II. Types: Precaution Levels

  1. Standard Precautions (all clinical settings)
    1. Hand hygiene
    2. Blood or bodily fluid exposure prevention (gowns, gloves, masks, Eye Protection)
  2. Expanded Precautions: Contact Isolation
    1. Indications: Transmission of serious illness via direct contact
    2. Protection
      1. Patient in private room
      2. Fluid resistant gowns and gloves
  3. Expanded Precautions: Droplet Isolation
    1. Indications
      1. Diphtheria
      2. HaemophilusInfluenza type B
      3. Pandemic Influenza
      4. Neisseria Meningitidis
      5. Mumps
      6. Rubella
      7. Parvovirus B19
      8. Pertussis
      9. Group A Streptococcal Pneumonia
      10. Severe Acute Respiratory Syndrome (SARS)
      11. Viral hemorrhagic fever (e.g. Ebola, Lassa, Marburg) - require extensive protection (see below)
      12. Other common airborne infections (Adenovirus, Rhinovirus, Mycoplasma)
    2. Protection
      1. Wear face mask when within 3 feet of patient
  4. Expanded Precautions: Airborne Isolation
    1. Indications
      1. Measles (Rubeola)
      2. Severe Acute Respiratory Syndrome (SARS)
      3. Smallpox
      4. Tuberculosis
      5. Varicella Zoster Virus
    2. Protection
      1. N95 Mask or air-purifying respirator
  5. Special circumstances: Ebola
    1. Indications (U.S.)
      1. Travel to west africa or Ebola-positive patients AND
      2. Fever, Headache, myalgias, Fatigue, Diarrhea or unexplained bleeding
    2. Protection
      1. Powered air-purifying respirator (PAPR) or N95 Mask
      2. Full Face Shield, helmet or headpiece
      3. Disposable hood covering Shoulder and neck
      4. Impermeable, disposable gowns and coveralls extending to calves
      5. Disposable nitrile gloves (2 pair with extended cuffs)
      6. Boot covers extending to mid-calf

III. Types: Level A Personal Protection Equipment

  1. Description
    1. Fully encapsulated suit with self-contained breathing apparatus
    2. Maximal protection against gases, vapors, aerosols, liquids and solids
  2. Indications
    1. Highest level of protection for lung, skin, eye and mucus membrane
    2. Indicated in prehospital "hot zone" environments with toxic gas/vapor or oxygen-poor environment
  3. Respiratory protection
    1. Positive pressure self contained breathing apparatus (SCBA)
    2. Positive pressure air respirator with escape SCBA
  4. Skin protection
    1. Fully encapsulating chemical protective suit
    2. Inner and outer chemical resistant gloves
    3. Chemical resistant boots (steel toe and shank)
  5. Communication
    1. Two way radio communications (safe and non-sparking)
  6. Disadvantages
    1. Requires a high level of training and expense
    2. Physically demanding with reduced mobility within the suit
    3. Limited oxygen supply

IV. Types: Level B Personal Protection Equipment

  1. Description
    1. Encapsulated suit with sealed seams
    2. Self-contained breathing apparatus outside the suit (or supplied air respirator)
    3. Protection against vapors, aerosols, liquids and solids
  2. Indications
    1. Prehospital "warm zone" with toxic solids, liquids and possibly toxic gases
  3. Respiratory protection
    1. Positive pressure self contained breathing apparatus (SCBA)
    2. Positive pressure air respirator with escape SCBA
    3. Requires FIT Testing
  4. Skin protection
    1. Under-clothing: Chemical resistant clothing
      1. Overalls and long-sleeved jacket or
      2. Disposable chemical resistant coveralls
    2. Over-clothing: Chemical resistant clothing
      1. Hooded two-piece chemical splash suit
    3. Inner and outer chemical resistant gloves
    4. Chemical resistant boots (steel toe and shank)
  5. Communication
    1. Two way radio communications (safe and non-sparking)
  6. Disadvantages
    1. Requires a high level of training and expense
    2. Physically demanding (but better mobility within the suit than Level A PPE)
    3. Limited oxygen supply or tethered to air line

V. Types: Level C Personal Protection Equipment

  1. Description
    1. Chemical-resistant splash suit with Powered Air Purifying Respirators (PAPR)
    2. Protection against vapors, aerosols, liquids and solids
  2. Indications
    1. Personnel working in controlled area with known substance and measured substance concentration
    2. Hospital "hot zone" in which toxins are liquid, solid or low vapor concentrations
  3. Respiratory protection
    1. Full-face or half mask, Powered Air Purifying Respirators (PAPR)
    2. No FIT testing required
  4. Skin protection
    1. Chemical resistant clothing
      1. One piece coverall
      2. Hooded two piece chemical splash suit
      3. Chemical resistant hood and apron
      4. Disposable chemical resistant coveralls
    2. Inner and outer chemical resistant gloves
    3. Chemical resistant boots (steel toe and shank)
  5. Communication
    1. Two way radio communications (safe and non-sparking)
  6. Advantages
    1. Offers a high level of protection requiring less cost and training (contrast with Level A and B PPE)
    2. Offers improved mobility and less physically demanding
  7. Disadvantages
    1. Inadequate protection against high concentrations of toxic gas or high levels of toxic splash

VI. Types: Level D Personal Protection Equipment

  1. Description
    1. Normal safety work uniform with gown, gloves and shielding of face and eyes
    2. Protection against solids (minimal)
  2. Indications
    1. Avoidance of nuisance contamination
    2. Hospital "cold zone" after patient decontaminated
  3. Respiratory protection
    1. None
  4. Skin protection
    1. Coveralls or gown
    2. Gloves
    3. Shielding of face and eyes
    4. Safety shoes or boots
  5. Advantages
    1. Offers full mobility, with low physical demands, and minimal additional training or expense
  6. Disadvantages
    1. No protection against chemicals or toxins

VII. Resources

  1. OSHA Personal Protective Equipment
    1. https://www.osha.gov/Publications/osha3151.html
  2. Minnesota Department of Health (MDH) Personal Protective Equipment
    1. http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/ppe/
  3. EPA Personal Protective Equipment Levels
    1. http://www2.epa.gov/emergency-response/personal-protective-equipment

VIII. References

  1. Campana, Patel and Martin (2016) Crit Dec Emerg Med 30(2): 14-9
  2. Seeyave and Bradin (2014) Crit Dec Emerg Med 28(12): 2-13
  3. Heon (2009) Clin Pediatr Emerg 10(3): 186-94 [PubMed]

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