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The Importance of PPE in Workplace Safety

Personal Protective Equipment (PPE) plays a crucial role in workplace safety and is a fundamental element of any comprehensive safety program. Its importance lies in protecting workers from various occupational hazards and reducing the risk of injuries, illnesses, and even fatalities. Tailored for specific workplace risks, PPE encompasses specialized equipment that protects individuals from potential workplace hazards. The required types of PPE can vary depending on the specific industry, job tasks, and potential risks. Many OSHA standards require the employer to provide PPE to their employees. Serving as the ultimate safeguard, PPE constitutes workers’ last line of defense. Here are the key reasons why PPE is essential for workplace safety:

• Hazard Protection: PPE is a barrier between workers and various workplace hazards. It includes equipment such as helmets, safety glasses, gloves, respirators, earplugs, and more, each designed to address specific risks like falling objects, chemical splashes, respiratory hazards, noise, etc.
• Injury Prevention: By providing protection against potential hazards, PPE helps prevent injuries to the head, eyes, ears, hands, feet, and other body parts. This is particularly crucial in high-risk industries like construction, manufacturing, and mining, where the risk of accidents and injuries is higher.
• Respiratory Protection: Respiratory hazards, such as harmful dust, fumes, gases, and airborne pathogens, can cause serious respiratory illnesses. Respirators are essential PPE to protect workers’ lungs from these hazardous substances, especially in environments with poor air quality.
• Infection Control: In healthcare settings, PPE like masks, gowns, and gloves are critical in preventing the spread of infectious diseases among healthcare workers and patients. During outbreaks or pandemics, widespread use of PPE can help contain the spread of contagious illnesses.
• Compliance with Regulations: Many occupations’ health and safety regulations and standards mandate using PPE in specific work environments. Employers are legally required to provide and ensure the proper use of PPE to protect workers from identified hazards.
• Confidence and Productivity: When workers feel safe and protected, it boosts their confidence, leading to increased productivity and better job satisfaction. Knowing that their employer prioritizes their safety fosters a positive work environment.
• Emergency Preparedness: In emergency response situations, such as firefighting or hazardous material handling, specialized PPE is essential for protecting responders from immediate dangers.
• Risk Reduction: While engineering controls and administrative measures are preferable for hazard mitigation, they may not always be feasible. PPE serves as a vital secondary control measure, reducing the risk of exposure to hazards.
• Preventing Long-Term Health Issues: Prolonged exposure to certain hazards can lead to chronic health problems, such as hearing loss, respiratory disorders, and skin diseases. Proper use of PPE prevents or minimizes the impact of such long-term health issues.
• Contractor and Visitor Safety: PPE is not only for employees; it is also necessary to protect contractors, visitors, and anyone else entering the workplace who may be exposed to hazards.

While the modern concept of PPE use in workplace safety emerged during the 20th century, earlier forms of protective equipment were used to address specific risks. In ancient times, soldiers wore armor made of leather, metal, or other materials to protect themselves from weapons and projectiles. In the 19th century, workers in mines used cloth masks or scarves to protect themselves from inhaling dust or other airborne particles. Early forms of PPE were a step toward recognizing the importance of protection but were limited in their effectiveness and sophistication. Today, PPE, which meets strict safety standards, has significantly improved worker protection and workplace safety. Here is a list of common types of PPE for workplace safety:

• Head Protection: Constructed from durable materials, such as rigid plastics and impact-resistant polymers, hard hats and helmets protect against falling objects, overhead hazards, and accidental bumps. Their innovative design incorporates suspension systems that help absorb and distribute impact forces, reducing the risk of skull fractures and traumatic brain injuries. Whether on construction sites, industrial facilities, or hazardous environments, wearing properly fitted hard hats and helmets is not just a matter of compliance but a proactive step towards safeguarding the well-being of workers and ensuring they can carry out their duties confidently.
• Safety glasses -Safety glasses are the most basic form of eye protection and are suitable for protecting against impacts from flying particles, dust, and debris. They typically have impact-resistant lenses and side shields.
• Goggles -Safety goggles provide a more comprehensive seal around the eyes, protecting against chemical splashes, vapors, and potential airborne hazards. They create a barrier between the eyes and the surrounding environment.
• Face shields -Face shields cover the entire face to provide protection against high-velocity impact hazards, chemical splashes, and other potentially hazardous substances. They are used in combination with safety glasses or goggles, not instead of.
• Welding helmets -Welding helmets are specialized face protection designed to shield against harmful radiation, intense light, and sparks generated during welding and related processes.
• Noise-canceling headphones
• N95 respirators
• Half-face or full-face respirators
• Powered air-purifying respirators (PAPRs)
• Supplied Air Respirator Systems (SAR)
• Self-Contained Breathing Apparatus (SCBA)
• Gloves (various types, such as leather, rubber, chemical-resistant, cut-resistant)
• Safety shoes
• Steel-toed boots
• Metatarsal guards
• Chemical-resistant boots  
• Chemical-resistant suits
• High-visibility vests
• Flame-resistant clothing
• Safety harnesses
• Fall arrest systems
• Anchorage points
• Personal Fall Protection System (PFPS)
• Thermal clothing
• Insulated gloves
• Heat-resistant gloves
• Cooling vests
• Respirators with specific filter cartridges
• Gloves and aprons resistant to chemicals and biohazards
• Insulating gloves
• Voltage-rated tools
• Arc flash suits
• Lead aprons
• Radiation-resistant clothing
• Protective eyewear
• Back support belts
• Wrist supports
• Anti-fatigue mats
• Disposable coveralls
• Beard covers
• Shoe covers

Determining the proper PPE for the job begins with a hazard assessment. Review OSHA requirements for PPE as set in the Code of Federal Regulations (CFR). OSHA requires many categories of PPE to meet the standards approved by the American National Standards Institute (ANSI).  Select the appropriate PPE for the task. Additionally, it’s essential to regularly inspect the PPE for any signs of wear and tear and promptly replace damaged, worn, or expired equipment. Properly train workers on the correct use, care, and maintenance of PPE and ensure proper fit. Most importantly, ensure that management enforces compliance with PPE use.

The importance of PPE in workplace safety cannot be overstated. It complements other safety measures and is critical to an overall safety culture. Employers must provide suitable PPE, ensure proper training on its use, and enforce its use to safeguard workers’ health and well-being.

Feel free to contact Safety Consulting Specialists with any inquiries about the necessary PPE for your workplace. We are here to offer our assistance and are happy to help. Moreover, we offer safety training, equipment inspections, and on-site safety professionals tailored to your construction project. Don’t hesitate to get in touch with us today!

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What is personal protective equipment?

Personal protective equipment, commonly referred to as "PPE", is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits.

What can be done to ensure proper use of personal protective equipment?

All personal protective equipment should be safely designed and constructed, and should be maintained in a clean and reliable fashion. It should fit comfortably, encouraging worker use. If the personal protective equipment does not fit properly, it can make the difference between being safely covered or dangerously exposed. When engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, employers must provide personal protective equipment to their workers and ensure its proper use. Employers are also required to train each worker required to use personal protective equipment to know:

• When it is necessary
• What kind is necessary
• How to properly put it on, adjust, wear and take it off
• The limitations of the equipment
• Proper care, maintenance, useful life, and disposal of the equipment

If PPE is to be used, a PPE program should be implemented. This program should address the hazards present; the selection, maintenance, and use of PPE; the training of employees; and monitoring of the program to ensure its ongoing effectiveness.

Personal protective equipment is addressed in specific OSHA standards for general industry, maritime, and construction. OSHA requires that many categories of personal protective equipment meet or be equivalent to standards developed by the American National Standards Institute (ANSI).

Provides references that may aid in recognizing the need for personal protective equipment (PPE) and provides information about proper PPE selection and usage.

Payment for PPE

Provides information on who is required to pay for personal protective equipment (PPE) when it is used to comply with OSHA standards.

Highlights construction information related to personal protective equipment (PPE).

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The Importance of PPE in the Workplace

Personal protective equipment (PPE) is a crucial aspect of workplace safety that cannot be ignored. Employees face a range of hazards that could cause injury or illness, such as working with hazardous substances or heavy machinery. The use of appropriate PPE can protect workers and help prevent accidents. 

This article discusses the importance of PPE, the types commonly used in the workplace, the legal requirements for providing PPE to employees, and the benefits of compliance with PPE legislation.

What is PPE?

PPE stands for Personal Protective Equipment. It is any equipment or clothing worn by a person to minimise exposure to specific workplace hazards, including physical, chemical, biological, or airborne agents. PPE includes items such as safety helmets, gloves, eye protection, high-visibility clothing , safety footwear, and respiratory protective equipment.

Why is PPE important in the workplace?

The importance of PPE in the workplace cannot be overstated. Without proper protection, workers are exposed to various hazards that can cause injury or illness. For example, exposure to hazardous substances such as chemicals and asbestos can lead to respiratory problems and cancer, while working with heavy machinery can result in cuts, bruises, and even amputations.

Wearing personal protective equipment is important not only for the safety and health of workers but also for the productivity and profitability of the workplace. When workers feel safe and secure, they are more likely to be productive and efficient in their jobs. Conversely, an unsafe workplace can lead to low morale, high employee turnover and potential legal issues.

Types of PPE for the workplace

There are several types of PPE, each of which should be worn when certain dangers are present. Employers must identify the hazards in their workplace and provide the appropriate PPE to protect their workers. 

Six of the most commonly used types of PPE in the workplace include:

• Head protection – This includes hard hats, helmets, and bump caps that protect the head from impact and penetration hazards.
• Eye and face protection – This type of PPE includes safety glasses, goggles, face shields, and welding helmets that protect the eyes and face from flying debris, chemical splashes, and harmful radiation.
• Hearing protection – This includes earplugs and earmuffs that protect the ears from loud noises that can lead to hearing loss.
• Respiratory protection – This type of PPE includes respirators and masks that protect workers from inhaling harmful dust, fumes, vapours, and gases.
• Hand protection – This includes gloves that protect the hands from various hazards, such as cuts, punctures, chemical exposure, and extreme temperatures.
• Foot protection – This type of PPE includes safety shoes, boots, and other types of footwear that protect the feet from falling objects, electrical hazards, and slippery surfaces.

Are employers required to provide PPE to workers?

In the UK, employers have a legal duty to provide their employees with appropriate personal protective equipment (PPE) to ensure their safety and protect them against workplace hazards. This responsibility is outlined in the Personal Protective Equipment at Work Regulations 1992 .

The regulations state that employers must provide PPE free of charge to employees, ensure the PPE is suitable for the risks involved, provide appropriate PPE training and instructions on how to use the PPE correctly, 

Employers are also required to ensure that PPE is maintained and replaced when necessary, carry out regular risk assessments to identify hazards and determine if PPE is required, and also guarantee that PPE is properly stored and readily available to employees when needed.  

Employers are also responsible for ensuring that employees use the PPE provided and cooperate with any instructions given on its use. Failure to comply with these legal requirements can result in fines and legal action against the employer.

How can PPE legislation compliance benefit your business?

One of the most significant benefits your business will gain through compliance is increased safety. Proper use of PPE can help to protect employees from work-related injuries and illnesses, thereby improving safety in the workplace. It will also reduce your liability in the event of a workplace injury or illness. 

Additionally, providing PPE demonstrates a commitment to workplace safety, which can improve the reputation of the business and attract new customers and clients. It is becoming increasingly common for businesses to require their suppliers and partners to meet specific safety standards, including the use of appropriate PPE.

Do you understand the importance of PPE in the workplace?

The importance of personal protective equipment in the workplace cannot be overstated. PPE plays a crucial role in protecting workers from potential hazards and ensuring their safety and health. 

It is the responsibility of employers to identify the hazards present in their workplace and provide the appropriate PPE to their workers. By doing so, employers can promote a safe, healthy and productive work environment while also meeting their legal and ethical obligations.

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19 Proven Reasons Why PPE Is Important

Is PPE (Personal protective equipment) important to you in your workplace? Its a very important question, and the answer should not just be about word of mouth but your action will determine if it truly is.

I once spoke to a carpenter working with a table saw without nose mask, when I asked why he wasn’t using his nose mask here was his response – “ I cannot breath well when I use it “.

Now for this individual, can we say the PPE is important to him? The answer is a big No.

At the end of this article, you will get to understand various reasons why PPE is important and why you should make your PPE your best friend.

Before we get the subject matter “ Why PPE is important ”, let use run through the definition of PPE.

Table of Contents

What is PPE

Personal protective equipment, commonly referred to as “PPE”, is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.

Generally, PPE is important because it prepares you for any health and safety risks and gives you extra protection in event of an accident or against the elements.

Why Is PPE Important

Safety is a major issue for day laborers and skilled laborers. Each year, accidents happen frequently in the construction industry and often times it is due to the absence of Personal Protective Equipment (PPE) or failure to wear the provided PPE. The purpose of PPE is to reduce employee exposure to hazards when engineering and administrative controls are not feasible or effective to reduce these risks to acceptable levels.

These hazard risks can be anything from wet floors to falling debris and everything in between. PPE includes items such as protective helmets, eye protection, high-visibility clothing, safety footwear, safety harnesses and, sometimes, respiratory protective equipment.

Aside from providing employees with instructions, procedures, training and supervisions to encourage safe and responsible working. PPE contributes to a safe workplace, so PPE is always going to be an integral part of running a successful and safe business.

Even when you have assessed your risks and put all safe systems of work into place, some hazards will still remain. These hazards can include injuries to: head and feet, eyes, lungs, body and skin; this is where PPE comes into play.

NOTE:  PPE should only ever be used as a last resort after putting all other controls in place.

Let’s explore some PPE commonly used on sites and their benefits:

Examples Of PPE And Their Benefits

Head protection.

Hard hats are common on construction sites. Just passing by a site, you can usually identify workers by their hard hats. They are designed to protect against flying or falling objects that would otherwise impact or penetrate the worker. Some hard hats are equipped with accessories such as face shields and earmuffs. Hard hats should be well-fitted; those that are too large or too small are inappropriate for use.

Eye and Face Protection

Eye and face protection are equally as important as head protection. Safety goggles, spectacles and full face shields can give you the protection needed for the eyes and face. Metal work, wood-work, hot-work and air-tool operations all require this type of protection. General laborers can also benefit from safety goggles since there is usually debris on construction sites.

Respiratory protection

Respiratory protection is vital on sites where toxic substances are present. Sometimes what you can’t see  can  hurt you. Respiratory protections like respirators are designed to protect you from dust, fumes, paint spray, pesticides and other dangerous substances that could cause permanent impairment. Respiratory protection should be used in environments with air contaminants. In work environments, respirators are relied upon when adequate ventilation is unavailable or other engineering control systems are not feasible or inadequate.

Hand & Skin protection

Construction jobs typically require the use of hands. Each year, around 150,000 hand injuries are reported. Occupational skin diseases such as contact dermatitis, skin cancers, and other skin injuries and infections are the second most common type of occupational disease and can be very costly. Because a lot of work is done with the hands, gloves are an essential item in providing skin protection.

Some examples of gloves commonly used as PPE include rubber gloves, cut-resistant gloves, chainsaw gloves and heat-resistant gloves. Using gloves helps to avoid hazards usually involved when working with chemicals, glass, sheet metal, electricity, hot materials or slippery objects.

Hearing protection

Industrial noise is often discounted as an occupational hazard since it isn’t visible to the eye. However, 22 million workers in the United States are exposed to potentially harmful noise levels annually. According to the National Institute for Occupational Safety and Health, about 82% of occupational hearing loss cases occurred to workers in the manufacturing sector.

The Occupational Safety and Health Administration establishes occupational noise exposure standards. NIOSH recommends that worker exposures to noise be reduced to a level equivalent to 85 dBA for eight hours to reduce occupational noise-induced hearing loss. Earplugs and earmuffs are common hearing protection tools. It is important to note that earmuffs are more effective in reducing high-frequency noise while earplugs are more effective for reducing low-frequency noise.

Using PPE, and wearing it properly, is vital to avoid unnecessary injury in the workplace. Choosing not to wear PPE can be dangerous especially when it could save your life.

It’s important to know that safety equipment provided on the job should meet  Personal Protective Equipment Regulation , and that it is most effective when it meets the correct size, fit and height of its user.

You may be accustomed to finding yourself in precarious situations on the job, but you should never feel like your physical being is likely to be harmed.

Reasons Why It’s Important To Use PPE In The Workplace

1. it keeps you from being liable for your own injuries.

One common speed bump that workers’ compensation attorneys deal with on the regular is an individual’s decision not to wear PPE, regardless of the fact that they were provided with it by their employer. This often makes the liability for a workplace illness or injury more of a gray area.

It varies from case to case, but faithfully using all PPE that you are provided with on the job is the best way to ensure that should an injury or illness directly result, your employer will absorb full liability. Even for those jobs that “only take a few minutes”, you should never allow for exemptions from wearing PPE.

Being found partially responsible in a court of law for your own workplace illness or injury from a failure to use PPE is a worst-case scenario. As an employee, you should be fully educated on which equipment is required of which tasks, and what it is meant to protect. If this is not the case, you should not be afraid to contact a manager or your HR department.

2. Long-term conditions may result from a failure to protect yourself.

Feeling fine at the end of your shift doesn’t pass for the fact that you’ve properly protected your body. Exposure to different chemicals and compounds on the job can have long-term effects on your body, with mesothelioma being a great example. In 2017, it was estimated that  3,000 Americans each year were diagnosed  with this rare form of cancer.

Between 70-80% of these diagnoses were from exposure to asbestos fibers used in the construction of materials in many different industries. Current safety regulations require those who work with asbestos to wear specific PPE, and to shower and change before leaving the workplace. But prior to modern regulation, there was not a connection made between asbestos exposure and cancer diagnosis.

Therefore, many of these daily mesothelioma cases were caused at a time before we knew so much about this disease. Workers should take advantage of the medical knowledge regarding risk factors that we have today, and use PPE to safeguard their health and well-being, both for now and down the road.

3. You only have one pair of eyes.

Safety glasses are probably one of the most common (and effective!) forms of PPE. This is because any substance, whether corrosive or not, and any material, sharp or not, can be hazardous when it comes in contact with your eyes.

Every year, roughly 2.4 million eye injuries occur in the United States, both at work and during leisure activities. Of these injuries, about 50,000 victims lost their eyesight to some degree. According to the American Academy of Ophthalmology (AAO), 90% of these eye injuries could have been prevented by safety eyewear.

Since 61% of eye injuries happen in manufacturing, construction or trade jobs, it is important to acknowledge that there are different types of PPE eyewear available for different situations. Don’t be afraid to inquire about upgrading your eyewear.

4. It increases the quality of your workday.

Think of PPE as a support system of sorts for the work your job requires you to do. It may be more physically demanding or slightly more hazardous than your average desk job, but the equipment is provided to make you feel that physical risk is minimal.

PPE items such as weight belts offer stability for duties that ask you to perform heavy lifting, and these might be the difference between having to go to work with strained muscles the next day or not. Measures should be taken to prevent basic trip and fall injuries that, on the most simplistic level, just flat out ruin someone’s day.

19 Reasons Why PPE Is Important

• PPE is your personal control which is there to look after you.
• It protects you. The whole reason for PPE is to protect you, so if you don’t wear or use it, it can’t do its job.
• It’s your last line of defence. Your PPE is the last barrier you have against hazards. There may be other controls in place, but your PPE is the control that stands in the way of any final or remaining risk, no matter how small.
• It is easy to replace. Gloves got ripped? Get a new pair. Your hard hat was hit? Get a new one. Not so easy to replace your skin or your skull.
• It protects your health. Other types of PPE protect your health. Like dust masks keeping dust out your lungs, and gloves stopping you developing dermatitis.
• It sets a good example
• Everyone should wear and use PPE. From directors and managers to visitors and new starters.
• It shows you care – Using and wearing the right PPE shows you care about health and safety, and about yourself.
• It gives a good impression – It looks professional because it is professional. It shows you have standards, and run a safe site.
• It helps your reputation – If everyone is wearing and using the right PPE, then that first impression helps build your reputation as a business that does things right.
• It saves your skin – Red, itchy, painful, blistering skin? Could that be dermatitis or even sunburn? PPE can help cover your skin and stop this happening to you.
• It prevents pain – No one likes pain. PPE can stop it.
• It’s your personal insurance policy – PPE shouldn’t be the only control, risks should be stopped before they reach you where possible. But like insurance, PPE is there should the worst happen.
• You will be prepared for the worst – If the worst should the worst happen, with your PPE you will have a better chance of escaping unharmed.
• It can stop an accident – We have mentioned how PPE can protect you from the results of an accident, but there are also types of PPE that can stop an accident. Think about how safety lanyards and harnesses can stop you getting into a position where you might fall.
• It can help you do your job – Your safety gloves can give you a better grip. A torch on your hard hat can help you to see. Your ear defenders can make a noisy work environment tolerable. Your PPE can help you do your job.
• It gives you peace of mind – You hope you don’t need your PPE, but it gives you peace of mind that you are better protected.
• It could save your life – Don’t believe me? A hard hat stops a brick breaking your skull, a harness stops you falling from a roof, a lifejacket keeps you afloat until help arrives. I’m sure you can think of many more examples.
• It’s the law – Ok, we left this one until last, but let’s not forget the legal requirements here. It’s the law to provide PPE where there is a risk to health and safety and to use and wear your PPE correctly.

Related Articles

When Should PPE Be Used in the Workplace?

What Is Risk Appetite?

Heat PPE: PPE Used To Prevent Heat in the Workplace

What Is PPE (Personal Protective Equipment)

What Does PPE Stand For In Medical Terms?

Ubong Edet is a seasoned Health and Safety Specialist (QHSE), a trainer and a coach.

With over 8 years of practical experience in Construction Safety and have been involved in several construction projects.

Certifications possess includes: NEBOSH, OSHA, ISO amongst others.

In HSEWatch, I am bringing my knowledge and experience to bare in other to help fellow professionals and newbies in the profession.

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Contact transmission and the role of hcp, ppe for preventing contamination, improving routine ppe use, improving ebola-specific ppe use, future directions, improving the use of personal protective equipment: applying lessons learned.

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Sujan C Reddy, Amy L Valderrama, David T Kuhar, Improving the Use of Personal Protective Equipment: Applying Lessons Learned, Clinical Infectious Diseases , Volume 69, Issue Supplement_3, 1 October 2019, Pages S165–S170, https://doi.org/10.1093/cid/ciz619

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Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.

Every day, people touch and carry a range of potential pathogens, some of which will ultimately cause infections. This includes healthcare personnel (HCP) and patients in healthcare settings where there are frequent opportunities for close contact that can lead to transmission of organisms between HCP and patients. Unrecognized transmission of pathogens can lead to colonization and infection of both patients and HCP. While many pathogens can lead to harm to patients, a few also pose a high risk to HCP. Personal protective equipment (PPE) is an important component in infection control strategies to protect HCP. By preventing contamination of HCP hands and garments, PPE is intended to prevent infections in the individual HCP, as well as secondary spread to other HCP and to patients. Understanding how and where HCP contamination occurs is important for improving PPE and infection control practices for both routine and specialized patient care. The 2014–2016 Ebola outbreak brought to light important gaps in HCP use of PPE and implementation of strategies for preventing patient-to-HCP transmission. Recent studies on Ebola-specific PPE and routine healthcare PPE, as described in the Centers for Disease Control and Prevention (CDC) guidelines [ 1–3 ], have shown that optimal use is difficult, HCP may alter healthcare delivery when utilizing PPE, and self-contamination occurs during the use of PPE, potentially endangering HCP and patients. Furthermore, strategies to address these challenges often lack strong evidence for effectiveness [ 4 ]. To increase our knowledge and facilitate improved design and use of PPE, the CDC expanded research and innovation funding through the CDC Prevention Epicenters Program beginning in 2015. The 2015 Prevention Epicenters investments focused on contact transmission and optimizing PPE use for preventing transmission in healthcare settings.

The CDC Prevention Epicenters Program is a unique collaborative research partnership among public health and academic medical centers in the United States that perform research and innovation in the prevention of healthcare-associated infections and antibiotic resistance. This supplement to Clinical Infectious Diseases provides insights from the recent work of the Prevention Epicenters Program for improving routine use of PPE and Ebola-specific PPE and for preventing contact transmission of pathogens to better protect patients and HCP. Although settings, equipment, and instructions for donning and doffing of routine PPE differ from Ebola-specific practices, insights gained from one scenario can be applied to the other. In this article, we discuss the recent work of the Prevention Epicenters, summarize the findings of their work presented in this supplement, and describe future directions for improving PPE and its use in healthcare settings.

Transmission of microbes between patients and HCP during routine care is common, regardless of whether the patient is actively infected or asymptomatically colonized. HCP can be contaminated during direct contact with patient skin or bodily fluids (direct contact transmission) or by contact with the patient’s environment (indirect contact transmission). The hands of HCP are frequently contaminated and are sources of transmission to others and to the environment. HCP clothing, including white coats, can also become contaminated and serve as a reservoir for pathogens. Standard precautions, including hand hygiene and the use of PPE, are the cornerstone to preventing transmission, based on the potential for exposure to blood, body fluids, or infectious material. Additional contact precautions are applied when a patient has a documented or suspected diagnosis with which contact with the patient, their body fluids, or their environment presents a substantial transmission risk [ 3 ].

Many factors related to the patient and HCP affect the risk for HCP contamination. Patient factors associated with pathogen shedding include their microbial burden, antibiotic exposures, and patient conditions, such as open wounds and bowel incontinence [ 5–7 ]. The type of HCP interactions with patients [ 5 , 8 ] and their environment [ 9–11 ] also influence the risk for contamination. Several Prevention Epicenters studies aimed to better identify HCP-to-patient interactions that resulted in contamination. Epicenters investigators found that that high-risk HCP-to-patient interactions involve direct contact with the patient or bodily fluids and include activities such as touching endotracheal tubes, changing wound dressings, and assisting with bathing, whereas low-risk interactions involve minimal patient contact, for example, glucose monitoring and medication assistance [ 12–14 ]. Understanding when HCP are at highest risk for contamination can help inform control strategies, including PPE.

Preventing exposures to infectious material in the healthcare setting is a fundamental part of protecting HCP and patients. Traditionally, a hierarchy of controls ( Figure 1 ) has been used to determine how to implement feasible and effective control solutions to occupational hazards. The hierarchy ranks controls according to their effectiveness, leading with elimination of a hazard as the most potentially effective control, and ending with PPE, whose effectiveness relies on consistent and correct use. In healthcare settings, elimination of an infectious disease from a facility is typically not possible, as patients with infections require medical care. Preventing the transmission of infectious agents that are spread by contact primarily involves the use of engineering controls (such as maintaining private patient isolation rooms), administrative controls (such as limiting patient movement out of isolation rooms to medical necessity only), and PPE. Because other control solutions cannot completely eliminate the risk for exposure to infectious diseases in healthcare settings, PPE remains an important tool in a comprehensive strategy for preventing the transmission of pathogens from patients to HCP.

Hierarchy of controls for occupational hazards [ 15 ]. Abbreviation: PPE, personal protective equipment.

HCP contamination can occur due to failure to use PPE, PPE malfunction, incorrect use of PPE, and self-contamination during care and in the doffing process. When immediate health consequences of contamination are not apparent for either patients or HCP, HCP may not recognize the importance of work practices, including correct and consistent PPE use. One study that used video monitoring showed that adherence to correct PPE use was 34% with variability by provider type [ 16 ]. Even when HCP wear PPE, incorrect use occurs, which can provide a false sense of security and lead to self-contamination and transmission events. Understanding the types of errors that occur in using PPE is one step toward identifying solutions. Investigators performed 325 HCP observations of adherence to contact and droplet precautions and observed 283 failures. Of these failures, 102 were deviations from safe operating practices or procedures, such as entering a room without donning PPE or not donning the gown completely; 44 process or procedural mistakes, such as being interrupted while doffing PPE, were identified; and 37 slips or lapses, such as unintentional self-contact without awareness, were identified [ 17 ]. Unfortunately, such failures can result in pathogen transmission. One study showed that 37% of HCP hands were contaminated after doffing contaminated gloves, but contamination varied based on the doffing technique [ 18 ]. Another study of glove and gown removal simulations showed that self-contamination of skin or clothing occurred in 46% of simulations, which would have gone unrecognized in real-world settings [ 19 ].

Prevention Epicenters investigators and others have noted that PPE design may affect errors in PPE use, and some have suggested that use of human factors engineering could help address some of these issues [ 20 ]. HCP describe a tension between doffing safely and doffing expediently and that PPE design can provide both barriers to or be facilitators of appropriate use [ 21 ]. Prevention Epicenters investigators and others are evaluating different designs of PPE, such as features to facilitate doffing gloves, designs that allow for easy removal around the neck, improved fasteners to facilitate donning and doffing, and color coding to aid in recognition of potentially contaminated areas [ 21–23 ].

Several retrospective studies have reported an association of contact precautions with patient adverse events, including depression, anxiety, anger, fear, loneliness, and other noninfectious adverse effects [ 24 ]. However, many of these studies were not designed to adequately address concerns that patients in contact precautions might have a greater severity of illness, and a prospective multicenter randomized controlled study did not demonstrate adverse events for patients cared for by HCP in gloves and gowns [ 25 ]. Nevertheless, the effect of contact precautions on HCP workflow has been documented with HCP entering isolation patient rooms less often [ 26 ]. Prevention Epicenters investigators found that job activities contribute to PPE errors and that HCP movement patterns, time with patients, care activities, and use of equipment vary by type of HCP and will require multiple solutions to improve PPE use based on the activities performed [ 27 ]. Ultimately, a better understanding of how contact precautions and PPE affect patient care activities can lead to strategies to mitigate unintended consequences.

Additional HCP-level interventions aimed at reducing HCP risk of contamination are being evaluated. Some institutions have implemented a policy of bare-below-the-elbows, which advocates for HCP to wear short sleeve shirts and avoid wearing white coats, hand and wrist jewelry, and neckties [ 28 ]. In a randomized controlled study that involved simulated patient care interactions with a surrogate marker, HCP in the short-sleeved group had less contamination than HCP in the long-sleeved group [ 29 ]. Separately, a recent clinical trial of antimicrobial-impregnated textiles, such as HCP scrubs, showed that antimicrobial-impregnated scrubs were not effective at reducing HCP contamination, despite having shown early promise [ 30 ]. The effect of additional strategies to reduce the risk of HCP contamination warrants further investigation.

The burden of contact precautions on HCP and healthcare facilities, potential adverse effects of contact precautions on patient care, and the existence of additional strategies to reduce the risk for transmission have led some to question the use of contact precautions for endemic pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus [ 31 ]. Although PPE is the most recognizable element of contact precautions, CDC recommendations for the use of contact precautions include engineering, administrative, and PPE controls [ 3 ]. While the recommendation to use contact precautions to prevent disease transmission is based on sound rationale and evidence, the impact on disease transmission is unclear, in part, because the optimal methods for evaluating the effect of contact precautions on transmission rates are not established. Due to this limitation, single-center quasiexperimental studies that evaluate the noninferiority of discontinuing contact precautions are unable to adequately establish its effect [ 32 ]. These studies may underestimate the impact of contact precautions by not including effects on colonization or downstream adverse events, such as postdischarge infections, which are more common than hospital-onset infections [ 33 ]. Notably, hospital-onset and healthcare-associated MRSA bloodstream infections have declined in the United States from 2012–2017, suggesting that current strategies, which include contact precautions, have been effective in reducing MRSA infections [ 33 , 34 ]. Regardless, conducting research aimed at establishing methodology to evaluate the effectiveness of contact precautions to prevent transmission could help optimize implementation of contact precautions in the future.

Errors in routine PPE use and patient care practices generally do not result in recognized harm to HCP; however, patient care for individuals infected with pathogens such as hemorrhagic fever viruses is much less forgiving. Successful PPE use and adherence to correct infection control practices require extensive, comprehensive training and demonstrated competency in donning, performing care activities, and doffing. It is recommended that a trained observer supervise Ebola-specific PPE donning and doffing to prevent unrecognized mistakes. However, even with guidance on the sequence of donning and doffing and training for HCP using Ebola-specific PPE, research from the Prevention Epicenters and others has shown that HCP actions still cause self-contamination in simulated environments [ 35–37 ]. Human factors engineering methodology can be utilized to identify doffing activities where self-contamination is more likely to occur; quantify the risk associated with those failures; and describe the mental, physical, and temporal load of each task [ 38 , 39 ]. A challenge for the field will be to reconcile differences in the results from individual facilities by finding commonalities in errors and identifying solutions that are applicable to other sites.

Human factors engineering has been used to describe reasons for PPE use errors and identify methods to reduce self-contamination while doffing PPE, such as optimizing PPE design, improving hand hygiene while doffing, and designing the built environment to facilitate successful doffing. Although glove decontamination prior to doffing decreases the concentration of bacteria on inner gloves, self-contamination still occurs [ 40 ]. Research evaluating methods of decontaminating hands (eg, wipes or spray) may help facilities compare methods [ 41 ], but facilities also need to consider occupational health hazards, such as adverse respiratory effects and falls. Prevention Epicenter investigators identified significant variation in hand hygiene technique, duration, and thoroughness at 4 Ebola treatment centers and showed that simple techniques, such as singing a song to help estimate time while performing hand hygiene, improved adherence and duration [ 42 ].

For HCP who care for patients with Ebola, Prevention Epicenters investigators identified 5 key features of the built environment that improve safety during doffing of complex PPE ensembles: the doffing area facilitates communication, the environment indicates zones of contamination; the doffing area provides stabilization to aid balance, the doffing area nudges automatic safe choices, and the environment provides situational awareness [ 43 ]. Investigators also implemented an optimized doffing area design in a simulated environment that included simple interventions such as a chair or grab bar for balance, demarcating zones of contamination on the floor, and use of a mirror to reduce risky behaviors while doffing [ 44 ]. Similarly, other Prevention Epicenters investigators showed that an intervention package that addresses PPE selection, teamwork building, doffing protocols, the built environment, and training all can effectively reduce self-contamination [ 45 ].

The Prevention Epicenters research provides an evidence base for how improving usability and effectiveness of PPE can better protect HCP. There is further need to be able to quantify transmission risk. Research in transmission dynamics and PPE efficacy to date has relied on the use of benign surrogate markers. These markers are a valuable tool to qualify and quantify the potential risk of pathogen transmission for research and for training [ 19 ]. Numerous studies that evaluated PPE use have used a range of fluorescent markers (liquid, lotions, or powder) with ultraviolet light either alone or in combination with other surrogates, such as bacteria, bacterial spores, nonenveloped bacteriophages (MS2), enveloped bacteriophages (ɸ6), cauliflower mosaic virus DNA, and polystyrene latex spheres PolyStyrene Latex (PSL). For instance, Epicenters investigators evaluated the use of PSLs in combination with fluorescent markers in order to quantify potential inhalational exposures [ 46 ]. Further developing appropriate surrogates, standardizing methods for applying surrogates to simulate real-life contamination, comparing various surrogates to each other, and, importantly, correlating them with pathogenic organisms are needed to move the field forward.

Based on the results of the Prevention Epicenters Program and related research, efforts to improve the use of PPE for contact precautions should include methods to improve adherence to recommended protocols for PPE use, improved PPE design that facilitates donning, patient care activities, and doffing, as well as further research into the risks, benefits, and best practices of PPE use.

First, improving adherence to recommended protocols for PPE use should involve HCP education, training, demonstrations of competency, monitoring, and creating a patient care environment that facilitates the appropriate use of PPE. HCP should be educated about the importance of transmission in healthcare settings, the role of HCP contamination in transmission events, and methods for reducing that risk. Furthermore, schools for healthcare providers (eg, medical and nursing schools) are critical places for early career engagement and instruction in transmission dynamics and the importance and use of PPE for creating a safe work environment.

Second, PPE design for both routine and specialized use should help HCP provide optimal care for patients, rather than diverting their attention during patient care while attempting to remember multiple steps and awkward actions needed for safe PPE use. Multidisciplinary partnerships, including industry partners, human factors engineers, healthcare epidemiologists, and HCP, can provide the diverse expertise for evaluating and improving PPE design and finding effective solutions to improve performance and usability in healthcare settings.

Third, our understanding of transmission events in healthcare settings is limited, and further research that links transmission risk to best practices in patient care, including PPE use, is needed. Common transmission events are unrecognized because acquisition of pathogens by HCP or patients is usually not clinically apparent or has delayed clinical manifestation (eg, after the patient is discharged from a facility). More detailed studies in real-world and simulated environments, including the use of surrogate markers, will be valuable in describing transmission dynamics, the role of HCP self-contamination in the spread of pathogens, and the effectiveness of different PPE strategies and care processes in preventing transmission. Specifically, assessing the contribution of PPE among multiple concurrent infection control interventions is an ongoing challenge. Mathematical modeling can be used to predict the effect of individual components of bundled interventions [ 47 ], but these models depend on appropriately detailed data points to parameterize important variables. The marriage of modeling with observational data collection might be an avenue whereby interventions could be evaluated. Sequencing of isolates to verify transmission events would give greater clarity to when transmission events are occurring and potentially aid in identifying the source of patient or HCP acquisition. Furthermore, a better understanding of the contribution of colonization status, shedding, and high-risk patient–HCP interactions could provide important insights for optimizing PPE use and design for all types of healthcare delivery.

All healthcare settings can benefit from improvements in PPE use and design. Postacute care settings, such as nursing homes and high-acuity skilled nursing facilities, have high rates of multidrug-resistant organism (MDRO) colonization and transmission [ 48 ] that can affect the regional control of MDROs [ 49–51 ]. Due to the higher prevalence of MDRO colonization, patient care workflow processes, communal living, and other factors, these settings need tailored approaches to prevent transmission, including strategies such as using PPE based on resident risk factors rather than pathogen-specific indications [ 52 ].

In summary, PPE plays an important role in preventing pathogen transmission in healthcare settings, but its optimal design and use need to be informed by dedicated research to achieve the reliability and effectiveness needed to protect patients and HCP. Current Prevention Epicenters projects on PPE explore improvements in the use and refinements in the design of PPE and foster innovation and research to reduce the risk of transmission of infectious diseases between HCP and patients.

Acknowledgments.  The authors thank Melissa Kornfeld, Karima Hunter, Tiffanee Woodard, and John Jernigan for their continued support of the Prevention Epicenters Program and this supplement.

Disclaimer.  The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supplement sponsorship.  This article appears as part of the supplement “Personal Protective Equipment for Preventing Contact Transmission of Pathogens: Innovations from CDC’s Prevention Epicenters Program,” sponsored by the CDC’s Prevention Epicenters Program.

Potential conflicts of interest.  All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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• ebola virus
• delivery of health care
• health personnel
• ebola virus disease
• pathogenic organism
• personal protective equipment
• contact precautions
• microbial colonization
• best practice

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• Toolbox Talks

Toolbox Talk: Importance of Personal Protective Equipment (PPE) in Workplace

• by Afnan Tajuddin
• PPE , Toolbox Talks

Personal Protective Equipment (PPE) is an essential aspect of workplace safety . This toolbox talk article aims to discuss the benefits of wearing PPE, the types available, common excuses for not wearing PPE, and the consequences of not using PPE. We will also go through specific PPE requirements for different jobs and situations. So let’s dive in!

Table of Contents

Benefits of Wearing PPE

Wearing appropriate PPE can greatly reduce the risk of workplace injuries and illnesses. Some of the key benefits include:

• Protection against physical, chemical, and biological hazards
• Prevention of long-term health problems
• Compliance with industry regulations and standards
• Reduction of workplace accidents and associated costs

Types of Personal Protective Equipment (PPE)

There are various types of PPE designed for different job tasks and conditions. Some common examples include:

• Safety helmets
• Safety goggles and monogoggles
• Safety shoes
• Hearing protection
• Safety belts/harnesses
• Respiratory protection
• Life jackets and life-saving equipment
• Specialized equipment like H2S monitors, LEL indicators, oxygen analyzers, and SCBA

Common Excuses for Not Wearing PPE

Despite the proven benefits of PPE, some workers still avoid wearing it. Typical excuses include:

• Discomfort or inconvenience
• Belief that PPE is unnecessary for their specific task
• Lack of awareness about the importance of PPE
• Unavailability of proper PPE

It’s crucial to address these excuses and ensure that workers understand the importance of wearing appropriate PPE.

What Can Happen If You Don’t Use PPE?

Failing to use PPE can result in severe consequences, such as:

• Increased risk of injury or illness
• Non-compliance with industry regulations, resulting in fines or penalties
• Higher workplace accident rates
• Potential long-term health problems

Key PPE Requirements for Different Work Situations

Coveralls must be worn in all workplaces, Special disposable coveralls recommended while entering contaminated areas

Safety Helmets

Safety helmets are required in all fieldwork areas, with exceptions only for indoor office spaces and while riding inside vehicles.

Eye Protection

Safety goggles or industrial-type eye protection is required in all fieldwork areas, with the same exceptions as safety helmets.

Safety Shoes

Safety shoes are required in all fieldwork areas.

Monogoggles

Monogoggles are required when entering posted areas/units or while doing PM jobs on batteries.

Leather, cotton, or rubber etc gloves are required as applicable, depending on the nature of the work. for example Chemical-resistant gloves or rubber gloves must be worn when handling hazardous chemicals or contaminated equipment and batteries.

Hearing Protection

Hearing protection should be used when working in noisy areas to prevent hearing loss.

Safety Belts/Harnesses

Safety belts and harnesses are compulsory while working on elevations 6 feet above grade to prevent falls.

Special PPE for Hazardous/Toxic Chemicals

Special PPE, such as H2S monitors, LEL indicators, oxygen analyzers, and SCBA, is required when opening process equipment and/or lines suspected of containing hazardous or toxic chemicals.

Respiratory Protection

Use proper respiratory protection suitable for the atmosphere, depending on the type of contaminant (e.g., dust masks for dust, chemical canister respirators for aerosols and chemicals).

Life-Saving Equipment

Life jackets, lifebuoys, rafts, and other life-saving equipment must be available when working above water at piers and berths.

SCBA must be worn if you are trying to control a toxic gas release. Do not attempt to use a breathing apparatus if you are not trained to use it.

Personal Protective Equipment (PPE) is vital for ensuring workplace safety. It’s essential to wear appropriate PPE for different job tasks and conditions, as failure to do so can result in severe consequences. Employers must provide proper PPE and ensure that workers are trained to use them correctly. Workers also need to take responsibility for their safety and wear PPE as required. Remember, wearing PPE is not optional but mandatory, and it can save lives and prevent injuries. So, always wear your PPE, and stay safe!

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What Is PPE and Why Is It Important in the Workplace?

Before the COVID-19 pandemic, hardly anyone outside a few select industries had heard about Personal Protective Equipment. If you asked the average person on the street, ‘What does PPE stand for?’ they probably wouldn’t have been able to answer you. These days, we all know how personal protective equipment like gloves and masks can protect us. But what about other types of PPE at work? What is PPE in the workplace and why is it important?

There are various rules and regulations regarding Personal Protective Equipment (PPE) at work. The type you use, how you use it, how you store it and even who has to pay for it are all laid out in UK health and safety law. If you’re an employer, you have an obligation to provide adequate protection for your teams. If you’re an employee, you’ve got a responsibility to use PPE safely.

Personal Protective Equipment is a pretty big deal. That’s why we’ve put together this short guide on what PPE is and why it is essential you use it correctly.

What is PPE?

Every workplace has hazards. Some workplaces, of course, are more hazardous than others. A construction site, for instance, is a riskier workplace than a second-hand record store. When workplace hazards can’t be eliminated, we must use other means to mitigate or control them.

On a construction site, there’s always the risk of harm from falling objects. This can’t be avoided. While a second-hand record store might seem safe, harsh chemicals are often used to clean old albums. Also, it is an unavoidable part of the job.

When these health and safety risks can’t be avoided, Personal Protective Equipment is used to protect workers. It can be categorised as any wearable device or clothing that protects the wearer from harm. A construction worker will wear a hard hat to protect them from falling debris. A second-hand record store employee might wear a face mask and perhaps gloves to protect themselves from chemicals.

Why is Personal Protective Equipment Important?

Some forms of protective equipment are compulsory and legally mandated, like the construction worker’s hard hat. Other forms are best practices or common sense, like the record store employee’s face mask and gloves.

Regardless of whether or not the use of PPE is specifically outlined, all employers in the UK have to ensure that the workplace is safe for their employees. So, suppose a risk can’t be eliminated or controlled in another way. In that case, the employer is legally obligated to provide the employee with PPE and ensure they know how to use it properly.

PPE is considered the last defence against workplace risk. It is the last thing you should resort to. It’s designed to protect only the person wearing it. If they’re not wearing it correctly, haven’t taken good care of it, or it isn’t suitable, it won’t provide any protection.

Wearing protective equipment can ensure that employees can do their tasks safely without worrying about getting harmed. This helps to keep people safe and increases their productivity.

PPE Training

Our Personal Protective Equipment Training course gives a thorough understanding of the right use of PPE to adopt safe working practices that help control and eradicate any workplace hazard or injury.

Real-Life Examples of Personal Protective Equipment in Action

The Covid-19 pandemic proved to everyone how valuable PPE can be. There are countless examples from across the globe about how it saves lives. Real-world examples include:

• A hard hat saved a 24-year-old man in Miami from being killed by a falling pulley weighing hundreds of kilos
• Arc flash gear saved a UK construction worker from severe burns when he drilled a jackhammer through an electrical cable
• Another UK man had his toes saved from being crushed because he was wearing steel-capped boots
• Every day, medical staff prevent the spread of disease by wearing PPE such as masks, gowns and gloves

In a tragic example of the consequences of not wearing PPE, a UK worker recently died working on a rail link site. Investigators determined that his death was directly caused by not wearing adequate PPE.

What Are the Different Types of PPE?

There are many different types of PPE . Disposal gloves, facemasks, hard hats, boots, aprons, respiratory apparatus, harnesses and shoe covers are all PPE.

The main types of protective equipment:

• Head Protection
• Hearing Protection
• Eye and Face Protection
• Respiratory Protection
• Hand Protection
• Body Protection
• Foot Protection
• Fall Protection

What Isn’t Classed as PPE?

Personal Protective Equipment has the specific purpose of preventing harm. Items that aren’t classed as PPE include:

• Everyday clothing or conventional uniforms
• Any clothing used to maintain food hygiene standards
• Equipment work for protection on public roads, for example, a motorcycle crash helmet
• Any offensive weapons used by professionals as a deterrent. For example, a police officer’s truncheon
• Any portable device used to prevent risk, such as a gas detector

How to Choose the Right PPE

Employers must provide Personal Protective Equipment for their employees if workplace risks can’t be eliminated or controlled in any other way. The use and provision of PPE is covered by UK health and safety legislation such as:

• The Personal Protective Equipment at Work (Amendment) Regulations 2022
• The Health and Safety at Work Act 1974 (HSWA)
• The Control of Substances Hazardous to Health (COSHH)

Complying with these laws means choosing the right type to use in the workplace.

An employer should first perform a thorough risk assessment of the workplace or have one performed by a competent person. The risk assessment will list all the hazards and what measures can be taken to eliminate or mitigate the risks posed by the hazards.

If PPE is required, it must provide suitable protection and carry the CE mark. This shows that it meets the minimum safety requirements.

Employers must ensure employees are fully trained to use, store and maintain PPE correctly. Before use, PPE should be visually inspected to ensure that it is in good condition. If required, employers must install PPE signs in the workplace . All PPE must be used in the manner for which it is intended. Employees should report any broken, malfunctioning or lost PPE immediately and not attempt to perform a task without it.

Can Employers Charge Employees for PPE?

Section 9 of the Health and Safety at Work etc Act 1974 states,

“No employer shall levy or permit to be levied on any employee of his any charge in respect of anything done or provided in pursuance of any specific requirement of the relevant statutory provisions.”

In non-legalese, employers cannot charge their employees for the protective equipment provided. This applies to single-use PPE, PPE that can be returned, and PPE provided to agency workers.

Employers can, however, set a budget for how much they are willing to spend on PPE. In some cases, this budget can be shared among several employees. Employers also have the right to ask their employees to clean or wash their PPE if necessary.

If you’re self-employed, you will need to provide your own PPE and pay for it yourself.

Learn More About PPE in the Workplace

Personal Protective Equipment can save lives. Employers and employees must understand PPE and why it is essential.

Sign up for our PPE Training course to fully understand Personal Protective Equipment at work.

It provides a thorough overview of the role of Personal Protective Equipment in the workplace and how to choose and use it correctly. The modules can be taken online whenever you like. Completing the course will earn you a downloadable certificate endorsed by the International Institute of Risk & Safety Management (IIRSM) and is recognised by industries across the UK.

Best of all, our PPE Training will ensure you stay on the right side of the law and safe at work. It’s perfect for people in all industries, from construction to selling second-hand records.

About the author(s)

Simon Morrison

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• Three reasons why personal protective equipment (PPE) supply remains critical

Demand for gloves, masks, gowns and other personal protective equipment (PPE) continues to grow in response to COVID-19.

In the early days of the pandemic, the demand for quality-assured personal protective equipment (PPE) skyrocketed. This led to severe supply restraints as competition grew between countries. To improve the situation, UNICEF led a joint tender on behalf of 13 United Nations agencies to establish long-term agreements for the supply of PPE. These agreements not only improved affordability and access, but also helped to prevent the risk of stock-outs during future health crises.

The use of personal protective equipment – especially medical masks – has become commonplace for people around the world. However, PPE is much more than medical masks. It includes gowns, googles, gloves, face shields and other items that are used by frontline health care and other essential workers. The proper use of quality-assured PPE is crucial to prevent exposure to infectious diseases, including COVID-19.

The demand for quality-assured PPE remains high. UNICEF continues to play an important role in the procurement and delivery of PPE. In fact, since the pandemic began, UNICEF has shipped more than 653.4 million items of PPE to 140 countries as part of the COVID-19 response.

This is made possible thanks to funding secured through sources such as UNICEF’s Humanitarian Action for Children Appeal and a donation from the Government of Denmark to the ACT-A Supplies Financing Facility (ACT-A SFF).

Here are three reasons why PPE remains an essential supply item.

1. Protecting health workers against COVID-19

Health workers are on the frontline of the pandemic response. They treat and care for patients with COVID-19 and face higher risks in the battle against this disease. PPE forms a barrier between health workers, COVID-19 and other infectious viruses and bacteria, and it is essential so they can continue to work safely and care for their patients.

“When I am protected, I feel safe, but when I see a reduction in supplies, I worry a lot because if we don’t have the protective gear, we get exposed,” said Sister Monica Murungi, Area Manager of the Maternity Department in Rukunyu Hospital, Uganda.

PPE is a critical resource that health workers like Sister Monica need to remain protected and feel safe while on duty.

2. Ensuring essential health care services continue

By providing the necessary equipment to help protect health workers from COVID-19 and other infectious diseases, PPE is directly supporting the continuity of health services such as routine immunization, primary healthcare, and mother and child health programmes.

One of the most essential health services impacted by the pandemic is routine immunization. In 2020 alone, 23 million children missed out on basic childhood vaccines – the highest number since 2009, and 3.7 million more than in 2019. Without the successful rollout of vaccine programmes to tackle diseases such as diphtheria, measles and polio, children’s lives remain at risk.

3. Preparedness and response

The threat of disease outbreaks other than COVID-19 has not gone away. PPE remains an indispensable supply item as part of health emergency preparedness and response against potentially fatal communicable diseases. UNICEF continues to ship PPE to support countries as part of their infection prevention and control planning against emerging pathogens like the Ebola, Lassa and Marburg viruses.

In fact, since the West Africa Ebola outbreak in 2014, UNICEF has worked with partners and industry to develop, standardize and scale-up the production of PPE used in high-risk Ebola treatment units, including coveralls, hoods, masks and gloves. Last year, UNICEF pre-positioned vital supplies including PPE in the Democratic Republic of the Congo and the surrounding region as part of the outbreak response.

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The Importance of PPE in the Workplace

Proper use of workplace safety equipment is essential for accident prevention during operations. Businesses that make use of the required PPE (Personal Protective Equipment) can easily avoid accidents and unnecessary manpower losses.

Increased PPE safety is an integral part of any successful business that requires protective equipment to complete tasks. That’s why this article delves into details about PPE in the workplace. Employers can take cues from this post to guarantee better use of PPE for smooth-running, safe operations.

Types of PPE

Equipment required for personal protection are in two categories, and they are:

• Complex PPE – equipment with technical builds, designed to protect against fatal risks.
• Simple PPE – safety equipment with basic designs to protect against non-fatal risks

• Respiratory PPE,
• Fall protection PPE, and
• Body protection PPE

Proper use of the different types of PPE proves crucial to prevent minor or life-threatening workplace injuries.

Why is PPE in the Workplace Essential?

There are several reasons why PPE is essential to the workplace, here are a few we would like to highlight:

Provides Ample Protection Against Accidents

No one wants an accident to happen, especially in an environment where such mishaps could cause injuries. The use of PPE is essential to provide enough protection against likely accidents in a work environment.

Specific PPEs are available to help workers protect their heads, eyes, skin, and other areas. Wearing PPE might not be the silver bullet against injuries, but it usually provides enough support to reduce workplace mishaps.

Ideal for Providing Protection Against Environmental Hazards

Specific PPE usage shields workers from getting into contact with environmental hazards in the workplace. Being exposed to the elements or chemical compounds around the work environment could take a huge toll on some employees.

Safety regulations mandate the use of specific PPE for different tasks to prevent exposure to hazardous substances or environments. Improved PPE safety proves vital to keep workers healthy when on the job and for much later.

Eliminates Liability for Workplace Injuries

Finally, PPE in the workplace is essential to help employees avoid liability for their injuries if accidents. Employees may not bear liability for an injury if staff is injured on duty while not wearing the required PPE.

Faithful use of PPE is essential to maintain a complete chance of getting full liability if injury or illness results from a workplace accident. There is no room for exemptions: wearing correct PPE is the only way to avoid getting injured or sick at work with no compensation.

Trust Advanced CT for Professional Workplace Safety Solutions

Advanced Consulting and Training is a CPO, CPO, WSIB, and TSSA-approved safety solutions provider. Our safety consulting services have been in demand for more than two decades.

We offer a Personal Protective Equipment course that aims to provide participants with the skills necessary to assess, select, and determine the correct PPR for the task they are performing.

Contact us today to get started on making your workplace safer for your employees.

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• v.26(3); Jul-Sep 2022

Prevalence of Physical and Psychological Impacts of Wearing Personal Protective Equipment on Health Care Workers During COVID-19: A Systematic Review and Meta-Analysis

Faculty, College of Nursing, Bhopal Memorial Hospital and Research Centre, ICMR, Bhopal, Madhya Pradesh, India

Gigini George

Abin varghese.

1 Faculty, College of Nursing, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

Jaison Joseph

2 Department of Psychiatric Nursing, College of Nursing, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India

N Vijayanarayanan

3 Department of Medical Surgical Nursing, RD Memorial College of Nursing, Bhopal, Madhya Pradesh, India

Associated Data

Background:.

The COVID-19 pandemic has necessitated the use of personal protective equipment (PPE) among the frontline health care workers (HCWs). Even though PPE helps in preventing infection, it poses significant physical and psychological impacts at varying levels. Correspondingly, multiple independent studies have brought out the PPE-associated problems. However, there exists a lacuna on comprehensive information of global prevalence related to the same.

To estimate the prevalence and risk factors of PPE among HCWs during COVID-19 across the globe.

Systematic review and meta-analysis.

The review was undertaken as per the protocol registered in PROSPERO CRD42021272216 following Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA) guidelines. Two independent reviewers have undertaken the search strategy, study selection, and methodological quality assessment. Discrepancies were addressed by the third reviewer. Heterogeneity was addressed through I2 statistics and forest plots generated by open meta-software.

A total of 16 articles conducted across 6 different countries among 10,182 HCWs were included in the review. The pooled prevalence of skin lesions, headache, sweating, breathing difficulty, vision difficulty, thirst/dry mouth, fatigue, and communication difficulty, anxiety, fear were 57 (47–66%), 51 (37–64%), 75 (56–90%), 44 (23–68%), 61 (21–94%), 54 (30–77%), 67 (58–76%), 74 (47–94%), 28 (24–33%), 14 (10–17%), respectively. Moreover, the various risk factors included are the use of PPE for >6 h and young females. In addition, the medical management of new-onset problems created an additional burden on the frontline health care personnel (HCP).

Conclusion:

The frontline HCWs encountered physical and psychological problems at varying levels as a result of wearing PPE which needs to be addressed to prevent the inadequate use of PPE leading to infections.

I NTRODUCTION

The ongoing COVID-19 pandemic has resulted in a tremendous increase in the usage of personal protective equipments (PPE) by health care workers (HCWs) to avert the transmission of SARS-CoV-2. The World Health Organization (WHO) defined PPE as a gown, non-sterile gloves, goggles, and respirator mask.[ 1 ] Although the PPE is designed to protect HCWs from the infection, the literature has reported multiple adverse effects due to its usage. The poor ergonomics of the respirator mask leads to pressure damage and infection since majority of them comes with restricted range of size and geometry.[ 2 ] Likewise, a vast majority (87%) of the HCWs have reported skin damage as a result of respirator mask use especially over the cheeks and the bridge of the nose. In addition, alarmingly higher rates (97%) of skin damage are reported by first-line HCWs.[ 3 ] Scarcity in the supply and availability of PPE across various countries has constrained the HCWs to utilize the available PPE for a longer period of time which in turn contributed directly to skin damage.[ 4 ] Extremes of temperature coupled with lack of air-conditioning have resulted in extreme sweating among HCW wearing PPE. Ultimately multiple recusant outcomes such as reduced tactile sensitivity, impaired vision, and difficult communication were encountered.[ 5 ] Furthermore, physiological adverse events in the form of breathing difficulty were reported by HCWs using masks without valves.[ 6 ] Similarly, headache was also reported as an adverse effect of N95 mask during earlier SARS pandemic.[ 7 ] COVID-19 has been reported to be transmitted through contact, so hand protection is one of the most important ways to avoid COVID-19 infection.[ 8 ] Wearing latex gloves effectively reduces the risk of contact infection among HCWs. However, the usage of gloves posed numerous unfortunate events such as dry skin, itching, and rash.[ 9 ] Surprisingly mental health impact in the form of somnolence, anxiety, and depression are also being reported by HCWs wearing PPE.[ 10 ] Consequent upon the multiple adverse outcomes, the PPE may not be used adequately leading to a higher chance of infection among HCWs. Absenteeism and shortage of HCWs can exhaust the already overwhelmed health care system. The aim of our systematic review and meta-analysis is to accrue the relevant literature and project a magnitude on the adverse effects of PPE for an enhanced level of understanding. Furthermore, no systematic reviews have so far addressed the current area of concern to the best of our knowledge. We believe the current review can aid the health care organizations to have an accurate insight on the physical as well as psychological problems faced by the HCWs due to the use of PPE. Eventually, this can assist the human resource team to allocate and rotate HCWs in an optimal manner between COVID and non-COVID areas.

The major focus of this systematic review was to meet the following objectives:

• The prevalence of physical impacts of wearing PPE on HCWs during COVID-19.
• The prevalence of psychological impacts of wearing PPE on HCWs during COVID-19.
• The risk factors contributing to the physical and psychological impact as a result of wearing PPE and the subsequent consequences.

Systematic review protocol registration

The protocol for this systematic review and meta-analysis has been registered at PROSPERO International Prospective Register of Systematic Reviews-CRD 42021272216.[ 11 ]

Ethical approval

Ethical approval was not obtained since the data used in the study was from individually published studies that were ethically approved.

Search process

The preferred reporting items for systematic review and meta-analysis were used to perform the systematic review [ Supplementary Table 1 ].[ 12 ] Original articles published from January 01, 2020 were searched in the databases; PubMed, MEDLINE, Science Direct, ProQuest Central, Corona Virus Research Database, and Google Scholar. Furthermore, we screened the footnote citations from potentially relevant articles to retrieve more articles. The entire databases search was completed on October 8, 2021. Multiple keywords that were used individually or in combination with Boolean operators (AND, OR) in the title/abstract were; “difficulties on wearing PPE,” “experience with PPE,” “compliance of PPE,” “physical and psychological effects,” “problems in the use of PPE,” “influences of PPE,” “self-reported issues on the use of PPE,” “health care workers,” “health care personnel,” “health care persons,” “health workers,” “workforce,” and “health personnel” [ Supplementary File 1 ].

Supplementary Table 1

Prisma statement and checklist

Eligibility criteria

The following inclusion and exclusion criteria were applied for the study: Inclusion criteria includes (a) assessed HCL working with PPE (mainly respirator mask) in hospitals; (b) analyzed the prevalence of physical and psychological outcomes due to the usage of PPE; (c) measured the prevalence of physical and psychological outcomes using validated instruments and questionnaires; (d) published articles in English language. We excluded studies with the following characteristics (a) studies not reporting the aggregate prevalence of physical and psychological outcomes even after contacting the corresponding author, (b) qualitative studies, systematic review, meta-analysis, case reports, case series, and non-accessible full-text articles; (b) studies with small sample size ( N < 60).

Study selection and data extraction

Three authors (RK,GG,AV) independently reviewed the title, abstracts of the retrieved articles across different databases for eligibility. Eligible full-texts studies were reviewed after removing the duplicates manually by each reviewer. Eventually, the full-text studies were included after a mutual discussion between the reviewers. The following information was extracted from all included studies: author, month and year of publication, country, population, age and gender, tools used, design, setting, sample size, the prevalence of physical and psychological problems, duration of PPE, and risk factors or consequences.

Appraisal of study quality

Loney criteria were used to evaluate the methodological quality of the included studies.[ 13 ] The criteria evaluate studies using eight criteria: (1) random sample or whole population (2) unbiased sampling frame (3) adequate sample size (4) standard measures (5) outcomes measured by unbiased assessors (6) adequate response rate and refusers described (7) confidence intervals (CI) and subgroups analysis and (8) study subjects described. Each item in the tool is assigned a score of one or zero with the total score ranging from 0 to 8, with more scores indicating a higher degree of quality. Eventually the scores were entered into Robvis tool to generate a risk of bias graph.[ 14 ]

Statistical analysis

Open meta was used to analyze the data (Wallace et al .[ 15 ] 2012). In all statistical analyzes, the significance level was considered as P < 0.05. The overall prevalence of physical and psychological outcomes among HCP was calculated using the random-effect model according to Der Simonian and Laird's approach with a 95% CI with Freeman turkey double arcsine transformation employed to stabilize the variance among the studies. Heterogeneity testing was performed using the I 2 and the Cochran's Q test.[ 16 ] Moreover, a leave one out sensitivity analysis was performed to address the potential sources of heterogeneity.

Study characteristics

The electronic search across various databases yielded 2403 citations. Among them, 1700 duplicates were removed by manual search and with the aid of software RAYAAN QCRI resulting in 703 articles that were further subjected to the title and abstract screening.[ 17 ] A total of 170 full-text articles were exhaustively reviewed by two reviewers (RK,GG). Out of the 170 articles, 150 were excluded since primary outcome data was not reported (150) and incomplete studies where author was not reachable (4). Eventually 16 articles were included for the systematic review and meta-analysis [ Figure 1 ].

Preferred reporting items for systematic review and meta-analysis flow chart depicting the selection process of included studies

A comprehensive record from the studies is being depicted in Table 1 . The studies included in the review utilized cross-sectional web-based surveys among frontline HCWs (doctors, nurses, paramedical professionals). The majority (62.5%) of the studies were conducted in a single-center or multicenter health facilities while 37.5% of studies were regional surveys. The total sample size was 10,182 ranging from 61 to 4306. As per the available data from the included studies, the majority of participants (72%) were females while 28% were males. Duration of PPE use varied from 4 to 12 h/day with the majority of the studies reporting >6 h/day.

Characteristics of included studies

Quality evaluation

The methodological quality of included studies was done by two reviewers (xxxx) using the Loney criteria. Discrepancies in the scoring were addressed by mutual discussion and consensus. The quality score varied from four to seven across the studies with six as the median (interquartile range: 5–6). Finally, the 16 studies with moderate and high-quality scoring were included for the estimation of pooled prevalence [ Figure 2 ; Supplementary Table 2 ].

Risk of bias across individual studies

Supplementary Table 2

Quality of included studies

Prevalence of physical and psychological problems due to PPE use

Multiple physical and psychological problems such as skin lesions, headache, sweating, breathing difficulty, vision difficulties, fatigue, communication difficulties, thirst/dry mouth, fear, anxiety, and depression were reported in the included studies at varying rates due to the usage of PPE by frontline HCWs [ Table 2 ]. (a) Skin lesions: Majority (75%) of the studies reported skin lesions in various forms. The pooled prevalence of skin lesions was 57% (47–66%) with significant heterogeneity ( I 2 = 98.51, P < 0.01) [ Figure 3a ]. (b) Headache was reported in 37.5% of the included studies with a pooled prevalence of 51% (37–64%) at significant heterogeneity ( I 2 = 95.37, P < 0.01) [ Figure 3b ]. (c) Sweating: Majority (56%) of the studies indicated sweating with a pooled prevalence of 75% (56–90%) at I 2 = 99.53, P < 0.01 [ Figure 3c ]. (d) Breathing difficulty: Respiratory difficulty was also reported as a problem with PPE by 31% of the studies with a pooled prevalence of 44% (23–68%) at I 2 = 98.28, P < 0.01 [ Figure 3d ]. (e) Vision difficulty: The use of goggle while wearing PPE caused vision difficulties as reported by 33.3% of studies with a pooled prevalence of 61% (21–94%) at I 2 = 99.49, P < 0.01 [ Figure 3e ]. (f) Thirst/dry mouth, fatigue, and communication difficulties were reported by 19% of studies with a pooled prevalence 54% (30–77%), 67% (58–76%), 74% (47–94%), respectively [Figure ​ [Figure3f 3f ​ 3fg g ​ gh h ].

Pooled prevalence of PPE-related problems on HCW

(a) Prevalence of skin-related problems due to PPE use. (b) Prevalence of headache due to PPE use. (c) Prevalence of sweating due to PPE use. (d) Prevalence of breathing difficulty due to PPE use. (e) Prevalence of vision difficulty due to PPE use. (f) Prevalence of fatigue due to PPE use. (g) Prevalence of thirst/dry mouth due to PPE use. (h)Prevalence of communication difficulty due to PPE use

Psychological problems such as anxiety and fear were reported only by two studies so a fixed effect model was used resulting in a pooled prevalence of 28% (24–33%) and 14% (10–17%), respectively.

Risk factors and consequences

The duration of PPE use was a significant risk factor for many of the ailments. In particular, the use of PPE >6, 8, and 12 h were more frequently reported to be associated with physical problems. Similarly, work shift exceeding 6 h was also a risk factor. Furthermore, young females reported more skin lesions with PPE use. Consequently, the physical and psychological problems had an impact on the work performance of HCP's which can compromise the already overwhelmed health care system. In addition, the medical management of new-onset problems created an additional burden on the frontline HCWs.

Sensitivity analysis

A leave-one-out sensitivity analysis was carried out for each of the outcomes in the study, such as skin lesions ( n = 12), headache ( n = 6), sweating ( n = 9), breathing difficulty ( n = 5), vision difficulties ( n = 4), fatigue ( n = 3), communication difficulties ( n = 3), and thirst/dry mouth ( n = 3). Accordingly, no individual studies in each of the specified outcomes had a considerable influence on the overall pooled prevalence [ Supplementary Figure 1a and b ].

D ISCUSSION

The index study summarizes the overall physical and psychological impacts of PPE among HCP during the COVID-19 pandemic across the globe. Although multiple physical and psychological problems were reported, skin lesions in various forms were the commonly reported adverse effects in the majority of studies with a pooled estimate of 57% (47–66%; n = 12 studies). Approximately 75% of the frontline workers had excessive sweating and communication difficulties with PPE along with their assumed responsibilities during the pandemic. The pooled prevalence of breathing difficulties, headache, and unusual fatigue related to PPE were 44%, 51% and 72%, respectively. There are some possible explanations for our findings. Our findings need to take with caution as there was significant heterogeneity among the studies. This was mainly due to the inconsistencies in the included studies based on outcome measures, study period, and study contexts. The onset and impact of the pandemic were different across the world. Additionally, there is a countrywide difference in health care resources and disaster preparedness. Moreover, our results are purely based on the self-reported measurements which were collected amidst the restrictions associated with the COVID-19 pandemic. Further, our findings might not be generalized considering the methodological limitations such as respondent bias and sampling bias during the global epidemic.[ 29 ] Certainly, all these lacunae might have influenced our findings but the present study opens an area of debate regarding the magnitude of problems related to PPE during COVID-19.

PPE use and prevalence of physical problems

Our findings revealed that skin problems were the most common side effects of PPE in the majority of the studies with an aggregate estimate of 57%. The most common skin problems were a form of skin lesions, acne, and itching and were directly related to prolonged use of masks and gloves. We also noted that wearing PPE for >6–8 h is the possible explanation for the skin adverse reactions. A recent systematic review reported the rate of skin side effects related to PPE to be 75.13%. This study also pointed out that these adverse events related to mask was 57.71%, and those associated with gloves and hand hygiene products was 49.16%.[ 30 ] In a systematic review, Keng et al .[ 31 ] identified that the most common skin problems related to PPE were in the form of xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. It is well known from the literature that wearing PPE for longer periods will result in pressure-related injuries leading to erythema and skin indentation at the initial stage which might progress to fissures, ulcers, and secondary infections.[ 27 , 32 ]

The possible solutions to manage these skin problems are consistent use of emollients and selecting the less irritating hand hygiene products.[ 33 ] Nine studies in our review reported that sweating was a major side effect related to the consistent use of PPE with a pooled prevalence of 75%. Sweating is a pertinent skin adverse effect related to PPE use especially in countries with tropical climates. Apart from the prolonged use of PPE in such climates and its longer use tends to mechanical trauma due to increased heat and humidity.[ 3 ] Additionally, the use of goggles while wearing PPE caused vision difficulties reported by four studies included in this review with a pooled estimate of 61%. We, therefore, recommend that health care institutions consider providing well-ventilated areas and sufficient manpower especially for those who are in anticipation of prolonged working hours in PPE. Strikingly, three studies included in our review pointed out the experience of 67% of unusual fatigue among HCWs due to PPE use. Minimizing the duration of time in PPE and allowing sufficient rest are the only possible solutions to manage these occupational hazards. It is worth noting that the adverse events of PPE are directly related to long working hours which further call for intensifying organizational policies to manage the crisis.[ 34 ] Five studies in our review reported that 44% of the HCWs had breathing difficulties. There is a wide variation in the prevalence of breathing difficulties associated with PPE use ranging from 12.2% to 65.5%.[ 6 , 35 ] This surprising wide range of the rate of breathing difficulties might be attributed to the type of masks and the pre-existing respiratory difficulties. The available empirical data suggest an N95 mask for causing significant breathing problems as compared to surgical masks.[ 36 ]

In this meta-analysis, we investigated PPE-associated symptoms among HCWs during the COVID-19 pandemic. Majority of the included studies attributed that many of the physical ailments were directly related to the duration of wearing PPE. Taken together our findings open a common consensus of limiting the work shifts to at least 6 h or fewer for maximizing the health and minimizing the side-effects of PPE among the frontline HCWs.

PPE use and prevalence of psychological problems

The fear and anxiety of wearing PPE during COVID-19 were reported to be 14–28% among the HCWs. Similar to the various uncertainties of the global pandemic, possible side effects of PPE were a significant burden as it was novel to the frontline workers. The existing studies suggest increasing stress and psychological morbidity among the HCWs during the pandemic.[ 37 , 38 ] This increased psychological distress may contribute to various psychiatric and medical illnesses. Apart from the assumed health care responsibilities, there was a significant work pressure in HCWs due to shortage of manpower, frequent and prolonged work shifts, lack of resources, etc. Further, the COVID-19 imposed lockdown and overload information in the media was a predisposing factor for mental morbidity among the HCWs.[ 39 , 40 ]

There is a need for innovative strategies systematized to address these emerging challenges and to reinforce the effective pathways to manage the crisis. To protect the psychological health of HCWs there must be specialized need-based interventions such as ongoing surveillance systems, web-based counseling, etc., The appropriate utilization of social media platforms is very helpful to reduce the mental distress during and aftermath of the Covid-19 pandemic crisis.[ 41 ]

Strength and Limitations

The study has been carried out as per the PRISMA guidelines with utmost scientific rigor. A comprehensive analysis of the pooled prevalence of various physical and psychological problems due to PPE use especially with the use of respirator mask across the world has been done. The limitations are also being addressed. The heterogeneity that existed across the studies needs to be taken into account while interpreting the results. Also the analysis was not possible for the individual type of PPE such as respirator mask, gloves, gown, and goggles separately since majority of the studies focused on respirator mask.

C ONCLUSION

The current review has addressed the prevalence of physical and psychological impacts of wearing PPE. A total of 16 studies conducted across European, Asian, and Pacific regions among 10,182 HCWs were included in the review. Even though multiple physical problems were reported, the most prominent among them were skin lesions in the form of xerosis, pressure-related erythema, contact dermatitis, and difficulties encountered in vision and communication. In addition, psychological problems such as anxiety and fear were reported at modest levels. Most of the studies have attributed the duration of PPE use as a significant risk factor for many of the ailments which can be effectively tackled by limiting the work shifts to a shorter duration.

R ELEVANCE TO C LINICAL P RACTICE

The findings have reported the existence and prevalence of physical as well as psychological problems associated with PPE use at a higher level. Appropriate interventional strategies need to be tailored at the organizational level to combat the impact of PPE use. The review sheds light on the following: shortened shift duty hours for HCWs, planned rotation of HCWs alternating with infectious and noninfectious wards, web-based counselling to monitor the psychological health and to assess the felt needs, allowing sufficient rest (in between duty as well as after a stretch of duty days) for HCWs working with PPE, providing optimal workforce, well-ventilated areas, and appropriate nonverbal training to deal with communication difficulties (while in PPE).

Author contributions

All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. All authors agree with the manuscript.

• Radha K: Conceptualization, methodology, formal analysis, data curation, writing-original draft
• Gigini George: Conceptualization, data curation, visualization, investigation, methodology, writing-original draft
• Abin Varghese: Review and editing, methodology, supervision, data curation
• Jaison Joseph: Conceptualization, data curation, visualization, methodology, writing-original draft
• N. Vijayanarayanan: Data curation, methodology, supervision

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Supplementary Figure 1

(a) Leave one out forest plot for the prevalence of skin lesions. (b) Leave one out forest plot for the prevalence of sweating

Acknowledgments

The authors acknowledge the assistance offered by the chief librarian-Mr. Vijay Singh Chauhan in retrieving potential articles.

S UMMARY B OX

What this paper contributes to the wider global community?

A higher prevalence of physical as well as psychological problems due to PPE use among HCW has been reported by the review.

Appropriate organizational policies should be constituted to prevent the impact of PPE on HCW as the pandemic is still unpredictably haunting the entire world.

The policies should address short shift duty hours for HCWs, planned rotation of HCWs between infectious and noninfectious wards, web-based counseling, optimal workforce, well-ventilated areas, and appropriate nonverbal training to deal with communication difficulties.

S UPPLEMENTARY F ILE 1

Search strategy across databases

1. MEDLINE (search hits = 1851)

((Difficulties wearing personal protective equipment's) OR (experience personal protective equipment's) OR (compliance personal protective equipment's) OR (physical psychological effects) OR (problems use personal protective equipment's) OR (influences of personal protective equipment's)) AND ((health care workers) OR (health care personnel) OR (health care persons) OR (health workers))

Filters: Full text, journal article, English, MEDLINE, from January 1, 2020 to August 31, 2021

2. Science Direct (search hits = 6)

Personal protective equipment physical effects or psychological effects

3. Coronavirus Research Database (search hits = 162)

Problems in the use of personal protective equipment AND health care workers OR health care personnel OR health care persons OR health workers OR work force OR health personnel

Narrowed by: entered date: 2020-12-01 to 2021-08-31

Source type: Scholarly journals

4. ProQuest Central (search hits = 191)

Keywords: problems in use of personal protective equipment, HCW, physical, psychological effects

Narrowed by: entered date December 01, 2020 to August 31, 2021

Full text: Full text

5. APA PsychInfo (Search hits = 8)

5. Google Scholar (search hits = 185)

The first 50 pages have been searched Narrowed by: entered date: 2020–2021; Source type: Scholarly Journals, Journal of Clinical Nursing (71), Journal of Advanced Nursing (32), International Journal of Mental Health Nursing (31), International Nursing Review (21), Asian Journal of Psychiatry (30)

R EFERENCES