PERSONAL PROTECTION GEAR
Having knowledge of infectious diseases and how to treat them is very important, but you’ll be more effective in preventing their spread by having some supplies. Which supplies? That all depends on the nature of the disease itself and the risk that the healthy population will be exposed to it.
Before you can be a successful caregiver and heal the sick in an epidemic, you must avoid becoming one of its victims. Viruses can be very contagious (like the airborne common cold) and have a low fatality rate. Alternatively, a disease may have a high fatality rate (like Ebola) and be less contagious (it’s not officially thought to be airborne). Rarely, a really infectious agent may be both very contagious and lethal (like The Pneumonic Plague in the Middle Ages).
In a truly virulent outbreak, healthcare providers are at serious risk. During the Ebola epidemic of 2014, being a medical worker was one of the principal ways to get (and die of) the disease. In 2020, the physician who first tried to warn the world of the coronavirus COVID-19 epidemic was, unfortunately, also one of its casualties.
Because of the risk to medical workers, strict protocols regarding what items a caregiver should wear are formulated and constantly modified based on new scientific evidence. A uniform way to to don (put on) and doff (take off) equipment is very important in safeguarding healthcare providers
PROTECTIVE GEAR TO WEAR
Here is what we think you should wear if you are taking care of a highly contagious patient. First, we’ll discuss which armor would give you the most protection. You should have…
• Coveralls (with head and shoe covers; some come with hoods and booties built-in)
• Masks (N95 or N100)
• Goggles or face shields (to be used with, not instead of, masks)
• Nitrile Gloves
Shoe covers and built-in attached booties alone do not give you enough protection. Rubber boots should be worn and can be sanitized between patient encounters.
ABOUT FACE MASKS
Medical masks are evaluated based, partially, on their ability to serve as a barrier to very small particles that might contain bacteria or viruses. Masks are tested at an air flow rate that approximates human breathing, coughing, and sneezing. The quality of a mask is determined by its ability to tightly fit the average human face. The most commonly available face masks use ear loops or ties to fix them in place, and are fabricated of “melt-blown” coated fabric (a significant upgrade over woven cotton or gauze).
Standard medical masks have a wide range of protection based on fit and barrier quality; 3-ply masks (the most common version) are more “breathable”, as you can imagine, than 6-ply masks. The latter, however, presents more of a barrier.
THE N95 MASK
The upgrade to the basic mask is the “N95” respirator mask. N95 Medical Masks are a class of disposable “respirators” that have at least 95% effective as a barrier against particulates larger than 0.3 microns in size. The “N” in N95 stands for non-oil resistant; there are also R95 (oil resistant) and P95 (oil proof) masks. These are used mostly in heavy industry and agriculture. Face masks that are approved by the National Institute of Occupational Health and Safety should have “NIOSH” somewhere on the label.
Few people understand just how tiny a micron is. Imagine that I took one of the hairs on your head and cut it in cross-section. Let’s say I enlarged the cross-section to the size of a dinner plate. A micron would be the size of a grain of pepper on the plate.
N95 masks protect against many contaminants but are not 100% protective. Although used less frequently due to cost, N99 masks (99%) and N100 masks (99.7%) are also available. Many masks will have a square or round “exhalation valve” in the middle, which helps with breathability. This can only be used if the healthcare worker is not potentially infectious to patients.
There are reusable versions of these masks as well, some of which cover your entire face. They often come with special disposable filters which are replaced after each use. As disposable masks become less available, more and more are considering this more expensive option.
PROPER FITTING OF THE N95 MASK
No mask is protective without a proper fit. Your N95 should be an appropriate size and shape to give a seal that will prevent airborne particles from entering through gaps. The mask should not be so large that it obstructs your vision. Any facial hair may affect the ability to get a good seal, so shave off that snazzy beard or handlebar moustache.
The fit test involves using both hands to mold the mask to your face as well as possible. Put your hands to touch the mask edges without applying pressure and inhale sharply. Many masks will indent if there is a tight fit. Then exhale. If you feel air escaping through the cheek, chin, or bridge of the nose, you’ll need to adjust the mask further. Proper placement, fit testing, and removal is demonstrated in the video below:
It should be noted that none of these masks cover the eyes, so it is important to have a mask with a “face shield” or indirectly-vented goggles in order to prevent infection through the eyes.
Many believe eye contamination is rare. In any airborne epidemic, however, small particles are floating in the environment and can easily touch the eye. The particles are then washed down to the tear duct, which opens into the nasal cavity and on to the oral cavity. All this is happening even if you’re wearing a mask. A face shield or goggles will provide the additional protection needed.
How Long Can I Wear An N95 Mask?
Respirator masks can be worn until they are damaged, dirty, or difficult to breathe through. Remember that aerosolized viruses can remain on mask fibers; do not touch the front of the mask when removing.
In future articles, we discuss how to properly don and doff personal protection items and how to put together an epidemic sick room, both topics discussed in my book “Alton’s Antibiotics and Infectious Disease”
(Note: this book is mostly about bacterial diseases and the antibiotics you can get to cure them but has a section on epidemic sick rooms and personal protection gear towards the end)
Joe Alton MD
Check out personal protection gear, medical kits, and individual supplies at store.doomandbloom.net.