Personal Protective Equipment (PPE) refers to specialized clothing or equipment worn to minimize exposure to hazards that cause illness or injury. In healthcare settings, PPE is a fundamental component of infection control, serving as a physical barrier against infectious agents. Droplet precautions are specific procedures designed to interrupt the spread of respiratory pathogens. These precautions are implemented when caring for an individual with a known or suspected illness transmitted through large respiratory droplets.
How Droplets Spread
Droplet transmission begins when an infected person expels large, heavy particles from their respiratory tract. This expulsion typically occurs through forceful actions such as coughing, sneezing, talking, or singing. These respiratory droplets are generally larger than five micrometers in diameter, causing them to follow a ballistic trajectory. Due to their size and mass, these particles cannot remain suspended in the air for long periods.
These droplets travel only a short distance before gravity causes them to fall onto surfaces or the mucous membranes of another person. The range of infectious exposure is generally considered to be within six feet (one to two meters) of the source. Diseases requiring this precaution include common illnesses like influenza, pertussis (whooping cough), and certain respiratory viruses. The goal of droplet precautions is to prevent these large particles from directly contacting the eyes, nose, or mouth.
The Required Protective Gear
The core defense against droplet transmission involves specific protective barriers designed to shield the face and body. The most universally required item is a surgical or procedure mask, which must be worn upon entering the patient’s area or coming within six feet of the individual. This mask filters large droplets and prevents them from reaching the wearer’s nose and mouth, which are susceptible entry points for pathogens.
Eye protection, such as goggles or a full face shield, is necessary when splashes or sprays of respiratory secretions are likely. The conjunctiva of the eye is a mucous membrane that can absorb infectious droplets, making this barrier a necessary complement to the surgical mask. A protective gown is required when close contact is anticipated, such as during bathing, turning, or any activity involving touching the patient or contaminated surfaces.
The gown creates a barrier for the wearer’s clothing and skin, reducing the risk of carrying the infectious agent out of the care area. Gloves should be worn when there is contact with the patient’s bodily fluids, non-intact skin, or contaminated objects and surfaces. Gloves prevent the transfer of infectious material from hands to the face or to other surfaces. Each item is designed to block the trajectory of expelled droplets and prevent the hand-to-face transfer of contamination.
Putting On and Taking Off PPE Safely
The sequence for putting on, or donning, personal protective equipment is designed to ensure maximum protection before contact. The procedure begins with thorough hand hygiene, using soap and water or an alcohol-based hand rub. Next, the gown is secured, covering the torso and arms, followed by the surgical mask, ensuring it covers the nose, mouth, and chin.
After the mask is in place, eye protection, such as goggles or a face shield, is put on to complete the facial barrier. The final step is to put on the gloves, ensuring the cuffs extend over the gown sleeves for a complete seal. This sequential order ensures that the most contaminated items, like the gloves, are the last to be applied, covering the body in a continuous barrier.
The removal sequence (doffing) is structured to prevent the transfer of contamination to the wearer’s skin or clothing. The process starts with removing the most contaminated item—the gloves—using a safe technique that avoids touching the outside surface. The gown is then removed, carefully turning it inside out as it is rolled into a bundle, preventing the contaminated exterior from touching the wearer.
After the gloves and gown are discarded, hand hygiene is performed immediately to clean any potential contamination. The eye protection is removed next, handling it only by the head strap or ear pieces, followed by the mask, which is removed by grasping the ties or elastic bands. The final step is to perform a second, comprehensive round of hand hygiene to complete the procedure and ensure all pathogens are removed.