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Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE)

For most jobs (except those in health care), using personal protective equipment such as wearing a mask is not likely to be effective. According to the Centers for Disease Control and Prevention, (in non-health care settings):

"Adults can shed influenza virus 1 day before symptoms appear and up to 5 days after onset of illness; thus, the selective use of masks (e.g., in proximity to a known symptomatic person) may not effectively limit transmission in the community. Instead, emphasis should be placed on cough etiquette for persons with respiratory symptoms whenever they are in the presence of another person, including at home and at school, work, and other public settings"

The Public Health Agency of Canada (PHAC), and the United States Health and Human Services (HHS) also state that at this time, there has been little or no evidence that using a mask in the community will be protective or practical once the virus is circulating widely. Health care workers may be required to use appropriate masks when they have close contact with patients.

If you choose to wear a mask, PHAC cautions "members of the public may wish to purchase and use masks for individual protection. They need to follow other infection control measures such as hand washing to avoid a false sense of security." (From Public Health Agency of Canada (PHAC), Canadian Pandemic Influenza Plan for the Health Sector (section 2.6)) However, masks may have some use if worn by those already infected with the virus in order to prevent them from spreading the germs. (Calgary Health Region)

Not all masks are the same

It is important to know that not all masks "work" the same way. Surgical masks work by keeping the large droplets "in" when released from the wearer through talking, coughing, or sneezing. Essentially, surgical masks can stop large droplets from "going out" into the air. They are not fitted against the face to stop the wearer from inhaling agents.

Respirators, on the other hand, are designed to "keep out" specific agents (particulates, viruses of specific sizes, etc). Respirators are certified and rated for very specific uses. It is essential to use the right respirator for the hazard that is present. For example, currently respirators classified as N95, N99, and N100 are recommended for protection from the avian H5N1 virus, as a minimum, when required.

Please know that surgical masks and respirators are not the same thing. Surgical masks are not respirators and are not certified as such. They do not protect the wearer from inhaling small particles that can remain airborne for long periods of time. For more information is available in OSH Answers about Respiratory Protection Against Infections for Health Care Workers

What can a workplace do?

Since we don't know exactly how the pandemic virus will spread, general recommendations for most workplaces and schools for infection control include to:

  • Ask individuals to stay home while they are infectious.
  • Promote respiratory hygiene/cough etiquette and hand hygiene as for any respiratory infection. This includes encouraging people to
    • cover their nose and mouth when coughing or sneezing, by using a tissue or to cough into your sleeve
    • use tissues to "catch" respiratory secretions and, after use, to throw the tissue immediately into the nearest garbage can,
    • do not touch their face (eyes and mouth) after they have touched surfaces such as doorknobs or handrails.
    • wash your hands with regular soap and water or alcohol-based hand rub after having contact with respiratory secretions and contaminated objects, and especially before handling or eating food.

Employers should make sure that tissues (and garbage cans) are available for containing coughs, as well as soap/water or sanitizers for hand washing are available. Communicate the importance of these steps with all staff.

When to wear PPE

At this time, it is thought that in most workplaces, PPE will likely not be effective or practical in containing the spread of the virus.

It will be important to stay current with announcements during the pandemic by agencies such as public health, or your local ministry or department of labour. Recommendations about the use of PPE will likely depend on the agent itself - how fast it spreads, the actual size of the agent, and how much of the agent you need to inhale before becoming ill. If the public health agencies or other governments departments recommend PPE, or if your workplace chooses to use PPE, it will be important to use the right kinds of PPE in the right way.

If PPE measures are required

If using personal protective equipment (PPE) becomes necessary, it is important to use PPE correctly.

Workplaces should first establish control measures to reduce the transmission of the agent which may include:

  • engineering controls such as specific ventilation systems for capturing and reducing the spread of the infectious agent
  • work practices such as cleaning (tools, surfaces, etc.), hand hygiene, respiratory hygiene and cough etiquette
  • administrative procedures such as screening, or social distancing
  • appropriate cleaning tools, equipment, and facilities
  • education and training on required personal protective equipment (PPE), its use, fit, handling, care and storage..

Should respirators, for example, be required in your workplace, it is essential to establish a complete PPE program which includes respirator fit testing, selection and care. See Table 1 below for a summary of possible protection types.

Table 1: Summary of Possible Influenza Protection Measures

Protection measure Where applicable
Hand hygiene, cough etiquette, ventilation Everyone, all the time
Organizational policies Every organization, all the time
Social distancing Everyone, whenever practical
Protective barriers In situations where regular work practice requires unavoidable, relatively close contact with the public
Disposable surgical mask(or respirator) Workers in any community or health care setting who are caring for the sick (this includes first responders) once the pandemic is in the community (WHO phases 4 and 5). Also as a possible adjunct to protective barriers
Disposable surgical masks (or respirator), eye protection, gloves, gowns / aprons Health care workers participating directly in close contact patient care when there is a high risk of contact with respiratory secretions, particularly via aerosols (mostly inpatient settings). Generally, in-patient care within one meter or less.

Adapted from: Calgary Health Region. Pandemic Influenza Planning Guide for Businesses (page 24)

Other personal protective equipment and procedures that may be required (currently recommended for health care settings) include

  • Use disposable gloves made of lightweight nitrile or vinyl or heavy duty rubber work gloves that can be disinfected. Gloves should be changed if torn or damaged. Remove gloves promptly after use, before touching non-contaminated surfaces.
  • Protective clothing, preferably disposable outer garments or coveralls, an impermeable apron or surgical gowns with long cuffed sleeves, plus an impermeable apron should be worn.
  • Wear disposable protective shoe covers or rubber or polyurethane boots that can be cleaned and disinfected
  • Wear safety goggles that protect the mucous membranes of eyes.
  • Use disposable particulate respirators (e.g., N-95, N-99, or N-100) at a minimum level of respiratory protection.
  • Throw away disposable PPE properly. Non-disposable PPE should be cleaned and disinfected as specified in local or provincial guidelines (from departments of health or labour).

Also, remember it is important to wash your hands after removing any PPE. (Adapted from: Center for Disease Control and Prevention: Interim Guidance for Protection of Persons Involved in U.S. Avian Influenza Outbreak Disease Control and Eradication Activities )

Be sure to follow guidelines for both wearing and removing PPE.