We spoke with Carole Hallam, an Independent Nurse Consultant in Infection Prevention, to get her opinion on the use of personal protective equipment (PPE) both in and out of healthcare facilities. Carole, who has more than 40 years’ experience working in infection prevention and control, shared her knowledge on the use of face masks, disposable gloves and personal protective equipment.

We have become very familiar with seeing images of healthcare professionals covered from head to toe in PPE, to protect them from exposure to COVID-19. The use of facemasks, disposable gloves and other personal protective equipment is essential to protect frontline healthcare workers, but is it necessary for the general public to wear protective equipment? We spoke with Carole about the effectiveness of this protective equipment when being used outside of healthcare settings.

Face masks

With lockdown restrictions beginning to be lifted across the world, many governments are advising that the public should wear face coverings whenever they are in public, to limit the spread of infection, Carole discussed her opinion on the matter.

Can face masks help protect you from COVID-19?

Covid-19 is predominantly spread through droplets. As we speak and talk, we expel the virus into the air through large droplet nuclei. These droplets can land in the mouths or noses of people who are nearby, however it is more likely that they will settle onto surfaces and become a contact transmission. We can pick this up on our hands and transfer it to our eyes, nose and mouth which can lead to infection. Face masks reduce the number of droplets people spray into the air, but improper use is leading to more harm than good.  

 

Do face masks offer a false sense of security?

Absolutely, there can be a real danger of the general public wearing face masks, as it can lead to complacency. Whilst a mask can protect you, there is an increased risk of contamination to the wearer when adjusting or removing the mask. Frontline healthcare workers have training in the safe use of this equipment, knowing how to wear it and how to remove it safely, without putting themselves or others at risk. This is not the case for the general population.

People wearing face masks in public

Face masks in public

A mask will only protect you from droplets in the air when worn correctly and used in combination with frequent and proper handwashing. On countless occasions, we have seen people wearing ill-fitting masks, not wearing masks properly (either under their nose or above their chin) or lifting the mask up and down to speak. Contaminated hands can be a big source of infection risk, so if the wearer puts their potentially contaminated hands near their mouth and nose to adjust and remove their mask, this puts them at a bigger risk of infection.

When should the public wear face masks?

Of course, in healthcare settings there is a real need to be wearing face masks, as healthcare professionals are regularly coming into close contact with infected individuals. However, in public where we can practice social distancing, we do not need to wear a mask.

The only exception to this is when people must be in enclosed spaces, such as on public transport, where social distancing is not possible. If we all stay more than 2 metres apart from each other and do not touch our faces, the virus is not going to pass and spread.

Disposable gloves

There has been a lot of contention about the use of disposable gloves. We have seen them become commonplace in public places such as supermarkets and workplaces, however, there is very little evidence to suggest that wearing gloves in public offers protection from contracting coronavirus. Public health bodies such as the World Health Organisation and CDC recommend that we do not use them, we spoke with Carole about her view on the issue.

 

Should disposable gloves be worn in public?

The use of gloves outside of the healthcare setting is really worrying, as it is giving people a false sense of security and distracting them from the fact that they need to wash their hands very regularly. This virus will not transmit through the skin on our hands, it has to get to our eyes, nose or mouth and wearing gloves does not prevent the virus from transmitting if you do touch your face in these areas.

Like our hands, gloves become contaminated, however unlike our hands, we cannot wash our gloves. Frequent hand washing is the most important thing you can do to protect yourself from the virus, particularly when you have been out in public.

Disposable gloves being worn in public supermarkets

Disposable gloves in public

Personal Protective Equipment (PPE)

We also spoke with Carole about the importance of personal protective equipment inside healthcare facilities. Over the last few months, there has been a lot of press coverage about the shortage of PPE, it doesn’t appear that we have enough supply to fulfill global demand and protect our front-line staff. Carole discussed her experience and view on the topic.  

How serious have PPE shortages been?

The level of PPE that has been required in the past few months has been beyond comprehension, so there has been a real challenge worldwide in getting supply. In the NHS, there were often concerns about whether there would be enough equipment to get through the weekend, but teams were resourceful and always made it work.

Whilst healthcare organisations have been challenged to provide PPE, the huge amount of press surrounding the issue also caused a lot of unnecessary anxiety in staff, which has not helped the issue.

 

What level of PPE should be worn in care settings?

When talking about PPE requirements in healthcare settings, it is important that we first understand the routes of infection transmission. 

There are certain procedures in healthcare that are aerosol generating, such as intubation and manual ventilation. During these procedures’ aerosols are generated in smaller droplet nuclei, which remain present in the air for long periods and can be easily transmitted. In these circumstances, staff need to wear high efficacy masks such as FFP3 or FFP2 masks. These work by filtering the very fine particles that might otherwise be transmitted, to provide extra protection for staff.

Nurse wearing full PPE including face shield and face mask

Nurse wearing full PPE

Whilst it is only necessary for these masks to be worn during aerosol generating procedures, the large amounts of coverage in the media surrounding COVID-19, caused a lot of anxiety in staff, who consequently felt they wanted full protective equipment for every procedure. Of course, PPE is essential to protect healthcare workers, but not necessarily to the level that many believe is required.  

What has fuelled the anxiety behind PPE?

We have seen some scary information in the news about global PPE shortages as well as the number of healthcare staff that have been affected by the virus.

When we first saw Covid-19 emerging in Wuhan, China, we saw healthcare staff suited in full hazmat gear, protective suits, face masks, boots and overshoes. This was appropriate at the time as COVID-19 was a new disease that we did not fully understand. As we have begun to learn more about this virus and its transmission, the guidance has changed. The new guidance is based on evidence of normal respiratory viruses and does not suggest that staff need full body hazmat suits for every procedure. Despite this, healthcare staff still feel that they need to wear full protective gear to protect themselves during their day to day duties.

Infection prevention and control experts working on the front line, are trying to reassure and educate staff in hospitals and care homes about what is the right method of PPE and when is the right time to wear it, as well as ensuring that staff are consistently following basic hand hygiene and social distancing processes.

Final Thoughts 

Education of the public and health care staff is so important at the moment, as we are dealing with a lot of misinformation in the news and online. Infection prevention and control (IPC) measures are key to fighting COVID-19 and we hope that this article provides clarity on the necessary use of protective equipment both in and out of healthcare settings.

It is crucial that we all continue to follow best practice guidance for IPC. The World Health Organisation is a great source of information and has provided detailed advice for both the public and health workers.

You can watch the full interview with our expert here:

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