 Selection and use of PPE by Nazrin Binti Junaidi. Factors influencing PPE selection. When you are selecting PPE, consider three key things. First is the type of anticipated exposure. This is determined by the type of anticipated exposure such as touch, splashes or sprays, or large volumes of blood or body fluids that might penetrate their clothing. PPE selection in particular, the combination of PPE also is determined by the category of isolation precautions a patient is on. Secondly, and very much linked to the first is the durability and appropriateness of the PPE for the task. This will affect for example whether a gown or apron is selected for PPE or if a gown is selected, whether it needs to be fluid resistant, fluid proof or neither. Third is fit. How many of you have seen someone trying to work in PPE that is too small or large? PPE must be fit the individual user and it is up to the employer to ensure that all PPE are available in sizes appropriate for the workforce that must be protected. With this as a break ground, let's now discuss how to select and use the specific PPE. Gloves. Gloves are the most common type of PPE used in the healthcare settings. As you can see here, there are several things to consider when selecting the right glove for a specified purpose. Most patient care activities require the use of a single pair of non-steral gloves made of either latex, nitrile or vinyl. However, because of allergy concerns, some facilities have eliminated or limited latex products including gloves and now use gloves made of nitrile or other material. Vinyl gloves are also frequently available and work well if there is limited patient contact. However, some gloves do not provide a snug fit on the hand especially around the wrist and therefore should not be used if extensive contact is likely. Gloves should fit the user's hand comfortably. They should not be too loose or too tight. They also should not tear or damage easily. Gloves are sometimes worn for several hours and need to stand up to the task. Do's and don'ts of gloves use. Gloves protect you against contact with infectious materials. However, once contaminated, gloves can become a means for spreading infectious materials to yourself, other patients or environmental surfaces. Therefore, the way you use the gloves can influence the risk of disease transmission in your healthcare setting. These are the most important do's and don'ts of glove use. Work from clean to dirty. This is the basic principle of infection control. In this instance, it refers to touching clean body sites or surfaces before you touch dirty or heavily contaminated areas. Limit opportunities for touch contamination. Protect yourself, others and environmental surfaces. How many times have you seen someone adjust their glasses? Rub their nose or touch their face with gloves that have been in contact with a patient. This is one example of touch contamination that can potentially expose oneself to infectious agents. Think about environmental surfaces too and avoid unnecessarily touching them with contaminated gloves. Surfaces such as light switches, door and cabinet knobs can become contaminated if touched by soil gloves. Do's and don'ts of glove use. Change gloves as needed. If gloves become torn and heavily soiled and additional patient care task must be performed, then change the gloves before starting the next task. Always change gloves after use of each patient and discard them in the nearest appropriate receptacle. Patient care gloves does not necessarily make them safe for use. It may not be possible to eliminate all microagranisms and washing can make the gloves more prone to tearing or leaking. Gowns or aprons. These are three factors that influence the selection of a gown or apron as PPE. First is the purpose of use. Isolation gowns are generally the preferred PPE for clothing but aprons occasionally are used where limited contamination is anticipated. If contamination of the arms can be anticipated, a gown should be selected. Gowns should be fully covered the torso, fit comfortably over the body and have long sleeves that fits snugly at the wrist. Second are the material properties of the gown. Isolation gowns are made either of cotton or a spun synthetic material that dictate whether they can be laundered and reused or must be disposed. Cotton and spun synthetic isolation gowns vary in their degree of fluid resistance. Another factor that must be considered in the selection of this garb. If fluid penetration is likely, a fluid resistant gown should be used. The last factor concerns patient wrist and whether a clean rather the sterile gown can be used. Clean gowns are generally used for isolation. Sterile gowns are only necessarily for performing invasive procedures such as inserting a central line. In this case, a sterile gown would serve purposes of patient and healthcare worker protection. Face protection. A combination of PPE types is available to protect all or parts of the face from contact with potentially infectious material. The selection of facial PPE is determined by the isolation precautions required for the patient and or the nature of the patient contact. This will be discussed later. Mas should fully cover the nose and mouth and prevent fluid penetrations. Mas should fit snugly over the nose and mouth. For this reason, mas that have a flexible nose piece can be secured to the head with a string ties or elastic are preferable. Goggles provide barrier protection for the eyes. Personal prescription lenses do not provide optimal eye protection and should not be used as substitute for goggles. Goggles should fit snugly over and around the eyes or personal prescription lenses. Goggles with anti-fog features will help maintain clarity of vision. Face protection. Can skin protection in addition to mouth, nose and eye protection is needed or desired. For example, when irrigating a wound or suctioning copious secretions, a face shield can be used as a substitute to wearing a mask or goggles. The face shield should cover the forehead, extend below the chin and wrap around the side of the face. Respiratory protection. PPE is also used to protect from hazardous or infectious aerosols. Respirators that filter the air before it is inhaled should be used for respiratory protection. Respirators yang paling commonly used in healthcare settings are the N95, N99 or N100 particulate respirators. The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameters. Like other PPE, the selection of a respirator type must consider the nature of the exposure and risk involved. For example, N95 particulate respirators might be worn by personnel entering the room of a patient with infectious tuberculosis.