NEJM posting provides helpful tutorial on PPE

A video in clinical medicine posted on the New England Journal of Medicine website on June 25, 2020, provides a guide to the proper procedure for putting on and removing personal protective equipment (PPE) designed to protect the skin and mucous membranes from exposure to SARS-CoV-2. The video, which runs for 8:43 minutes, was prepared by Rafael Ortega MD and colleagues from the Department of Anesthesiology, Boston Medical Center, Boston, MA, USA. The website includes a link for downloading the video and a transcript of the audio narration that is also downloadable as a PDF file. The procedure for putting on and removing PPE is demonstrated using PPE that has been recommended by the Centers for Disease Control and Prevention (CDC) in the United States for use in American hospitals for minimising the risk of exposure to infectious material by individuals caring for patients with COVID-19. It is noted that the procedure may be revised if emerging information leads to changes in best practice. In addition, it is mentioned that there are other acceptable methods for putting on and taking off PPE and that individuals should follow guidelines from the CDC and their institution. The video provides a description of proper PPE. The materials include a fluid-resistant gown or coveralls that as a minimum cover the body from the neck to the mid-calf; medical gloves that extend to cover the wrists of the gown; a respirator with a rating of at least N95 or a face mask if a respirator is not available; and a full face shield to protect the face and neck or goggles. Disposable respirators should be certified by the National Institute for Occupational Safety and Health and tested for proper fit. A certified powered air-purifying respirator is an acceptable alternative to a respirator and face shield, but its use is not demonstrated in the video. The instructions for putting on PPE begin with preparatory measures and recommend having an observer watch to assure proper technique. Observation by a colleague is also recommended when removing PPE. The video cautions that proper removal and disposal of contaminated PPE poses the greatest challenge to preventing pathogen exposure. PPE is put on before entering the patient’s room, but the procedure for taking off PPE begins before leaving the room with removal of both gloves and the gown. The face shield and respirator are removed outside of the patient’s room. The portion on removal of PPE also includes instructions pertaining to discarding and/or disinfecting the equipment and disinfecting the hands.