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Personal protective equipment (PPE) is necessary to ensure the safety of the health care provider while providing high quality patient care. In a crisis, there should be a concern for shortages on PPE. Understanding the etiology of the crisis and level of PPE is paramount. Then, mobilization of the health care facility to focus on the crisis, limiting non-emergent entry into the patient room, and recycling mitigate PPE shortages. This chapter will discuss levels of PPE and the requirements for various pathogens. Due to the immense increase in use of PPE during the COVID-19 pandemic, techniques for recycling different aspects of PPE were revisited, analyzed, and examined anew. We review the types of PPE, mechanisms, and safety of reusing PPE, as well as other techniques to minimize PPE and to keep front-line health care workers safe.
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Biocontainment refers to the safety measures on research and laboratory staff who work with infectious agents to prevent contamination and outbreaks. The level of safety is determined by several factors of the infectious agent including its infectivity, transmissibility, virulence, the type of work being conducted, and whether there are existing protective measures for said agent including vaccination or treatment. These levels are referred to as biosafety levels and have been outlined by the Centers for Disease Control (CDC).1,2 (See Table 5-1.)
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The CDC outlines four basic levels of isolation precautions: standard, contact, droplet, and airborne. Standard precautions are meant to reduce transmission from blood borne pathogens or known or unknown sources. This includes hand hygiene, the use of PPE (such as masks, gloves, and gowns based on risk assessment), and respiratory hygiene/cough etiquette.
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Contact precautions are additional precautions for diseases that are epidemiologically important or multi-drug resistant that can easily be transmitted through the patient’s intact skin or contaminated surfaces. Droplet precautions are additional precautions to prevent contact with respiratory secretions, usually within 6 feet of the patient. Surgical masks may be sufficient. Airborne precautions are additional precautions for pathogens that can remain suspended in air.3 The following tables list the level of precautions and necessary PPE for the different types of pandemics (Table 5-2) and pathogens for bioterrorism (Table 5-3).
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