PPE and ME

What is PPE
● Stands for Personal Protective Equipment
● Includes:
○ Masks
○ Gowns
○ Gloves
○ Face shields
● According to Occupational Safety and Health Association, OSHA, PPE is
“specialized clothing or equipment, worn by an employee for protection
against infectious materials.”
Types of PPE
● Depends on field of work
○ Construction PPE
○ Medical PPE
○ Fire Department PPE
○ Police PPE
Masks/Respirators

● Protect mouth and nose

● Types of masks
○ Homemade cloth masks
○ Surgical Masks
○ N95 Respirator
○ P100 Respirators
Mask Use
● Most masks are not meant to protect you from getting a disease, but rather
prevent you from spreading a disease.
● Although they do “reduce the “inoculum” or dose of the virus for the mask
wearer, leading to more mild and asymptomatic infection manifestations,”
(Gandhi, 2020)
Homemade Masks
● Best Material
○ According to an article published in ACS Nano “Cotton performs better at higher weave
densities and can make a significant difference in filtration efficiencies,” (Konda 2020).
○ Hybrids with cotton work extremely well due to “the combined effect of mechanical and
electrostatic-based filtration,” (2020). Such as cotton and flannel.
○ Recommended at least two layers with a filter between them
● Can be easily reused
○ Remember to wash once or twice a week minimum.
● Cost depends on materials
● Easily modified to fit better
Downsides to Homemade Masks
● User Error
○ They go ABOVE THE NOSE
■ Your nasal passages do connect to the lungs
● Leakage
○ Tend to be poorly fitted especially around the nose
○ Try and tighten mask
○ Can be fixed by a piece of metal going across the nose, like that in an N95 respirator.
○ “result in over a 60% decrease in the filtration efficiency,” (Konda, 2020)
● Oversized
○ Leads to mask falling down
○ Can be remedied with anything that pulls the mask tighter to the face
Surgical Masks
● Used to help block large-particle droplets, splashes, sprays, or splatter that
may contain germs, keeping it from reaching your mouth and nose and may
also help reduce exposure of your saliva and respiratory secretions to others,
(FDA).
● Tend to be the cheapest option
● Considered disposable, so change every 3-4 days minimum
○ Especially if damage or soiled.
Downsides of a Surgical Mask
● User-Error
○ Like cloth masks, cover your nose
● Leakage
○ Use one with a metal band to close holes around nose
○ Ends of mask on cheeks can cause leakage without proper fit
N95 Respirator
● Arguably the best option to stop the spread of disease
● SARS-CoV-2 is an enveloped virus ≈0.1 μm (100 nm) in diameter, (Bar-On,
2020), and N95 respirators are able to filter material complying with the N95
criteria (filtering ≥95% particulate), (Cherrie, 2018). Elemental carbon (15-
300nm) was used to measure filtration
● Remember, most virus particles travel in respiratory droplets significantly
larger than the virus. As pksafety.com says “The mask will stop the droplets.”
● Midline in price
● Hard to come by currently
● Should be changed every 3-4 days, if mask. Every 60 days if respirator filter.
Downsides of N95
● Exhalation Valve
○ Given masks are mostly used to stop the infected from spreading it to the healthy, a valve on
the mask is counterintuitive
● Poor fit
○ In the clinical setting, a whole process, a sensitivity to aspartame, is gone through to ensure a
proper fit for the mask and that it sealed correctly.
○ Most people do not have those resources at home.
P100 Respirator
● Blocks at least 99.97%, (CDC), of particulate and is strongly resistant to oil
particles
○ Will block the virus droplets.
● Can be extremely expensive
○ Cost of respirator, plus filters
● Replace filters every 60 days minimum
Downsides to P100 Respirator
● Has a valve for exhalation, so you can transfer virus if you are infected.
● Poor fit
○ Adjust straps to ensure a proper fit
Other Types of Masks
● Full Face Respirator
○ Same positive and negatives as N95 or P100 masks/respirators.
○ Provides barrier for eyes
○ Extremely expensive
● Self-Contained Breathing Apparatus
○ Best way to avoid infection or pass on infection
○ Could make infection worse if already infected
○ Requires training to use
○ Example: Scuba Gear
Debate on Masks
● Evidence for the use of masks to avoid infection has been thoroughly studied
○ Masks help with lowering the chance of spreading the disease and to stop the wearer from
getting as infected
● Why would surgeons wear a mask in a sterile room if they did not work?
● Evidence against masks is anecdotal at best
○ Asthma
○ Lung Transplants/Issues
○ Heart Issues
● Social media does not count as research into an issue
Debate Continued
● Masks can block CO2 and O2
○ False, “A CO2 molecule is 0.33nm diameter,” (Howard, 2020)
○ No mask can block a particle that small
● A 27 μm respiratory droplet contains 1 virion on avg and would evaporate to 5 μm in a few
seconds (2020).
● Most droplets drop to the floor due to gravity, smaller droplets would evaporate very quickly.
● A PM2.5 filter in a cloth mask would block most droplets.
○ Blocks particulate matter 2.5 μm or larger
○ Some have activated carbon to further filter out particulate
Gowns
● Second most used PPE in healthcare setting (Kilinc, 2015)
● Used to protect skin and clothing
● Useful for chemical spills or avoiding contact with infected bodily fluids.
● Material
○ Disposable
■ Nonwoven materials, sometimes with a plastic film for decreased liquid penetration
○ Reusable
■ typically made of 100% cotton, 100% polyester, or polyester/cotton blends (Kilinc).
■ Chemically finished to provide heightened liquid barrier properties
● Used most commonly in the operating room
● Used when entering highly infectious patients room
Downsides of Gowns
● Depending on material/fiber properties
○ Allows easier travel of bacteria or fluids through gown
○ The higher the fiber count, the better
● Cheap gowns
○ Can rip and tear easily allowing fluids to pass barrier
○ Tend to be made of plastic
Gloves
● Create a barrier between hands and bodily fluids or other hazardous materials
● Used to stop cross-contamination between patients along with hand washing.
● Material
○ Latex
○ Nitrile
○ Vinyl
● Most healthcare facilities use nitrile or vinyl gloves due to latex allergies
Use of Gloves
● Most widely used PPE in clinical settings
● A single set of gloves is used in most cases when dealing with patients when
it is expected to come into contact with bodily fluids
● Occasionally a double set of gloves may be used
○ When dealing with a disease with high R₀, such as Covid-19 or Tuberculosis
○ Dealing with diseases that transfer through bodily fluids, such as HIV
○ Invasive surgeries
Public Use of Gloves
● Not recommend for public
● Contributes to cross contamination of objects at a grocery store
● Better off just washing hands
● Keep them out of your mouth
Face Shields
● Used for splash protection from bodily fluids
● Also blocks some respiratory droplets
● Protects face including eyes, nose, and mouth
● According to the CDC, “should cover forehead, extend below chin and
wrap around side of face.”
Downside of Face Shields
● Not a replacement for a mask
○ A face shield does not cover your entire face and air can still flow around the shield
● Both used in conjunction leads to one of the greatest protections from
receiving and/or passing on an infection.
Downsides to Public Use of Disposable PPE
● Pollution
○ The inability of people to walk to a trashcan and throw away their disposable masks and
gloves is appalling.
○ “75 per cent of the used masks, as well as other pandemic-related waste, will end up in
landfills, or floating in the seas,” (news.un.org).
● Cross Contamination
○ Gloves are best used when dealing with one object/person and then changing them
Things to Remember

● Masks work
● Try and get a good fit to minimize leakage from your mask
● Gowns and gloves should not be worn in a public setting
● Wash your hands
● Face shields do not replace a mask
● Use a trash can
References
Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. (n.d.). Retrieved from https://pubs.acs.org/doi/10.1021/acsnano.0c03252

Bar-On, Y. M., Flamholz, A., Phillips, R., & Milo, R. (2020, April 02). SARS-CoV-2 (COVID-19) by the numbers. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224694/

Center for Devices and Radiological Health. (n.d.). N95 Respirators, Surgical Masks, and Face Masks. Retrieved from https://www.fda.gov/medical-devices/personal-protective-

equipment-infection-control/n95-respirators-surgical-masks-and-face-masks#:~:text=If worn properly, a surgical,and respiratory secretions to others.

Five things you should know about disposable masks and plastic pollution | | UN News. (n.d.). Retrieved from https://news.un.org/en/story/2020/07/1069151

Kilinc, F. S. (2015, September). A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791533/

M. Gandhi, D. Y., X. He, E. L., M. Gandhi, D. H., SE. Eikenberry, M. M., A. Handel, Y. L., DS. Miller, T. K., . . . DS. Hains, A. S. (1970, January 01). Masks Do More Than Protect

Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. Retrieved from https://link.springer.com/article/10.1007/s11606-020-06067-

8#:~:text=Although the benefit of population,leading to more mild and

Particle sizes for mask filtration. (n.d.). Retrieved from https://www.fast.ai/2020/06/26/particle-sizes/

https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf