The WHO and CDC have made it clear that using PPE is an important factor in reducing the spread of the COVID-19 virus. Asian countries are familiar with how to use PPE to protect the public.
Wearing a protective face mask in public places has long been a cultural norm. However, western countries like the US do not traditionally respond to illness by advising the public to use PPE. Many Americans are unaware of how to use PPE properly. As a result, the less-informed public is grappling to adapt to this practice.
The World Health Organization [7] advises that COVID-19 can be transmitted between people through close contact and droplets like saliva. ScienceDaily reports that surfaces and airborne droplets are also a vehicle for spreading COVID-19. On COVID-19 hard surface survival, they report:
“Scientists discovered the virus is detectable for up to three hours in aerosols, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.”
Individuals who are in close contact with COVID-19 patients are at the highest risk for infection [7]. These include healthcare workers and people who share a household with infected patients. Next, there are essential employees that must report to work. They are exposed to community spread because they cannot fully isolate themselves.
When it comes to the general public, PPE use has also been advised. Americans have been told to stay at home and only leave once every ten to fourteen days to obtain necessary supplies. If members of the public absolutely need to leave their homes, face coverings have been recommended.
The US situation has been confusing and complicated because the Federal government has left it up to states to decide on issuing stay at home orders. However, voices like Dr. Anthony Fauci have made it clear that this is an essential measure to slow down the virus to a level that hospitals can manage better and prevent infection.
Many US citizens have disregarded this advice. In states such as Texas, streets and stores remain busy as infection levels and deaths rise. Likewise, the use of PPE by the public has been adapted better in some regions than others.
The American spirit of freedom and liberty is proving to be stronger in some minds than the importance of slowing and preventing the deadly COVID-19 infection.
Here is a situational example of the public can use PPE and adhere to Coronavirus guidelines in their routine:
“I need to go pick up groceries, so the first thing I do is wash my hands. Next, I put on my mask followed by using hand sanitizer. I put on my gloves and get in my car. In my car, I have left a designated credit card and my driver’s license, plus hand sanitizer, disinfectant, and some extra clean gloves. I leave my purse and phone at home because I do not need them and don’t want to contaminate them.
I drive to the store after spending two weeks inside. I stay six feet away from other shoppers as I purchase only two weeks worth of groceries and supplies because I am thoughtful about the needs of others and have no need to panic or hoard. I return to my car, place the groceries in the trunk, then I take off my gloves before touching my car door and car interior. I open the door, use hand sanitizer and disinfect my keys and card. I put the gloves in a ziplock bag to dispose of in a trash can later.
Next, I return home. I put on a fresh pair of gloves to bring in the groceries. I wipe them down with disinfectant and throw away as much of the outer packaging as possible. Then I throw away my gloves and mask and wash my hands. I put away the groceries and wipe down anything that was touched while bringing the groceries in. Finally, I wash my hands again and feel relieved that I can go another ten to fourteen days without needing to do this again.”
-Sherry Slitts, former virology and microbiology scientist
Wearing PPE correctly is not something the public has been trained in. It can be helpful to think in “zones.” Your home is your green zone, your car is your yellow zone, and anything else is a red zone. When you go from one zone to another, you are mixing the environments. When you bring items from a red zone to the green zone, you need to fully disinfect yourself and the area to return it to green zone status.
Most people that have to wear PPE are given extensive training in its proper use. Likewise, it is important for you to know how to use PPE to make the most of it. This starts with knowing the difference between single-use PPE and reusable PPE.
Single-use disposable PPE includes gloves, masks, protective disposable fabric clothing, and shoe protectors [1]. These items are designed to be worn once and then throw out. If they do not have blood on them they can be put in the normal trash. It is best to tie them off in a smaller bag to contain them.
In a healthcare or laboratory setting, bloody PPE is put into special biohazardous waste bins. In a home setting, you can place them in a small trash bag, spray them down with disinfectant, then tie off the bag and place it in your normal trash.
Please understand that single-use disposable PPE should not be reused [3]. The FDA urges people not to reuse PPE, saying:
“Disposable PPE is designed to be used only one time and by one person; it cannot be washed. Washing PPE changes its protective or barrier capabilities, and it may no longer be effective”
Likewise, this PPE should not be shared. The FDA explains:
“In general, most PPE cleared by the FDA is intended to be used only one time and by one person. Sharing PPE is not advised... Sharing PPE that is intended for single-use may expose another person to infectious materials.”
In healthcare, laboratory, or manufacturing environments, reusable PPE items like heavy-duty gloves and boots can be sanitized and reused. Reusable PPE is normally intended to provide physical barriers and protection from physical hazards. It is not intended to protect from biological hazards like bacteria and viruses.
For the general public, cloth masks and thick rubber cleaning gloves can be treated like reusable PPE. Cloth masks should be washed and dried after use, and gloves can be soaked in bleach, rinsed, then air-dried.
Before you put on PPE, make sure that you are fully dressed and have any items you need to keep with you organized and ready to go. In a healthcare setting, this first step for workers is to put on disposable gowns or lab coats to cover their clothing [5].
Next, you can put on your mask. Make sure it fits around your face and adjust the flexible nose bridge. If you are wearing a respirator, you will want to make sure it is not leaking air around the edges of the mask. To check this you can inhale deeply, then exhale slowly and pay attention if you feel air escaping. If you are wearing eye protection, that can be applied at this time.
Finally, you will need to wash your hands before you put gloves on. If hand sanitizer is available, that should be used too. If you do not have gloves, it is still a very good idea to wash your hands before you leave the house, and upon returning.
While you are wearing PPE, remember these key points [5]:
First, the gloves need to come off [5]. Remember, the outside of the gloves is contaminated. Pinch the palm of one gloved hand and slide your fingers up as you pull the glove back. In this way, you can invert one glove over the other hand. The un-gloved hand can hook the inside of the glove cuff and then pull down to invert the other glove over. Place the gloves immediately in a waste container, then wash your hands or use hand sanitizer.
Next, you can remove any other PPE like protective clothing or eyewear [5]. Remember to treat the exterior of these as if they were contaminated. They will need to be cleaned or contained immediately after use.
Finally, you can remove your mask or respirator [5]. Don’t touch the front of the mask when you do this. Treat that area as if it were contaminated. Use minimal contact by removing it from the ear bands. Then you can either dispose of the mask or decontaminate and store it.
Be sure to wash your hands after you have removed PPE [5]. If you think your hands may be contaminated during the PPE removal process, take the time to wash them or at least use hand sanitizer.
In the workplace, respirators are only given to a person after they have undergone a fit test [4]. A fit test is a standardized testing protocol that verifies that a respirator comfortably and correctly fits the user. Fit test regulations are set out by OSHA, and conducted by certified agencies. When you are using PPE as a member of the general public, you will not have access to a fit test. One measure you can take to help verify your respirator is working is called a seal check.
A seal check is a procedure to make sure a respirator is properly situated on the face [4]. To test the positive pressure of the seal around the mask, you gently exhale while blocking the paths for exhaled breath to exit the facepiece. You should feel pressure pushing out on the mask, increased pressure (a stronger exhale) may cause air to leak out. To check the negative pressure for a seal check, you can sharply inhale while blocking the paths for inhaled breath to enter the facepiece. The facepiece should collapse slightly as you inhale.
If you absolutely must leave the house for supplies every ten to fourteen days, you may want to wear gloves in addition to a face mask. When used properly, gloves can provide additional protection from pathogens. When used improperly, gloves and other PPE can actually spread pathogens [3].
It is very important to disinfect hands before putting on gloves and after taking them off. Likewise, it is important to wear gloves when entering the public space, but remove them when you enter your private space. Keeping a ziplock bag on you to place dirty gloves can help prevent cross-contamination and avoid littering.
Most alcohol-based hand sanitizers contain ethanol, which increases the permeability of gloves [2]. Re-using PPE is highly frowned upon because it degrades the materials which are intended, in most cases, to be disposable. In normal times, no healthcare worker or laboratory scientist would ever re-use any kind of PPE. However, PPE is in short supply and it may be necessary to reuse items.
Alcohol-based hand sanitizers should be used before putting on gloves and masks, and after removing them [2]. It should be allowed to fully dry so it does not breakdown the PPE material. If it is necessary to re-use gloves, bleach (sodium hypochlorite) should be used because it will not degrade the material.
To disinfect gloves using bleach, a 10% bleach solution should be freshly prepared. The gloves should be completely soaked in the solution for ten minutes. Take caution when handling bleach because it can ruin metal and irritate skin and airways [2]. Bleach solutions should be freshly prepared at least weekly because they breakdown very quickly.
Even healthcare workers are struggling to obtain PPE. It is important that their needs are considered above those of the public. Healthcare workers have an absolute need for PPE like gloves and respirators. By contrast, the public has been advised to use alternatives that are not appropriate for the healthcare industry. An example of this is to use a surgical mask, dust mask, or cloth mask instead of an N95 respirator.
There are several steps in addition to staying home that the public should take to prevent infection and community spread of COVID-19. These include [6,7]:
Your personal mindset is the biggest tool against preventing COVID-19 infection and spread. These are unusual times, but you do not need to panic. Just follow the guidelines that everyone has been given and be more aware of your surroundings and your interactions with your surroundings. Take universal precautions and assume that anything and anyone can be contaminated with COVID-19, but know that if you simply follow the guidelines you will be as safe as possible.
Remember that home is the safest place to be right now and following guidelines is the best thing you can do to support healthcare workers. Their number one request is that people simply remain home. Staying home is the most simple, affordable, and practical way to keep your family, friends, and self safe.
