Role of PPEs during Covid-19 crisis in India

Dr Sona Pungavkar, Senior Consultant Radiologist, Global Hospital, Mumbai, gives insight on the urgent need for WHO recommended PPEs for front line health workers handling Covid-19 patients

To begin with, the Indian government has done a wonderful job of staying ahead of the virus. And I cannot help but acknowledge the impressive efforts put in by the police and municipal health workers into containment of the crisis.

At the same time, the Indian healthcare manufacturing sector is rising up to the occasion. These are small and medium-sized industries who are coming out to work in these dreaded times and supporting the government, in spite of the risk to their own lives. However, these industries are pressurised by lack of funds, staff and raw material. 

I visited one enterprise in the suburbs of Mumbai and  am so impressed with the hard work these people are doing. They need to be congratulated in the same manner as doctors. They also face the limitation of the lockdown and the workers are being obstructed from reporting to work. Also, they are not being allowed to transport goods to the required sites, as the enforcement authorities are not aware of the goggles, which form a part of the personal protection equipment (PPE) kit, being part of essential services in this crisis.

What is personal protection equipment or PPE, as it is now known? Viruses can enter the caregiver’s system by direct contact, with blood or fluids of the patient, who is sick with the virus, with objects (surfaces such as bathroom floor or equipment such as USG etc), which could have been contaminated. The virus enters through the broken skin or unprotected mucus membranes such as eyes, mouth and nose, if unprotected.

Health workers coming in contact with either the patient or the stuff used by the patient, require PPEs. The idea is to cover the body, including the clothing on the worker, and the exposed mucous membranes, i.e. eyes, mouth and nose. 

The established global manufacturers of PPE include 3M, Ansell, Honeywell and Dupont. The standards are specified by WHO and have to follow the EU and EN – European norms. The PPE kit requires  several certifications including ISO, CE , GMP and SITRA. A new certification by Haffkine has also been recently introduced to avoid flooding of the market with low quality material, which could give a false sense of protection to the worker. The material used to make the covering has to be impervious to fluid and virus particles and is the essence of the kit. The material used is polypropylene with lamination on one side or both sides, which makes it impermeable to fluids including blood. 

The other important thing that needs to be considered is the GSM .i.e. the density or weight of the fabric. It also needs to not stick to the body, while the health worker is focussed on the work, which is called breathability. So a breathable fabric is preferred, over a non – breathable fabric.

Some kits are reusable after a wash and sterilisation, though most are designed for single use.

The kit consists of 

•  Coverall suit covering the head and forehead also with a 2-way zipper, which helps the person to be comfortable to sit in the suit
• Shoe covers with leggings made of same material as the coverall
• A pair of goggles, with an adjustable band and which can accommodate the prescription glasses
• A pair of nitrile gloves, which are powder free and resistant to chemicals and do not tear easily
• N95 or an equivalent FFP2 mask, which has an accepted filtration capacity

A disposable bag, face shield, hood and apron can also be included, especially for the people who are intubating, though these may be difficult to manage for the manufacturers, in view of scarcity of raw material and labour and the urgent requirements by the hospital. The pack has to be sterilised before use, particularly for use in the Covid-19 patient wards and ICU.