What is PPE? Everything You Need to Know About Personal Protective Equipment Amid the Coronavirus Outbreak
PPE: it's an acronym that you've likely heard a lot in the past few weeks—particularly in terms of shortages for medical professionals. It stands for personal protective equipment, and it's one crucial way to both stop the spread of COVID-19 and keep the healthcare workers (doctors, nurses, other caregivers) currently on the pandemic's frontlines safe.
While the equipment is necessary for both public and personal health, there's one glaring issue in the US right now concerning PPE: a major shortage—and its putting any one who comes into contact with COVID-19 patients at risk,
“Doctors cannot do [social distancing] when seeing patients," Lauren Pischel, MD, infectious disease fellows at Yale School of Medicine, tells Health, explaining why doctors and nurses need PPE. "They need to be close to patients often for often prolonged periods of time, whether that is to take a history of what a patient's symptoms are, do a physical exam to look for clues about what is going, or do a procedure."
But the lack of PPE isn't just an issue within the US—it's a global concern. "The current global stockpile of PPE is insufficient, particularly for medical masks and respirators," explained the World Health Organization (WHO) in a March 19 document summarizing recommendations for the "rational use" of PPE, adding that “the supply of gowns and goggles is soon expected to be insufficient also.” The WHO goes on to explain that the current PPE shortage is "driven not only by the number of COVID-19 cases but also by misinformation, panic buying and stockpiling"—something that, if it continues, will only lead to further shortages of PPE.
Dr. Pischel echoes this: “As the world has been treating cases from this pandemic, a lot of PPE has been used up. This creates a great stain on supply chains with resulting significant shortages of PPE with different regions impacted more severely than others,” she explains. “Many health systems are starting to ration PPE because this pandemic will likely go on for some time so we need to save PPE for several weeks to months for now in order to avoid a situation where there is no PPE at all.”
What exactly is considered PPE?
According to the Food and Drug Administration (FDA), PPE works as a barrier between an individual’s skin, mouth, nose, or eyes and viral and bacterial infections. In order to be used in a medical setting, most PPE—medical gloves, gowns, and N95 respirators—is regulated by the government agency and must meet their regulations.
“When used properly and with other infection control practices such as hand-washing, using alcohol-based hand sanitizers, and covering coughs and sneezes, [PPE] minimizes the spread of infection from one person to another,” the FDA explains on its website.
PPE also varies situationally, per the World Health Organization (WHO). For example, the sufficient gear needed to treat patients with the flu varies from that which is crucial when dealing with those infected with Ebola. In the context of COVID-19—which is spread primarily between people through close contact and droplets, not by airborne transmission—PPE includes the following, but can vary between medical professionals, hospital cleaners, and patient visitors:
- Medical masks
- Respirators (N95 or FFP2 standard, or equivalent)
- Eye protection
- Boots or closed-toe work shoes
Certain procedures also necessitate a greater need for PPE, says Dr. Pischel, pointing to intubation (the process of inserting a tube through a patient's mouth and into their airway) and nebulizer treatments (a machine that delivers medicated mist to the lungs). "These procedures create a large amount of virus in the air so anyone around would need to wear PPE." But really, Dr. Pischel points out that “anyone who is entering into a patient’s room with known COVID-19,” is in need of the recommended protective gear.
Can PPE be reused or shared?
The issue with most PPE items stems from the first word of the acronym: personal. With few exceptions, “in general, most PPE is designed to be used only one time and by one person prior to disposal,” explains the FDA. Therefore, washing and reusing or sharing equipment with other users is not intended.
However, new medical research published by MedRxiv (a database for preprints of studies that have not yet been peer reviewed) on March 27 may be game-changing in regards to N95 masks. Yale Medicine doctors found that many N95 masks can be reprocessed, using vaporized hydrogen peroxide to sterilize them for reuse. In short, they were able to clean a room full of N95s all at once using a system used to fumigate hospital rooms after patients with the hospital infection C. Diff are discharged. The results were replicated three times.
“There is data showing that you can do this to N95 respirators without damaging their ability to act as a high efficiency filter, but there has never been any showing that this is effective for viruses on a respirator,” Patrick Kenney, MD, medical director of the supply chain for Yale Medicine and Yale New Haven Health, explains to Health. “We inoculated N95s with three different viruses that are a reasonable proxy for SARS-CoV-2 and then reprocessed them. A highly sensitive test showed no evidence of residual virus.”
While the CDC is expected to recommend that Americans begin wearing cloth masks or face coverings to prevent the spread of COVID-19, surgical masks and N95 masks are definitely not recommended for the general public, a message that Dr. Pischel echoes. This is incredibly important in regards to the shortage, because for every civilian who is hoarding one of these much-needed masks, there is a healthcare worker whose own health is being compromised.
While various companies that don't usually produce PPE are working hard to make supplies for medical professionals, and government leaders are trying to supply hospitals with shipments of PPE, it's still not enough—yet. If you're currently in possession of extra masks, or know a company that is, you can donate them to various initiatives including PPE Link and the website #FindtheMasks, among others.
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.
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