Introduction
The COVID-19 pandemic, also known as the coronavirus pandemic, is caused by severe
acute respiratory syndrome coronavirus 2 (SARSCoV2). The outbreak was first identified
in Wuhan, China, in December 2019. The World Health Organization declared the outbreak
a public health emergency of international concern on January 30, 2020 and a pandemic
on March 11, 2020. As of May 31, 2020, the Ministry of Health and Family Welfare have
confirmed a total of 89995 cases, 86983 recoveries (including 1 migration), and 5164
deaths in the country.[[1]]
The virus primarily spreads among people during close contact, most often via small
droplets produced by coughing, sneezing, and talking.
Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE)
Personal Protective Equipments (PPEs) are protective gears designed to safeguard the
health of workers by minimizing the exposure to a biological agent. Occupational Safety
and Health Administration (OSHA) defines PPE as “specialized clothing or equipment
worn by an employee for protection against an infectious material”.[[2]]
Components of PPE
Coverall, gloves, shoe cover, triple-layer mask, N95 respirator, head cover (hood),
face shield, and goggles.
Levels of PPE
Level 1 PPE: For Standard Infection control precautions – It includes disposable gown and disposable
gloves. If risk of spraying or splashing is anticipated, surgical mask and face shield/goggles
are recommended.
Level 2 PPE: For direct/indirect contact precautions/droplet precautions/airborne precautions
– It includes fluid-resistant disposable gown and disposable gloves. If risk of spraying
or splashing is anticipated, surgical mask and face shield/goggles are recommended.
Head cover and N95 respirator are to be considered in cases of airborne infection.
Level 3 PPE: Enhanced precautions for suspected or confirmed infectious diseases of high consequence
which spread by direct/indirect contact or by airborne route – It includes fluid-resistant
coverall with hood/long-sleeved gown with disposable fluid-resistant hood, N95 mask,
face shield, two sets of gloves, and shoe covers.
Details of Each Element of PPE
Details of Each Element of PPE
Fluid-resistant coverall: The coverall should have following specifications - Impermeable
to blood and body fluids, single use, meets or exceeds ISO 16603 class 3 exposure
pressure, or equivalent. The coverall should be SITRA or DRDO approved if manufactured
in India.
Disposable gown: Impermeable to blood and body fluids, single use.
Disposable gloves: Nitrile nonsterile, powder-free gloves are preferred.
Value of gloves in COVID-19 scenario: Gloves should be worn when providing direct care for a COVID-19 case and then removed,
followed by hand hygiene. Extended use of gloves for caring COVID-19 cases is not
recommended. Changing gloves between dirty and clean tasks during care to a patient
and when moving from a patient to another, accompanied by hand hygiene, is absolutely
necessary. Double gloving is not recommended, except for surgical procedures that
carry a high risk of rupture.
Triple-layer surgical mask: The triple-layer surgical mask should be made of a melt-blown
polymer, most commonly polypropylene, placed between nonwoven fabrics.
N95 mask: Ideally should be NIOSH N95, EN 149 FFP2, or equivalent.
Triple-layer mask or N95: N95 masks should be used in COVID suspect and positive cases. Surgical mask should
only be used for routine cases in which there is no suspicion for COVID infection.
Only in crisis times and nonavailability of N95 masks, surgical mask with visor may
be considered for examining COVID suspect cases with all due precautions.
Face shield: It should be made of clear plastic and provide good visibility to both
the wearer and the patient. It should be fog resistant, should have adjustable band
to attach firmly around the head and fit snuggly against the forehead, and completely
cover the sides and length of the face.
Goggles: Goggles should have transparent glasses with zero power. It should be covered
from all sides with elastic band/or adjustable holder. It should have good seal with
the skin of the face and should be fog and scratch resistant.
Shoe cover: It should be made up of the same fabric as of the coverall and should
cover the entire shoe and reach above the ankles.
Rational Use of PPE in Radiology
Rational Use of PPE in Radiology
Various PPEs that have to be used in diagnostic as well as interventional radiology
services are listed in [[Tables 1] and [2]].[[3], [4], [5], [6]]
Table 1
Appropriate use of PPE in non COVID areas in diagnostic radiology[[3]-[7]]
|
Diagnostic radiology non-covid areas
|
|
Setting
|
Target personnel
|
PPE
|
Level of PPE
|
Remarks
|
Patient oriented
|
|
Hospital Attendant and Housekeeping staff in non-COVID areas should wear triple-layer
mask, gown, heavy duty gloves, heavy duty boots, goggles or face shield if splash
of fluid is expected. Anywhere where there is aerosol generating procedure, Level
3 PPE to be used. PPEs are not alternative to basic preventive public health measures
such as hand hygiene, respiratory etiquettes which must be followed at all times.
Doctor and nursing staff should wear gloves while handling patients whose clothes
are visibly soiled
|
|
Radiology Reception Area/ Help Desk
|
Receptionist/Data entry operator
|
Triple-layer mask
|
|
Ideally, build glass/plastic screens to create a barrier between health care workers
and patients
|
Physical distancing to be followed at all times
Patients should wear a cloth mask/triple-layer mask at all times
|
|
X-ray
|
Radiologist/ Technician
|
Gown and triple-layer mask
|
-
|
-
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
Fluoroscopy procedures
|
Radiologist/ Nurse/Technician
|
Gown, triple-layer mask, gloves
|
Level 1
|
Face shield/goggles with a visor, when splash of body fluid is expected
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
Ultrasound
|
Radiologist/ Nurse/Attendant
|
Gown, triple-layer mask
|
-
|
Ideally, build glass/plastic screens with a hole for hand to create a barrier
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
Mammography
|
Radiologist/ Technician
|
Gown, triple-layer mask, gloves
|
Level 1
|
-
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
CT
|
Radiologist/ Nurse/Technician
|
Gown, triple-layer mask
|
|
Face shield/goggles with a visor, when splash of body fluid is expected or a patient
being imaged is on ventilator
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
MRI
|
Radiologist/ Nurse/Technician
|
Gown, triple-layer mask
|
|
Face shield/goggles with a visor, when splash of body fluid is expected or a patient
being imaged is on ventilator
|
Patients should wear a cloth mask/triple-layer mask at all times
|
Table 2
Appropriate use of PPE in non COVID areas in Interventional Radiology and all COVID
areas in radiology[[3]-[7]]
|
Interventional radiology non-covid areas
|
|
Setting
|
Target personnel
|
PPE
|
Level of PPE
|
Remarks
|
Patient oriented
|
|
Hospital Attendant and Housekeeping staff in non-COVID areas should wear triple-layer
mask, gown, heavy duty gloves, heavy duty boots, angoggles or face shield if splash
of fluid is expected. Anywhere where there is aerosol generating procedure, Level
3 PPE to be used. PPEs are not alternative to basic preventive public health measures
such as hand hygiene and respiratory etiquettes which must be followed at all times
|
|
Emergency Vascular/ Nonvascular Intervention procedure
|
Radiologist/Nurse/ Technician
|
Water impervious gown, gloves, shoe cover, head cover or cap, triple-layer mask, and
goggles/face shield if aerosol generation/splash expected
|
Level 3
|
- Ideally, build glass/plastic screens to create a barrier between health care workers
and patients
- N95 respirator to be used if patient from hot spot/containment zone
|
Patients should wear a cloth mask/triple-layer mask at all times if feasible
|
|
Elective Vascular/ Nonvascular Intervention procedure
|
Radiologist/Nurse/ Technician
|
Linen gown, gloves, shoe cover, head cover or cap, triple-layer mask, and face shield
if feasible
|
Level 2
|
- N95 respirator to be used if patient from hot spot/containment zone
- Any procedure involving lung or pleural cavity wear full PPE
|
Patients should wear a cloth mask/triple-layer mask at all times
|
|
Emergency USG/CT guided procedures
|
Radiologist/Nurse/ Technician
|
Water impervious gown, gloves, shoe cover, head cover or cap, triple-layer mask, and
goggles/face shield if aerosol generation/splash expected
|
Level 2
|
Ideally, build glass/plastic screens to create a barrier between health care workers
and patients - N95 respirator to be used if patient from hot spot/containment zone
|
Patients should wear a cloth mask/triple-layer mask at all times if feasible
|
|
Elective USG/CT/Mammography guided procedures
|
Radiologist/Nurse/ Technician
|
Linen gown, gloves, shoe cover, head cover or cap, triple-layer mask, and face shield
if feasible
|
Level 2
|
- N95 respirator to be used if patient from hot spot/containment zone
- Any procedure involving lung or pleural cavity wear full PPE
|
Patients should wear a cloth mask/triple-layer mask at all times if feasible
|
|
All radiology procedures in covid areas
|
|
All Diagnostic and Interventional procedures
|
Radiologist/ Nurse/Technician/ Housekeeping/ Hospital Attendant
|
Full component of PPE
|
Level 3
|
- Physical distancing to be followed at all times
- Ideally, build glass/plastic screens to create a barrier between health care workers
and patients
|
Patients should wear a cloth mask/triple-layer mask at all times if feasible
|
Conclusion
As the Government is in the process of opening the lockdown and stressing on opening
of non-COVID hospitals, diagnostic centers will soon be flooded with patients for
imaging. Rational and appropriate use of PPE that is reusable, economical, and recyclable
is the need of hour. The above guidelines depend upon the resources available with
the institutions, hospitals, and diagnostic centers. One can think of using their
own customized PPEs as many local textile manufacturers are coming up with economical
solutions as announced by our Honourable Prime Minister for implementing the Atmanirbhar
Bharat Abhiyan scheme.[[7]]
