Droplet Precautions PPE: A Complete Guide
If you’re visiting a family member in a hospital, sometimes you may find colored signs hanging on the door of their room saying “droplet precautions” or “airborne precautions.”
And you begin to wonder what those signs are.
If you’re wondering about PPE for airborne precautions and want to know the difference between it and droplet precautions PPE, you’ve chosen the right article.
Moreover, suppose you are working in the medical field.
In that case, whether you’re a doctor, nurse, or housekeeper in a medical care facility, you should be familiar with some precautions that help protect you and your patients against diseases.
Here, we will go through the types of PPE for different precautions and determine which one you should use in different situations.
Let’s begin.
Why is it important to stick to the droplet’s precautions PPE?
Around 2 million patients get a hospital-acquired infection yearly, and 90.000 die. (1)
Sticking to the infection control measures that include standard precautions, PPE for droplet precautions, airborne precautions, and contact precautions is essential to prevent infection and decrease these numbers.
In a study to determine medical staff’s commitment to wearing PPE, only 27.9% of nurses and nursing assistants adhered to proper personal protective equipment (PPE) compared to 100% of physicians and 85.7% of housekeeping staff.
Does this mean that nurses shouldn’t wear the proper PPE?
Not!
Nurses and nursing assistants spend more time with patients than other healthcare team members. (2)
Accordingly, the chances of them getting sick are higher.
Therefore, it’s of significant importance that they follow infection control measures.
What are the types of precautions?
Precautions are preventive measures and steps used in healthcare facilities around the world.
They are followed by healthcare workers and staff (doctors, nurses, etc.) to prevent illnesses and hospital-acquired infections for their patients and themselves.
That’s why the Centers for Disease Control and Prevention (CDC) defines some universal standards that must be applied to all care activities.
In other words, these standards are the minimum infection prevention steps that must be followed with all patients, regardless of their status.
What are standard precautions?
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Hand hygiene
Proper washing of the hands with soap or alcohol-based sanitizers before and after contact with a patient
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Appropriate use of personal protective equipment
PPE is used before handling patients and when exposure to blood, body fluids, excretions, secretions (except sweat), mucous membranes, or non-intact skin is expected.
This includes gloves for hand protection, masks, eye protection when splashes or sprays of blood or bodily fluids may happen, and gowns to protect your clothes.
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Respiratory Hygiene/Cough Etiquette
It includes covering your mouth and nose with a tissue when coughing or sneezing and properly disposing of the used tissue.
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Injections and sharp tools
Proper and safe use and disposal of injections and intelligent tools and objects, which includes not recapping, bending, breaking, or hand-manipulating the used needles; if recapping is needed, you should only use a particular technique called “one-handed scoop.”
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Waste disposal and cleaning supplies
This includes procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient-care areas.
- Textiles and laundry
Instructions on handling them so the microbes do not spread to other patients, people, or surfaces.
As we mentioned, these are just the basic standards that cover all patients; now, what about airborne, contact, and droplet precautions?
Airborne, contact, and droplet precautions
In addition to standard precautions, the CDC adds further steps known as “transmission-based precautions” to prevent the spread of disease from patients with known or suspected infections.
This is especially important for those infections that can be transmitted quickly and easily, in addition to common critical pathogens.
Depending on the type of pathogen and method of spread of the infection, these precautions include the following:
- Contact
- Airborne
- Droplets
While the duration of standard precautions should last as long as the patient is under care, the time of the transmission-based ones varies from one infection to another.
Sometimes they are used for periods when patients are immunocompromised and have viral infections.
What’s more, a different type of PPE is required for every kind of precaution.
For even more accurate use of each type, they recommend putting up visible signs in each patient’s room to define the precaution category and explain the type of PPE needed.
Let’s go through each type.
What is PPE for contact precautions?
Contact precautions are used when patients are known or suspected to have an infection transmitted through contact.
In other words, when you are in direct contact with the patient or their environment, this includes the patient’s room, clothes, and objects that might have been contaminated.
In addition to things such as tray tables and medical equipment used with the patient (e.g., a blood pressure cuff),
Here are some infections where contact precautions are used, according to the CDC:
- Major abscess removal
- Major wound infections
- Hepatitis A
- Herpes Simplex Virus
- Impetigo
- Lice
- Scabies
- Multidrug-resistant organism infections (MDROs), such as MRSA and VRSA
What do contact precautions include?
Contact precautions include placing the patient in a single room if available.
Additionally, the patient’s transport and movement outside their room should be limited to what is necessary; if they must move, ensure that they are covered or that the infected area is contained.
As long as the patient is covered and the infected area is controlled, you don’t need to wear PPE during the movement.
Nevertheless, you should wear it when you receive a patient on the transport side.
Furthermore, try to use disposable equipment for each patient, and if you have to use the same equipment for multiple patients, make sure to disinfect them properly before use.
Finally, make proper use of the contact precautions PPE.
Let’s dig deeper into that.
What type of PPE is used for contact precautions?
The most important PPE used for contact precautions is gloves and gowns.
They are used before contact with the patient and removed after, followed by proper hand hygiene.
Gloves are worn whenever you’re doing a task that involves touching the patient’s skin, for example:
- Taking blood pressure, temperature, and pulse
- Giving in
- Bathing and dressing the patient
- Care for the eye and ears (without secretions)
Usually, these routine tasks don’t require examination gloves; however, when patients are under contact precautions, you must wear gloves.
In addition to the usual tasks that require gloves, whether there are contact precautions or not, such as draining an abscess, inserting and removing an IV line, or drawing blood.
What’s more, you should use them when:
- Handling and disinfecting tools and equipment
- Emptying vomit bins
- cleaning up spills of blood or vomit.
- Changing Diapers
Meanwhile, gowns are worn when you feel your cloth might come in contact with the patient or surfaces and equipment close to them.
Now that we know about PPE for contact precautions let’s learn more about those for airborne precautions.
What is PPE for Airborne precautions?
Airborne precautions are used to prevent the spread of highly infectious diseases transmitted by air.
These diseases are caused by tiny microorganisms (5 micrometers or smaller) that can stay viable and suspended in the air for a long time.
When we breathe in those tiny microorganisms or the dust that carries them, we can quickly get infected and become ill.
Moreover, we can even spread it to other people through sneezing, coughing, talking, or any activity that might produce aerosolized particles.
Many serious diseases occur because of airborne pathogens, which various microorganisms, including , viruses, and fungi, cause them.
Here are some examples of these diseases:
- Measles
- Mumps
- Anthrax
- Disseminated herpes zoster
- Tuberculosis
- Chickenpox
- Severe acute respiratory syndrome (SARS)
- Rotavirus
- Influenza
- Rhinovirus
- Pneumonia
- Middle East Respiratory Syndrome (MERS)
- Coronavirus Disease 2019 (COVID-19)
Moreover, airborne particles can also come from sources other than the patient.
To illustrate, healthcare professionals perform several medical and surgical procedures daily that can result in aerosolized infectious particles.
Such as:
- Manual ventilation with a bag and mask
- Intubation
- Bronchoscopy
- Lung surgery
- Nebulizer therapy and steam inhalation
- An autopsy of the lungs
Therefore, PPE for airborne precautions is required during such procedures.
Primarily if the patient is known or suspected to have a disease that can be transmitted through the air.
So what is the PPE for airborne precautions?
Let’s find out.
What is the PPE for airborne precautions?
In addition to standard precautions such as wearing gloves and a gown, the CDC recommends additional PPE for airborne hazards.
They should be worn before entering the room and removed after leaving.
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Disposable Respirators
Respirators filter the air around you to protect you from possible infectious airborne microorganisms.
N95 and N99 are the most common types of disposable air-purifying respirators (APRs), also known as “surgical respirators” in the healthcare industry.
That is why they are helpful in PPE for airborne pathogens: they can filter out 95% and 99%.
They can filter particles smaller than 0.3 mm.
In addition to their ability to protect against biological particles such as pollen, mold spores, bacteria, viruses, and allergens, they can protect against dust, fumes, mists, aerosols, and smoke particulates.
What’s more impressive about them is that they offer droplet protection.
Nevertheless, they do not protect against chemicals or gases in the air; the N stands for “Not resistant to oil mists.”
Respirators can be worn for a maximum of eight hours and should be replaced regularly.
All respirators must be NIOSH-approved and follow OSHA’s 29 CFR 190.134 and NOISH’s 42 CFR Part 84 regulations for respiratory protective devices.
Moreover, they must have a fit test before using them for the first time and at least every year after.
To explain, they must have a tight seal against your face around the nose and mouth to allow you to breathe in all the air through them rather than through the gaps if they are not correctly fitted.
For this reason, healthcare workers must know how to position, adjust, remove, and put them on, and this is usually done through respiratory protection programs.
One important thing to know about respirators is that they usually don’t fit people with beards and mustaches, as the hair gets in the way of the tight sealing.
That’s why PAPRs might be used instead.
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Powered air-purifying respirator (PAPR)
These are reusable respirators with replaceable filters (HEPA filters only); they have half or full facepieces or a hood or helmet covering the nose, mouth, and eyes.
Moreover, they work through a battery-powered blower that pulls air through filters into the hood or the facepiece.
Consequently, create a positive pressure that reduces the inward leakage of contaminated air.
For all of these reasons, they are in Airborne Precautions PPE.
They are used when the N95 cannot fit or a higher level of protection is needed.
PAPRs with a hood o helmet have an assigned protection factor (APF) of 25, whereas a half-mask has an APF of 50, and a full-piece has an APF of 1000.
Moreover, PARR is a level C PPE that should follow OSHA’s respiratory protection standard (29 CFR 120.134).
On the other hand, in Europe, there are various standards for the requirements, testing, and CE marking of APRs and PAPRs, including EN 12941, EN 12942, and EN 143.
Although they do not require fit testing, you might be subjected to a medical evaluation before using them.
Why?
Because sometimes, wearing respirators make breathing difficult, it can increase your heart rate, and occasionally, claustrophobic individuals panic upon using them.
Therefore, you must be evaluated to see if you can wear it with ease in addition to knowing how to use, put on, position, adjust, and remove them.
In addition, people with existing medical conditions such as a history of heart attacks, asthma, shortness of breath, or chronic obstructive pulmonary disease (COPD) cannot use respirators.
So, what are the other airborne precautions that should be followed?
What are the other airborne precautions?
In addition to wearing the proper PPE for airborne precaution, there are more steps to follow regarding airborne infections.
To illustrate, patients are put in an “airborne infection isolation room” (AIIR) to help prevent the spread of disease to other people.
AIIR must provide the following:
- Negative pressure
- A 6–12 air change rate per hour
- Either exhausting air directly to the outside of the room or recirculating it through a high-efficiency particulate air (HEPA) filter.
Furthermore, if the patients cannot be placed in such a room, they must have a mask on and be put in a private room with a closed door.
And just like with the contact precautions, moving the patients should be limited to necessary medical interventions, and if they have to move, they must wear a surgical mask.
Regardless, the healthcare workers moving the patients only have to follow good hand and respiratory hygiene and needn’t wear a mask or respirator during transport if the patient is wearing a mask and is well covered.
Moreover, the susceptible individual should be restricted from entering the patient room if other personnel are available.
Now that we understand PPE for airborne precautions let’s move on to PPE droplet precautions.
What is PPE for droplet precautions?
Droplet precautions are essential when working with patients suspected or known to be infected with a pathogen that can be spread through droplets of mucus or saliva.
Those droplets are about 30–50 micrometers in size and are produced by coughing, sneezing, talking, and close contact with an infected patient’s breathing.
In addition, they are present while performing medical procedures, just like in airborne precautions.
When these droplets come in contact with mucosal membranes in the eyes, nose, and mouth, they cause infection.
So, what kinds of infections can be spread by droplets?
The most common are influenza and other respiratory viruses like the common cold and severe acute respiratory syndrome (SARS), in addition to bacteria that cause diseases like:
- Pneumonia
- Pertussis (whooping cough)
- Diphtheria
- Meningococcus
- Streptococcus
- Mumps
- Rubella
- Plague
What are the four items in PPE for droplet precautions?
In addition to the standard precautions of wearing gloves and gowns, healthcare providers should wear protective surgical masks and eye protection when needed.
These PPE are worn before working with patients or in their areas.
Let’s see each of the four items in PPE for droplet precautions:
1. Gloves
Gloves are essential equipment for protecting the wearer from various hazards.
Not only do they protect against biological agents, but also against chemicals and physical injuries that you may face.
Medical gloves protect against infections in the blood, excretions, bodily fluids such as urine and stools, and broken skin.
Moreover, they protect against chemicals used in health care facilities, such as cleaning solutions and detergents to clean rooms, surfaces, workstations, and counters.
Finally, they offer protection against cuts and needles used in medical and surgical procedures.
They are categorized into
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Examination gloves
They are used to examine patients; these gloves can be sterile or non-sterile.
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Surgical gloves
These gloves are used in operating rooms and must be sterile to prevent infections.
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Chemotherapy gloves
A type of glove used when handling toxic chemicals and cytotoxic drugs like the ones used in chemotherapy for cancer.
For all these reasons, gloves are essential for droplet precautions, in-contact, and even standard ones.
Disposable gloves can be made of latex, nitrile, or vinyl.
They are the most comfortable; they have been the top choice in the medical industry for years as they have excellent protective properties against microorganisms, cuts, and tears.
However, other alternatives must be available with the rise of Latex allergies.
A glove was now known as the gold standard; they offer an even better barrier than latex gloves against microorganisms, cuts, and tears, in addition to chemicals.
Moreover, they lack latex proteins and have limited chances of allergic reactions. They’re available in sterile and non-sterile forms.
They are not as protective as latex or nitrile and have a loose fit.
Regardless, they are the most cost-effective; therefore, they are mainly used in lightweight duty tasks that don’t involve high contamination risks or cuts and tears.
Medical gloves should follow OSHA’s Bloodborne Pathogens Standard (29 CFR 1910.1030) in addition to some other standards, such as:
- EN-ISO 21420
- EN-374
- EN-388
- EN 455
2. Gowns
Gowns are considered level D PPE because they are usually fluid-resistant and non-sterile.
They protect you from diseases if you come into contact with liquid droplets and solid materials that may contain contagious microorganisms and prevent the infection from spreading through clothing.
Gowns are worn as standard, droplet, airborne, and contact precautions PPE
There are many types of dresses used in hospitals:
- Procedural gowns
- Non-surgical gowns
- Operating room gowns.
- Surgical gowns
- Isolation gowns
Masks and Respirators
Surgical masks create a physical barrier between your nose and mouth and direct contact with biological and chemical fluids.
Therefore, they protect you against droplet-based infections.
They are loose-fitting disposable PPE made in different thicknesses and with other properties to protect against droplets.
Although they differ from face masks, they can be labeled as dental, medical, or face masks.
What’s important to realize is that surgical masks don’t protect against airborne diseases; they only protect against droplets.
That’s why, sometimes, when both droplet and airborne precautions are required, N95 respirators may be used.
Furthermore, masks are not designed to be used more than once, and they should be changed when they are wet with breath torn or damaged.
Finally, they must adhere to 21 CFR 878.4040. Regulation.
Face and eye protection
Eye protection in droplet PPE includes goggles and face shields.
They protect the eye and face against blood sprays and other body fluids in droplets.
Nevertheless, personal eyeglasses and contact lenses are not considered sufficient for protection.
Just like all levels of PPE, face shields and goggles should follow the 29 CFR 1910.133 regulations and be tested according to ANSI/ISEA Z87 or EU Standards as follows: EN-166, EN-167, and EN-168.
In addition to those four main items in PPE for droplet precautions, some situations may require the use of extra items such as:
- Double-gloving technique.
- Disposable shoe covers.
- Disposable leg covers.
What are other droplets precautions?
Droplet precautions are not very different from airborne ones.
They include the same measures without isolating the patient in an AIIR; the patient in a private room will do the job.
Now let us find out more about droplet precaution PPE for housekeepers.
Droplets precautions for housekeepers
Whether to look after patients recovering at home or clean isolation rooms daily, housekeepers face many risks daily.
This includes hazardous chemicals and cleaning solutions they use.
One of the most serious risks they face is biohazard exposure, such as bloodborne pathogens and infectious microorganisms.
They can be exposed by breathing in dust that contains these pathogens while dusting or sweeping.
Therefore, it’s vital to protect themselves by wearing the correct type of PPE for each risk.
What PPE should a housekeeper wear for droplet precautions?
For housekeepers cleaning and caring for patients with infectious diseases that can be spread through droplets, PPE for droplet precautions is essential.
Respirators are one the essential pieces for droplet or airborne precautions.
They protect against dust, pollen, or germs, and viruses.
Furthermore, cleaning gloves are vital for almost all tasks, as well as for droplets and contact precautions.
When you are cleaning the table next to a patient’s bed, the toilet he used, or the room floor, germs on them can easily infect you.
Therefore, you must wear the proper gloves for the appropriate task, for example:
Use needle-proof gloves when removing medical waste that contains needles to prevent needlestick injuries.
Wear medical gloves when cleaning up blood or vomit spills and cleaning the room and surfaces that have come into contact with infected patients.
Choose chemical-resistant gloves when cleaning with harsh chemicals and detergents.
It’s important to remember to change gloves for different cleaning tasks; for example, don’t use the same gloves for cleaning the toilet and other surfaces.
In addition, housekeepers must wear gowns or aprons and eye protection for droplet precautions.
Moreover, extra PPE might be proper when mopping the floors, such as slush boots and shoe coverings (“booties”).
Conclusion:
Meanwhile, precautions are specifically used when the patient is known or suspected to have a particular infection.
They depend on the source of spread: contact, airborne, and droplets.
Further, they include instructions on how to place and move patients, what PPE to use, and how to clean the area.
PPE for contact includes gloves and gowns, while airborne requires an extra N95 or N99 respirator or PAPR.
Standard PPE, masks, and eye protection are also required for droplet precautions.
Finally, they should be followed by everyone working in the medical areas, such as doctors, nurses, housekeepers, and janitors, to prevent infections.
We hope you have everything you need about PPE for droplet precautions.
If you have more questions, please send them to us.