PERSONAL PROTECTIVE EQUIPMENT (PPE)

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PERSONAL PROTECTIVE EQUIPMENT (PPE)

Personal protective equipment – known as ‘PPE’ – is used to protect health care workers while performing specific tasks that might involve them coming into contact with blood or body fluids that may contain some infectious agents (germs).

Personal protective equipment is special equipment you wear to create a barrier between you and germs. This barrier reduces the chance of touching, being exposed to, and spreading germs. Personal protective equipment (PPE) helps prevent the spread of germs in the hospital. This can protect people and health care workers from infections.

It includes many of the items often associated with health care by the public – gowns, gloves and masks. These items will be for single use only – that is, you MUST use them once and then discard them – while others are retained, cleaned and reused.

All hospital staff, patients, and visitors should use PPE when there will be contact with blood or other bodily fluids.

Types of PPE

These are mainly categorized under the following classes;

Masks
Eye Protection PPE
Clothing PPE

Masks

It is defined as the protective covering for the face or part of the face. i.e. they cover your mouth and nose.

Types of masks

There are two types of masks on the Ugandan market namely:

Medical masks
Non- Medical masks

Medical masks

Medical masks should be preserved for health workers in health facilities and are not reusable There are 2 main types of masks used to prevent respiratory infection namely

Surgical masks also called the face masks
Respirators e.g. N95 and KN95

Surgical masks

Definition: A surgical mask is 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. These are sometimes referred to as face masks, as described above, although not all face masks are regulated as surgical masks.

Note:

Surgical masks are made in different thicknesses and with different ability to protect you from contact with liquids.
These properties may also affect how easily you can breathe through the face mask and how well the surgical mask protects you.
Surgical masks are not intended to be used more than once.
Surgical masks are not to be shared and may be labeled as surgical, isolation, dental, or medical procedure masks.

While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures.

Respirators

A respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles.

Note that the edges of the respirator are designed to form a seal around the nose and mouth. Types of respirators

N95 (commonly used in Uganda)
KN95

General Respirator Precautions

People with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their health care provider before using an N95 respirator because the N95 respirator can make it more difficult for the wearer to breathe.
Some models have exhalation valves that can make breathing out easier and help reduce heat build up. Note that N95 respirators with exhalation valves should not be used when sterile conditions are needed.
All respirators are labeled as “single-use,” disposable devices. If your respirator is damaged or soiled, or if breathing becomes difficult, you should remove the respirator, discard it properly, and replace it with a new one. To safely discard your N95 respirator, place it in a plastic bag and put it in the trash. Wash your hands after handling the used respirator.
N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection.

Comparison between a surgical mask and a respirator

A surgical mask is 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 whereas a respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles.

Wear medical masks with

A proper fit over your nose and mouth to prevent leaks
Multiple layers of non-woven material
Disposable masks are widely available.

Do NOT wear medical masks with

Wet or dirty material

Ways to have better fit and extra protection with medical masks

Wear two masks (disposable mask underneath AND cloth mask on top)
Combine either a cloth mask or disposable mask with a fitter or brace
Knot and tuck ear loops of a 3-ply mask where they join the edge of the mask
Use masks that attach behind the neck and head with either elastic bands or ties (instead of ear loops)

Non-medical masks

The non-medical masks are made out of fabric (cloth)

They are sometimes called reusable masks because one can wash and iron then wear them again The community in Uganda is encouraged to use non-medical masks (masks made out of fabrics e.g. cotton masks

A 2 layered cotton mask with a filter material e.g. paper towel or coffee filter or polypropylene (the material often used for non-plastic shopping bags placed between the 2 layers may improve the mask . This material acts as a filter and can be removed before washing. Polypropylene is washable and reusable Cloth Masks can be made from a variety of fabrics and many types of cloth masks are available.

Wear cloth masks with

A proper fit over your nose and mouth to prevent leaks
Multiple layers of tightly woven, breathable fabric
Fabric that blocks light when held up to bright light source mask considerations tightly woven Do NOT wear cloth masks with
Gaps around the sides of the face or nose
Exhalation valves, vents, or other openings (see example)
Single-layer fabric or those made of thin fabric that don’t block light

Who should wear masks

All adults
Children aged 6 years and above
Children aged 2- 6 years are very active and cannot take care of their masks and observe hygiene. They should only put on masks under close supervision

NB: Children below 2 years should not wear a mask as they have a small lung capacity Places to where masks in this COVID 19 pandemic

When going to public places – e.g. work, public transport, markets, supermarkets, shops, classrooms, places of worship, healthcare facilities etc
When acceptable social distancing is not possible
When one has a cough, cold or sore throat even when at home
When at home and visited by a person who is not part of the household
When in any congested area
At work places, especially when with colleagues

NB: Do NOT wear a mask when running, jogging, or doing other physical activities

It is not necessary to wear a mask when you are alone in the car but have it ready in case of another passenger or when you step out

Precautions of wearing the masks pandemic

To put on the mask, hold onto the straps or loops and place it over the nose and mouth all the way to the chin
Avoid touching the front and inner sides of the mask
The mask should be kept on even when talking
In case of need to remove the mask like for eating or drinking, the mask should be removed completely by holding on to the straps and folded with the inner side in and placed in a clean container such as an envelope. It may also be hanged on nails, hooks e.t.c, in such a way that it does not touch any surfaces
Wash hands with soap and water or use a hand sanitizer whenever one touches the front or inside of the mask

How well should one care the mask

Ensure the mask covers the nose, mouth and chin when wearing it.
Keep the mask hanging in a clean area or in a clean envelope/container when not wearing it
Wash and dry reusable fabric (cotton) masks daily.
Remove the filter before washing the mask.
If the filter is washable (e.g. polypropylene) wash and dry it separately

Eye protection PPE

These PPE protect mainly the eyes. They includes

Face shields
Goggles.

These protect the mucous membranes in your eyes from blood and other bodily fluids. If these fluids make contact with the eyes, germs in the fluid can enter the body through the mucous membranes.

Clothing PPE

These are often used during surgery to protect you and the patient.

They are also used during surgery to protect you when you work with bodily fluids. Visitors wear gowns if they are visiting a person who is in isolation due to an illness that can be easily spread. They include

Gowns
Aprons
Head covering
Shoe covers.

Aprons/Disposable aprons

Aprons must always be changed after you finish care activities with each person.

These aren’t needed to carry out many normal aspects of Day today care with patients/clients, such as helping them to go for short walks, but you will need one when you are:

Performing or assisting in a procedure that might involve splashing of body fluids
Performing or helping the patient/client with personal hygiene tasks
Carrying out cleaning and tidying tasks in the patient’s/client’s living space, such as bed making. You must always perform hand hygiene before putting a disposable gown on and after taking it off and placing it in the correct clinical waste bin.

Note that different organizations have different colored aprons for different tasks – you should always check your workplace’s local policy.

Putting on

Pull the apron over your head and fasten at the back of your waist.

Taking off

Unfasten (or break) the ties.
Pull the apron away from your neck and shoulders, lifting it over your head and taking care to touch the inside only, not the contaminated outer side.
Fold or roll the apron into a bundle with the inner side outermost.
Dispose of the apron in the clinical waste bin.
Perform hand hygiene.

Gloves/Disposable gloves

This is a type of clothing that covers the hand thereby preventing the spread of infection through the hands Disposable gloves should only be worn if you’re performing or assisting in a procedure that involves a risk of contact with body fluids, broken skin, dirty instruments and harmful substances such as chemicals and disinfectants.

Types of glove

Examination gloves: These are used by health workers during examination of the patient or non invasive procedures e.g. general body examinations, taking vital observations.
Surgical gloves: These are worn during surgeries, wound dressing and while performing any invasive procedure

Gloves should not be routinely used or put on ‘just in case’. This is dangerous for the patient/client as you will not be able to wash your hands when you are wearing gloves.

Gloves need to be used in specific circumstances only i.e. procedures that involve:

A risk of being splashed by body fluids (blood, saliva, sputum, vomit, urine or faeces, for instance)
Contact with the patient’s/client’s eyes, nose, ears, lips, mouth or genital area, or any instruments that have been in contact with these areas.
Contact with an open wound or cut .
Handling potentially harmful substances, such as disinfectants.

Note: that disposable gloves are NOT necessary for many parts of routine day care, like helping a patient/client to wash and dress or bed making.

Gloves should:

Fit you comfortably (not be too tight or too loose)
Be changed between patients/clients and between different tasks with the same patient/client
Never be washed or reused.

When you’ve finished the procedure, you should take the gloves off, avoid touching the outer surfaces (which are likely to be contaminated with germs), and dispose of them in the correct waste disposal system. You must then perform hand hygiene.

Putting on gloves

Select the correct glove size and type.
Perform hand hygiene.
Pull to cover wrists.

Taking off gloves

Grasp the outside of the glove with the opposite gloved hand and peel off.
Hold the removed glove in the gloved hand.
Slot your finger under the lip of the remaining glove and peel it off, taking care not to touch the contaminated outer surface.
Dispose of the gloves in the clinical waste bin.
Perform hand hygiene.

Warning!

Some gloves have a substance called ‘latex’ that can cause serious allergies. If you know you have an allergy to latex, you must tell your employer so that alternative gloves can be supplied.
Some nursing staff experience sore hands as a result of their job, usually caused by a mixture of things such as wet work (bathing, washing patients), using wipes and alcohol hand gel, wearing gloves and not drying their hands properly.
If you have sore hands you should tell your manager and report it to your occupational health department or lead.

Benefits of using PPE in the health care facility

It prevents the transmission of infection between

Patient to patient
Health worker to patient and vice versa
Health worker to health worker
It motivates health workers to provide care to patients with infectious diseases comfortably

FIRE EXTINGUISHERS

A fire extinguisher is an active fire protection device used to extinguish or control small fires, often in emergency situations.

Elements of fire

Actually, it’s a tetrahedron, because there are four elements that must be present for a fire to exist.

There must be oxygen to sustain combustion
Heat to raise the material to its ignition temperature,
Fuel to support the combustion
Chemical reaction between the other three elements. It is summarized in the picture below which is the fire triangle.

NB: Remove any one of the four elements to extinguish the fire.

Types of fire

Most household fires fall into one of the following categories:

Class A: These are fires in ordinary combustibles such as wood, paper, cloth, rubber, and many plastics.
Class B: These are fires in flammable liquids such as gasoline, petroleum greases, tars, oils, oil-based paints, solvents, alcohols. Class B fires also include flammable gases such as propane and butane. Class B fires do not include fires involving cooking oils and grease.
Class C: These are fires involving energized electrical equipment such as computers, servers, motors, transformers, and appliances. Remove the power and the Class C fire becomes one of the other classes of fire.
Class D: These are fires in combustible metals such as magnesium, titanium, zirconium, sodium, lithium, and potassium.
Class K: These are fires in cooking oils and greases such as animal and vegetable fats.

NB: Some types of fire extinguishing agents can be used on more than one class of fire. Others have warnings where it would be dangerous for the operator to use on a particular fire extinguishing agent.

Classification of fire extinguishers

Classification according to the type of fire they extinguish

There are four classes of fire extinguishers – A, B, C and D – and each class can put out a different type of fire.

Class A extinguishers will put out fires in ordinary combustibles such as wood and paper
Class B extinguishers are for use on flammable liquids like grease, gasoline and oil
Class C extinguishers are suitable for use only on electrically energized fires
Class D extinguishers are designed for use on flammable metals

Classification of fire extinguishers according to chemical composition

Water and Foam fire extinguishers: They extinguish the fire by taking away the heat element of the fire triangle.

(a). Foam agents also separate the oxygen element from the other elements.
(b).Water extinguishers are for Class A fires only – they should not be used on Class B or C fires. The discharge stream could spread the flammable liquid in a Class B fire or could create a shock hazard on a Class C fire.

Carbon Dioxide fire extinguishers: They extinguish fire by taking away the oxygen element of the fire triangle and also by removing the heat with a very cold discharge. Carbon dioxide can be used on Class B & C fires. They are usually ineffective on Class A fires.
Dry Chemical fire extinguishers: They extinguish the fire primarily by interrupting the chemical reaction of the fire triangle. Today’s most widely used type of fire extinguisher is the multipurpose dry chemical that is effective on Class A, B, and C fires. This agent also works by creating a barrier between the oxygen element and the fuel element on Class A fires.
Wet Chemical fire extinguishers: This is a new agent that extinguishes the fire by removing the heat of the fire triangle and prevents re-ignition by creating a barrier between the oxygen and fuel elements. Wet chemicals of Class K extinguishers were developed for modern, high efficiency deep fat fryers in commercial cooking operations. Some may also be used on Class A fires in commercial kitchens.

Halogenated or Clean Agent extinguishers: They include the halon agents as well as the newer and less ozone depleting halocarbon agents. They extinguish the fire by interrupting the chemical reaction and/or removing heat from the fire triangle. Clean agent extinguishers They are effective on Class A, B and C fires.
Dry Powder extinguishers: Dry Powder extinguishers are similar to dry chemicals except that they extinguish the fire by separating the fuel from the oxygen element or by removing the heat element of the fire triangle. However, dry powder extinguishers are for Class D or combustible metal fires, only. They are ineffective on all other classes of fires.
Water Mist extinguishers: They are a recent development that extinguish the fire by taking away the heat element of the fire triangle. They are an alternative to the clean agent extinguishers where contamination is a concern. Water mist extinguishers are primarily for Class A fires, although they are safe for use on Class C fires as well.

Rules for fighting fire

They are 3 A’s

ACTIVATE the building alarm system or notify the fire department by calling 911. Or, have someone else do this for you.
ASSIST any persons in immediate danger, or those incapable on their own, to exit the building, without risk to yourself.
Only after these two are completed should you ATTEMPT to extinguish the fire.

Only fight fire if:

The fire is small and contained
You are safe from toxic smoke
You have a means of escape
Your instincts tell you it’s OK

Fire extinguisher use

It is important to know the locations and the types of extinguishers in your workplace prior to actually using one.

Fire extinguishers can be heavy, so it’s a good idea to practice picking up and holding an extinguisher to get an idea of the weight and feel.
Take time to read the operating instructions and warnings found on the fire extinguisher label. Not all fire extinguishers look alike.
Practice releasing the discharge hose or horn and aiming it at the base of an imagined fire. Do not pull the pin or squeeze the lever. This will break the extinguisher seal and cause it to lose pressure
When it is time to use the extinguisher on a fire, just remember PASS!

(a). Pull the pin.
(b).Aim the nozzle or hose at the base of the fire from the recommended safe distance.
(c). Squeeze the operating lever to discharge the fire extinguishing agent.
(d). Starting at the recommended distance, Sweep the nozzle of hose from side to side until the fire is out. Move forward or around the fire area as the fire diminishes. Watch the area in case of re ignition.

Maintenance of a Fire extinguisher

In addition, fire extinguishers must be maintained annually in accordance with local, state, and national codes and regulations. This is a thorough examination of the fire extinguisher’s mechanical parts, fire extinguishing agent, and the expellent gas.

Your fire equipment professional is the ideal person to perform the annual maintenance because they have the appropriate servicing manuals, tools, recharge materials, parts, lubricants, and the necessary training and experience.

Inspection of a fire extinguisher

Like any mechanical device, fire extinguishers must be maintained on a regular basis to ensure their proper operation. You, the owner or occupant of the property where the fire extinguishers are located, are responsible for arranging your fire extinguishers’ maintenance.

Fire extinguishers must be inspected or given a “quick check” every 30 days.

For most extinguishers, this is a job that you can easily do by locating the extinguishers in your workplace and answering the three questions below.

Is the extinguisher in the correct location?
Is it visible and accessible?
Does the gauge or pressure indicator show the correct pressure?

Precautions of Fire extinguishers

Don’t Ignore the Instructions: Thoroughly read the operating instructions that came with your fire extinguisher. Make sure all able members of your home read and understand the instructions. Review them regularly when you conduct fire drills and go over your evacuation plan.
Don’t Use the Wrong Type of Fire Extinguisher: Never use a fire extinguisher for a class of fire that is not indicated on the label. Most importantly, extinguishers that are labeled for Class A fires only cannot be used on electrical or grease fires. However, it is safe to use an extinguisher labeled for Class B and C fires on a Class A fire. While Class K fires are technically a subset of Class B fires, other contents in Class B extinguishers can make Class K fires worse, so it’s best to get a separate extinguisher for cooking fires.
Don’t Let Your Extinguisher Go Bad: Fire extinguishers come with an expiration date, after which the extinguishing agent is no longer effective. Know the dates on your fire extinguishers and replace them as needed.
Don’t Forget about Exits: When you decide where to keep your fire extinguisher, make sure it is in an easily accessible location near exterior doors. Also, consider the most common places where fires occur in a home
Don’t Keep It a Secret: Make sure that everyone in your home knows where the fire extinguishers are kept. Share the location, along with your entire fire escape plan, with babysitters, house sitters, and any long-term visitors.

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PERSONAL PROTECTIVE EQUIPMENT (PPE)