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In the present day, the confirmed cases of novel coronavirus have crossed 7 million worldwide. India has also entered in top 5 worst-hit countries due to the biggest recorded spike in the COVID-19 cases in the last few days.

In these all issues, there is one sector which is exerting all their energy in saving the suffering people, this is the healthcare sector. The warriors of this sector work day and night to defeat the infection. In this gigantic emergency, the PPE kits have proven as of top helping equipment for these corona warriors.

Highlights:
-Role of PPE kits in COVID-19 pandemic
-MoHFW guidelines on the rational use of PPE kits
-MoHFW additional guidelines on PPE kits
-Points to remember while using PPE

Role of PPE kits in COVID-19 pandemic

This personal protective equipment (PPE) work as a shield to protect healthcare warriors from this deadly viral infection. The PPE kit involves potent protective wears, for instance, head shield, mask, gown, gloves, goggles, head mask, and shoes, which acts as a barrier against the virus.

However, these days where the need for such PPE kits is at the peak, the quality has suffered a lot somewhere. The low-quality PPE kits can put the lives of these treasured warriors on stake. Therefore, WHO has listed and recommend specific specifications to define the quality of PPE kits. These specifications help to validate and choose the accurate PPE kit.

In the next place, another essential thing regarding PPE kits is their rational use. The irrational use of these kits has also contributed to their shortage.

Ministry of Health and Family Welfare (MOHFW) has formalized specific guidelines on the use of PPE kits for its proper employment.

MoHFW guidelines on the rational use of PPE kits

requirement-of-ppe-kit

These guidelines by MoHFW are for health care workers, other working in points of entries (POEs), laboratories, quarantine centers, primary health care centers, and community settings to guide workers regarding the proper use of PPE gears in different settings.

The use of PPE is based on the risk profile of a health care worker. For different working areas of the hospital, the Ministry adjudicates different levels of PPEs. These guidelines were issued on 24 March 2020.

The guidelines are based on four risk zones:

No risk zone, low-risk zone, moderate risk zone, and high-risk zone. PPE wears are recommended as per the risk zones:

No-Risk Zone: No PPE.

Low-Risk Zone: Triple layer medical mask and gloves.

Moderate Risk Zone: N-95 mask and gloves.

High-Risk Zone: Full complement of PPE.

Guidelines on the rational use of PPE kits

1) POINT OF ENTRY

Low-Risk Zone

Health desks, customs, immigration desks, airport security, and temperature recording stations.

Moderate Risk Zone

Holding area or isolation facility of PHO/APHO, who’s work is to interview and clinically examination.

High-Risk Zone

APHO who attend severely ill passenger.

2) HOSPITAL SETTING

2. 1 Out Patient Department (Respiratory Clinic / Separate screening area)

Low-Risk Zone

Visitors accompanying young children and elderlies.

Moderate Risk Zone

Triage area, screening area, help desk, temperature recording station, waiting area, Doctor chamber and sanitary staff.

2. 2 In-patient services

Low-Risk Zone

ICU/critical care (work involves dead body transport to mortuary) and Caretaker accompanying the admitted patient (taking care of the admitted patient).

Moderate Risk Zone

Individual isolation rooms/ cohorted

isolation rooms (for clinical management) and Sanitation work.

High-Risk Zone

ICU/critical care unit (work involves critical care and dead body packaging).

2. 3 Emergency department

Moderate Risk Zone

Handling emergency cases.

High-Risk Zone

Handling severely ill patients of SARI (severe acute respiratory illness).

2. 4 Pre-hospital (Ambulance) Services

Low-Risk Zone

Driving the ambulance.

Moderate Risk Zone

Transporting patients, not on any assisted

Ventilation.

High-Risk Zone

Management of patient while transporting.

2. 4 Ancillary/Other Supportive Services

No-Risk Zone

Involves people doing supportive services like administrative, financial, engineering, or security, etc.

Moderate Risk Zone

CSSD/Laundry (handling linen of COVID patients) and mortuary (dead body

handling).

High-Risk Zone

Mortuary (while performing autopsy) and laboratory (while sample collection, transportation and sample testing).

3) HEALTH WORKERS IN COMMUNITY SETTING

Low-Risk Zone

ASHAs/ Anganwadi and other field staff doing field Surveillance.

Moderate Risk Zone

Doctors at the supervisory level conducting a field investigation, involving field Surveillance and clinical examination.

4) QUARANTINE FACILITY

Low-Risk Zone

Persons being quarantined, healthcare staff at health monitoring and temperature recording section and support staff.

The person who is quarantine is required only a triple layer mask.

Moderate Risk Zone

Clinical examination of symptomatic persons.

5) HOME QUARANTINE

No-Risk Zone

Family members with no infection.

Low-Risk Zone

Persons being quarantined (need to wear a triple-layer mask) and designated family members to take care of a person being quarantined (needs gloves).

Furthermore, the Ministry has also issued additional guidelines on the rationale of the use of PPE kits in non-COVID hospitals and non-treatment areas of a hospital, which contains a COVID block.

MoHFW additional guidelines on PPE kits

These guidelines also involve there zones and PPE are recommended as per these zones.

Low-risk zone: Triple layer medical mask and latex examination gloves.

Moderate risk zone: N-95 mask/triple layer mask (as per work area), goggles, nitrile or latex examination gloves and face shield.

High-risk zone: Full complement of PPE (N-95 mask, coverall, goggle, Nitrile

examination gloves, shoe cover).

Low-Risk Zone

Outpatient department: Help desk, doctor chamber, pharmacy counter, and sanitary staff (for cleaning frequently touched floor and surfaces).

In patients department: Individual or ward rooms involve clinical management and critical care or ICU involves dead body packing.

Emergency department: Workers attending emergency cases.

Ancillary services: Laboratories, radiodiagnosis, blood bank, CSSD/laundry and other supported services such as kitchen, administrative or financial.

Ambulance services: Driving and transporting patients, not on ventilation.

Moderate Risk Zone

Outpatient department: Pre-anesthetic check-up clinic and the chamber of dental/ENT doctors/ ophthalmology doctors.

In-patients department: ICU (critical care management), labour room, and operation theatre.

Emergency department: Laboratories collecting respiratory samples.

High-Risk Zone

Emergency department: Workers attending to severely ill patients while performing aerosol-generating procedures.

Ambulance services: Management of SARI patients.

These are the guidelines on the rational use of the PPE kits. However, some essential steps need to be followed while using PPE.

Points to remember while using PPE

-PPEs are not an alternative to essential preventive measures like respiratory etiquettes and hand hygiene. So, must do that regularly and while using PPE.

-Always maintained a distance of at least 1 meter.

-Follow a detailed and whole procedure of wearing and disposing of PPE kits with great care.

Follow these preventive measures and the guidelines to prevent the irrational use of PPE kits.