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COMMENTARY  
Year : 2021  |  Volume : 31  |  Issue : 5  |  Page : 204-206
Rationalizing personal protective equipment (PPE) in radiology in the time of COVID-19


1 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
2 Department of Professor Pediatric Surgery and Medical Superintendent, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
3 Department of Professor Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India

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Date of Submission13-May-2020
Date of Acceptance17-Jul-2020
Date of Web Publication23-Jan-2021
 

How to cite this article:
Sureka B, Garg PK, Khera PS, Sinha A, Misra S. Rationalizing personal protective equipment (PPE) in radiology in the time of COVID-19. Indian J Radiol Imaging 2021;31, Suppl S1:204-6

How to cite this URL:
Sureka B, Garg PK, Khera PS, Sinha A, Misra S. Rationalizing personal protective equipment (PPE) in radiology in the time of COVID-19. Indian J Radiol Imaging [serial online] 2021 [cited 2021 Mar 3];31, Suppl S1:204-6. Available from: https://www.ijri.org/text.asp?2021/31/5/204/307718



   Introduction Top


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) Top


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 Top


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 Top


Various PPEs that have to be used in diagnostic as well as interventional radiology services are listed in [Table 1] and [Table 2].[3],[4],[5],[6]
Table 1: Appropriate use of PPE in non COVID areas in diagnostic radiology[3],[4],[5],[6],[7]

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Table 2: Appropriate use of PPE in non COVID areas in Interventional Radiology and all COVID areas in radiology[3],[4],[5],[6],[7]

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   Conclusion Top


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.



 
   References Top

1.
Ministry of Health and Family Welfare [Internet]. Available from: https://www.mohfw.gov.in/. [Last cited on 2020 May 25].  Back to cited text no. 1
    
2.
Centres for Disease Control and Prevention [Internet]. Available from: https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf. [Last cited on 2020 Apr 05].  Back to cited text no. 2
    
3.
4.
Ministry of Health and Family Welfare [Internet] .Available from: https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf. [Last cited on 2020 Apr 05].  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare [Internet]. Available from: https://www.mohfw.gov.in/pdf/Additionalguidelines onrationaluseofPersonalProtectiveEquipment settingapproachforHealthfunctionariesworkinginnonCOVIDareas.pdf. [Last cited on 2020 Apr 05].  Back to cited text no. 5
    
6.
National Centre for Disease Control [Internet]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html. [Last cited on 2020 Apr 05].  Back to cited text no. 6
    
7.
Moy L, Toth HK, Newell MS, Plecha D, Leung JWT, Harvey JA. Response to COVID-19 in breast imaging. J Breast Imaging 2020;2:180-5.  Back to cited text no. 7
    

Top
Correspondence Address:
Dr. Binit Sureka
Associate Professor, Department of Diagnostic and Interventional Radiology, Deputy Medical Superintendent, All India Institute of Medical Sciences, Basni, Jodhpur - 342 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijri.IJRI_443_20

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