment); The common communicable diseases handled by the staff nurse; The level of agreement among staff nurses regarding the effectiveness of colorful mask in decreasing the possibility of acquiring different communicable diseases being it as a medium of protection; The materials used in making colorful mask; The mood(s) elicited when wearing colourful mask (during interaction); The significant difference in wearing a colourful mask in preventing the occurrence of communicable diseases and in setting the mood among nurses and patients in comparison with the traditional mask; and The effect of colorful mask in the working relationship with that of nurse and patient and the efficacy of colorful mask in preventing communicable diseases.

The study will utilize a Mixed Method Approach wherein both quantitative and qualitative designs will be used: Consent forms will be given to the selected institutions; Quantitative; Questionnaire will be made Qualitative; Central question will be placed Validation and reliability testing will follow; Floating of questionnaires will be done; Retrieval of questionnaire were afterwards done; Tallying of data was done; and Data analysis will be conducted.

At the end of the study it is expected that: The airborne and droplet infections are the most common type of communicable disease handled by staff nurses; The usage of colourful mask garnered a great level of agreement among staff nurses in terms of preventing communicable disease; Upon wearing colourful mask moods are elicited among nurses and patients; and There is no significant difference in wearing a colourful mask in preventing the occurrence of communicable diseases and no significant difference in setting out of mood between nurses and patients in comparison with the traditional mask.

Research Paradigm Figure 1

Conceptual Framework Input The researchers seek to find the inquiries such as: (1) the profile of the respondents which comprises profession, assignment; their and (2) the age, gender, of

area

common

communicable diseases handled by the staff nurses; (3) the level of agreement among staff nurses regarding the effectiveness of colourful mask in decreasing the possibility of acquiring different communicable diseases being it as a medium of protection; (3) materials used in making colorful

mask; (4) the mood(s) elicited when wearing colorful mask especially during nurse patient interaction; (5) the significant difference in wearing a colorful mask in preventing the occurrence of communicable diseases and in setting the mood among nurses and patients in comparison with the traditional mask; and (6) the

effect of colorful mask in the working relationship with that of nurse and patient and the efficacy of colorful mask in preventing communicable diseases. Process The study will utilize a Mixed Method Approach wherein both quantitative and qualitative designs will be used. Consent forms will be given to the selected institutions. For quantitative approach, questionnaire will be made. For qualitative approach, a central question will be placed in the formulated questionnaire. Validation and reliability testing will be done. Floating of questionnaires will follow; and a one hundred percent retrieval rate will be assumed, afterwards. Tallying of data will be done and data analysis will be conducted. Output At the end of the study the following answers to the research's inquiries are being expected: (1) the airborne and droplet infections are the most common type of communicable disease handled by staff nurses; (2) the usage of colorful mask garnered a great level of agreement among staff nurses in terms of preventing communicable disease, upon wearing colorful mask moods are elicited among nurses and patients; and (3) lastly, there is no significant difference in wearing a colorful mask in preventing the occurrence of communicable diseases and no significant difference in setting out of mood between nurses and patients in comparison with the traditional mask.

Theoretical Framework

The researchers relate their study to Neuman's Systems Model. Betty Neuman ( Neuman & Fawcett, 2002 Cited in Kozier et.al, 2004) is a community health nurse and a clinical psychologist. Her model is based on the individual's relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Neumans assertion (Oxbridge Writers, 1999) stated that every person had a line of defense that could be affected by stress. It could affect the persons physiology, psychology, sociocultural interaction, developmental and spiritual wellbeing at any time without warning. Moreover, Neuman (Oxbridge Writers, 1999) put together four essential concepts in relation to the individual's identification and attitude (mood) towards stress: (1) the person; (2) nursing; (3) health; and (4) the environment. Person. Neuman presented the concept of a person as a client or client system wherein the focus is not only within the individual but also within the individual's surrounding and interrelationships. Nursing. In her model she presented that nursing is more than caring for the ill. She believed that nursing was about viewing the patient as a whole and examining every part of them that can be affecting their health such as emotional and spiritual well being. Health. Neuman asserted that health is an optimal wellness wherein the individual meets its total system needs. On the other hand, she pointed out that the reduced state of wellness is the result of unmet system needs. Environment. Neuman mentioned that the environment [of the person] plays a significant role in determining its perception to stress. She added that the

person's

environment

can

be

internally

and

externally

classified.

Internal

environment can be viewed within the person and that the stress may also arise from it. The external environment, on the other hand, focuses on the person's physical surrouding (e.g. the room, the people surrounding him or her, etc.). Moreover, Neuman's Systems Model outlined an organized nursing

interventions that can be carried out on three preventive levels: (1) primary; (2) secondary; and (3) tertiary (Kozier et.al, 2004). Primary prevention. It focuses on protecting the normal line of defense and strengthening the flexible line of defense. Secondary prevention. It focuses on strengthening internal lines of restistance, reducing the reaction, and increasing resistance factors. Tertiary prevention. It focuses on the readaptation and stability and protects reconstitution or return to wellness following treatment. The researchers relate their study to Neuman's in terms of the client's identification and attitude (mood) towards stress; and likewise, the nurse's views in terms of client's emotional experience. With Neuman's Systems of Model the researchers are able to expound further on the two different variables focused in the study. First, the client's ability to elicit appropriate attitudes or moods towards the external [physical] factor(s) (in this case- the use of colorful mask by his or her attending nurse) and internal factor(s) (in this case- the client's attitude towards the use of colorful mask by his or her attending nurse). Second, the nurses views and actions in terms of preventing communicable disease and promoting optimum health with that of the nurse and client, similarly.

Definition of Terms The researchers provided a quick reference to the following terms presented for the readers who might encounter difficulties in comprehending fully the general view of the study.

Airborne Infection (Disease). It refers to an infection that is contracted by inhalation of microorganisms or spores suspended in air on water droplets or dust particles. Client. It refers to the party to which professional services are rendered. Communicable Disease. It refers to an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agency, and a vector or an inanimate object (Navales, 2007). Droplet. It refers to a particle which is expelled through sneezing, coughing, or talking that may harbor infections. The distance it occupies from the point of exit is within three (3) feet (Navales, 2007). Droplet Infection. It is an infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by someone already infected (droplet nuclei). Epidemic. It refers to the trending of an event (usually disease) in disproportionately large number of individuals within a population, community, or region at the same time. Facemask. It refers to a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in

the immediate environment. Hazards. It refers to a chance or risk of being injured, harmed, or dangered. Microorganism. It referes to a microscopic living organism, such as a bacterium, virus, rickettsia, yeast, or fungus. It may or may not cause harm to its host (Navales, 2007). Mood. It refers to the patient's self-report of prevailing emotional state and is a reflection of the patient's life situation (Stuart and Sundeen, 1988). Nurse Patient Interaction (Relationship). This refers to a relationship that focuses in enhancing the client's well-being, and the client may be an individual, a family, a group or a community. The relationship depends on the interaction of thoughts, feelings, and actions of each person. Pandemic. It refers to the occurrence of event (usually disease) over a wide geographic area and affecting an exceptionally high proportion of the population. Patient. It referes to any recipient of healthcare services. It is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider. Personal Protective Equipment (PPE). This refers to any type of face mask, glove, or clothing that acts as a barrier between infectious materials and the skin, mouth, nose, or eyes (NHS Trust and School of Medicine as cited in PPE at Work Regulations, 1992). Pneumonia. It refers to an acute or chronic disease marked by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms and sometimes by physical and chemical irritants. (MedlinePlus, 2011) Public Health Nursing. It refers to a specialized form of registered nursing that

combines nursing and public health principles. Severe Acute Respiratory Syndrome (SARS). It refers to a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV (MedlinePlus, 2011). Swine flu. It referes to a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barkinglike cough, decreased appetite, and listless behavior (WHO & CDC, 2007). Tuberculosis. It refers to a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis. (MedlinePlus, 2011).