Wednesday, 2 December 2020

PPE

During the first UK lockdown Matt Hancock, Secretary of State for Health and Social Care, stated “NHS and care staff protect us. Every day, while we’re safe at home, they go off to work to care for us. We owe it to them to get them the kit they need to protect themselves” (Department of Health & Social Care 2020). The kit to which he refers is personal protective equipment (PPE); this phrase has become part of everyday conversation and used almost daily in news reports and government press briefings where it had previously only resided in the lexicon of the health & safety specialist.

Although most of us going about our normal business can be protected by keeping our distance, washing our hands, and utilising reusable facemasks, disposable plastics PPE has proved vital in the coronavirus COVID-19 pandemic for those in unavoidable close contact with people. When a disease is so infectious, like COVID-19, single-use PPE helps to stop the spread by blocking and containing any infectious material. It does, however, need to be the right equipment for the right job. To be effective, PPE also needs to be safely removed to avoid self-contamination, be within its expiry date, and be safely and cleanly stored.

Public Health England suggest that gloves are important to protect the hands from encountering a patient’s body fluids, such as blood, broken skin or mucous membranes and that they should be changed immediately after each patient and in some cases between each procedure on the same patient. Aprons need to be worn to protect uniform or clothes especially when a carer or member of NHS staff are providing direct care within 2 metres of a COVID-19 case, alternatively a full body gown could be used. To protect the face and eyes the suggestion for staff is to wear visors and Type IIR face masks to cover the mouth and nose, these should not be touched or allowed to hang around the neck between uses. (Public Health England 2020)

Where PPE comes in different sizes, the correct size should be selected as a good fit will ensure the best protection available. Donning (putting on) and doffing (taking off) needs to be done with great care to prevent self-contamination. Even with PPE it is important to maintain good hand hygiene using an alcohol-based solution. The first piece of equipment to put on is the long sleeve gown, followed by the mask, goggles, visor, and then finally the gloves. When removing such equipment, the gloves are the first to be removed following an 8-step procedure: ‘(1) start by pinching and holding the glove (with the other gloved hand) between the palm and wrist area, (2) peel the glove away from the wrist, (3) until it turns inside out covering the fingers. With the now half-gloved hand, (4) pinch and hold the fully gloved hand between the palm and wrist, (5) peel the glove away from the wrist (6) until it turns inside out and covers the fingers. Now that both hands are half-gloved, (7) remove the glove from one hand completely by grabbing the inside part of the glove and peeling it away from the hand, and do the same for the remaining half-gloved hand using the non-gloved hand, while always grabbing the inside part of the glove. Dispose of the gloves (8) in a biohazard bin.’

Once the gloves are removed, the hands should be cleaned with an alcohol-based solution before another set of gloves are donned to continue the removal of the rest of the PPE. Now the gown can be removed, disposable gowns should be pulled away from the body keeping the contaminated front part inside the gown. Touching the front part of the goggles should be avoided as they could be contaminated so if they are the type with an elasticated strap around the back of the head this should be used to remove them. Masks should be removed by the ear straps, and then finally the gloves should be removed and hand hygiene carried out once again (European Centre for Disease Prevention and Control 2020).

The extensive use of PPE within both the medical setting and by the general population has seen an increase in polymer sales. The production of N95-type masks in China went from 20 million units per day before the pandemic to 150 million as the virus began to spread significantly. As demands changed from one material for a particular product fell, manufacturers changed their working practices to keep their businesses going, in some cases this meant changing their equipment to cope with the new materials, one manufacturer ‘that customarily produces polyolefin film needed special dryers installed so it could run polycarbonate instead. Other firms have installed new rollers or hydraulic screws that pump molten resin. Yet others have ordered up tools to begin injection molding the long stems for the nasopharyngeal swabs used for COVID-19 tests.’ Makers of engineering polymers makers also witnessed a rush on materials for medical devices (Tullo 2020).

PPE has not only been used by the healthcare professionals, with an estimated monthly usage being estimated as 89 million medical masks, 76 million gloves, and 1.6 million goggles, but the general public have increased their usage as well. Unfortunately, this has led to the poor disposal of gloves and face masks with an increase of littering in public spaces. The fear of reusable items being carriers of the virus has also led to calls to withdraw bans on single-use plastic bags and other such items (Prata et al. 2020). There are organisations, such as TerraCycle, who are looking at ways of gathering and recycling certain types of PPE (TerraCycle 2020) but there are costs involved making it prohibitive for many individuals, however, organisations including MoDiP can have receptacles in place to collect nitrile gloves and single-use masks which are then sent off to TerracCycle to use the materials to create other products.

MoDiP has put on a small exhibition of PPE which is designed to be used in a medical and caring setting. 

MoDiP's PPE exhibition


Polythene (PE) aprons (1) offer protection from low level hazards where risk of injury is minimal. They can be removed quickly by pulling at the material which breaks easily. Such large quantities are used each day that they are purchased in bulk. However, it is important to store them properly so they do not gather dust; a potential breeding ground for bacteria. 

 

Disposable aprons


Face masks and shields are effective in reducing the spread of airborne disease by capturing liquid particles from the mouth and nose. Disposable masks, like the Wondo Medical Surgical Masks (2), are used extensively by frontline staff, surgeons and other medical professionals on a daily basis. Being made of three layers: an outer of non-woven polypropylene (PP), a middle layer of high efficiency blown melt material which is possibly PP, and an inner layer of non-woven polyester (which is soft against the face), they have a high bacterial filtration efficiency at more than 98%. 

 

Various objects of PPE on display.


Masks with ear loops can be extremely uncomfortable if worn for a whole session of 3 or 4 hours, so to alleviate the pressure and prevent wounds, flexible PP ear guards (3) are worn at the back of the head with the ear loop threaded over one set of hooks on each side. Alternative masks like the Handanhy FFP3 NR D face mask (4) have elastic straps which sit across the back of the head. This mask is graded a FFP3 which denotes the level of protection provided by the mask against very fine dust, fibres, aqueous mists and oil-based mists. FFP stands for Filtering Face Piece and NR means non-reusable. To offer additional protection, a face shield can be worn over a mask and goggles or glasses. The Barriguard face shield (5) offers high level protection to the face and eyes from airborne viruses with the foam headband offering a ‘no-gap’ design protecting the wearer from liquid or air entry. 

 

Thumbloop gown.


The Biogel Neoderm surgical gloves (6) have a long cuff to cover the wrist and lower arm. The inner coating of Biogel makes it easier to put them on even with wet hands and helps to soothe the skin to help prevent moisture loss. Gloves can be worn with PE gowns with long sleeves and thumbloops (7) to create good, secure, coverage of the upper body particularly during prolonged contact with fluid.

Objects

1. Disposable polythene aprons, Unknown, 2020. AIBDC : 008492

2. Face Shield Visor, Barriguard, 2010s circa. AIBDC : 008486

3. Medical Surgical Face Masks, Hunan Wondo Medical Supplies, 2020. AIBDC : 008487

4. Face mask ear guards, Fenton Precision, 2020. AIBDC : 008488.5

5. FFP3 NR D face mask, Handan Hengyong Protective & Clean Products, 2020. AIBDC : 008489

6. Biogel Neoderm gloves, Molnlycke Health Care, 2020 circa. AIBDC : 008490

7. Protective thumbloop gown, Finess Healthcare Group for Gen Med Enterprises, 2020. AIBDC : 008491



Louise Dennis, Curator of MoDiP 



References

Department of Health & Social Care, 2020. COVID-19: personal protective equipment (PPE) plan [online]. GOV.UK. Available from: https://www.gov.uk/government/publications/coronavirus-covid-19-personal-protective-equipment-ppe-plan/covid-19-personal-protective-equipment-ppe-plan [Accessed 26 Oct 2020].

European Centre for Disease Prevention and Control, 2020. Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19 [online]. Stockholm. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-guidance-wearing-and-removing-personal-protective-equipment-healthcare-settings-updated.pdf [Accessed 26 Oct 2020].

Prata, J. C., Silva, A. L. P., Walker, T. R., Duarte, A. C., and Rocha-Santos, T., 2020. COVID-19 Pandemic Repercussions on the Use and Management of Plastics. Environmental Science & Technology, 54 (13), 7760–7765.

Public Health England, 2020. COVID-19 infection prevention and control guidance [online]. Available from: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control [Accessed 26 Oct 2020].

TerraCycle, 2020. TerraCycle [online]. TerraCycle. Available from: https://www.terracycle.com/en-GB [Accessed 26 Oct 2020].

Tullo, A., 2020. Plastics during the pandemic. C&EN Global Enterprise, 98, 24–25.




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