Abstract
Personal Protective types of Equipment (PPE) are needed for everybody who would be in danger of threatening state; the COVID-19 pandemic raised the need and global demand for PPE, one of the most used and required equipment are gowns, coveralls, and torso protectors; which their shortage of supply raised the cost globally too. This review article gathered the guidelines and recommendations from manufacturers, international organizations, and self-experiments of authors for these utilities. And, provides recommendations on the level of protection needed for each condition.
Author Contributions
Copyright© 2021
Valikhanlou Nayyereh, et al.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
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Results
We have reached three general guidelines from WHO about PPE use for healthcare providers
Discussion
All health care workers and who may be in direct or indirect with the blood or body fluid of blood-borne infection must wear protective body-wear that: Covers all skin and mucus membrane Should be waterproof and impenetrable to viruses and fluids empowered if needed to gain more accuracy of protections recommended to be done under the supervision of a fellow with a checklist to reduce the probability of breach in the donning and doffing of the PPE Coveralls seems to be introduced while Ebola Outbreak in 2015 and also are known as Ebola PPE too; however using gowns may be preferred among health care providers due to the following statements, there is no strong recommendation for or against any of these options, and the comfort of the user is mandatory: The most crucial in choosing between gown or overall is the comfort of the user during the working shift, ease, and freedom of activity in the wearing. Gowns may be preferred due to their familiarity among health care providers and better compatibility with donning and doffing them. In some cultures, it s not acceptable for women to wear coverall-like body wears, and therefore gowns are tolerable. Gowns may be better tolerable in heat climate. In case the coverall s size doesn t fit the provider, two gowns may protect the provider s torso when the first one is putting on like a casual coat and protect the back, then the second one should be done as usual to protect the front. It s not recommended to reuse the gowns or aprons in WHO guidelines, which means as they have been contaminated, they should be taken off and done by new body wears. However, note that in case of resource shortage, using heavy-duty products that could be disinfected between patients and at the end of working shifts may be logical. Either use of heavy-duty and reusable gown, apron or coverall, the headcover or whatever part that would be responsible for protecting the head and face and is donning and doffing through the head, shouldn t exceed from the nipple line length to reduce the probability of pathogen transmission during doffing the PPE. And to remind leaning forward while doffing any PPE that is used for head and neck region protection. Whenever the separate head-cover is not available, a coverall with a hood can be worn after donning the facial and respiratory protectors, which maintains the mucosal protection after taking off the hooded coverall. A plastic Apron may be used on the gown or coverall to add impenetrable efficacy to the fabric. The footwear that is used by healthcare providers in the crisis of blood-borne infection site, should be waterproof and washable. It s recommended to wear waterproof boots (rubber/gum boots) over shoes due to their optimal protection against pathogens and better protection when the floor is wet. Boots also can stay in place while the whole working shift time and easily get cleaned or disinfected if needed. If the provider prefers to use shoes, they should be closed shoes that may seal the dorsum of the foot better; and it s recommended to put on waterproof covers that their length may cover up to the mid-calf region. As a full set of PPE is mandatory for all health care workers that may be in direct or indirect contact with blood-borne pathogens; the use of a full set of PPE is not recommended for air-borne diseases and this could be a resource management capability during crisis and resource shortage.
Conclusion
Choosing gown or coverall depends mostly on providers’ comfort of use. Breathable fabric may protect the same as non-breathable also provide better comfort and less heat stress for providers. The apron may be used on gown or coverall to strengthen its impenetrability. Doffing all PPE which is worn through head and neck should be provided in a leaning forward position to reduce the risk of eye and mucous contamination. Foot wear should be impenetrable, seal the dorsum of the foot, and washable; it’s also recommended to use a cover on the foot wear that may extend to the calf and been fixed in place. In the time of supply shortage, using heavy-duty materials could be logical to both protect the providers and reduce the budget. Also, providers should be aware of indications for contact, droplet, and air-borne precautions.