Types of personal protective equipment

Face coverings & accessories

Medical face coverings fall into three groups: surgical masks, procedure masks – also known as isolation masks – and N95 respirator masks. The CDC refers to them all as “medical masks,” but there are important differences.

The easiest way to tell them apart is that procedure masks affix with stretch loops behind the ears, while masks intended for use in surgery have two sets of ties for a more secure fit to the face. N95 respirator masks usually have over-the-head elastic bands to hold them firmly in place.

Both surgical and procedure masks for use in a medical setting are made with non-woven fabrics designed to protect the wearer and the patient from the transfer of microorganisms and large droplets and splashes of blood and other body fluids. They are disposable and only intended for single use.

Industry-standard “ASTM” test methods are used to measure mask performance. To carry an “ASTM Rating,” the FDA requires that masks be tested for:

• Fluid resistance
• Flame resistance
• Particulate filtration
• Bacterial filtration
• Breathability

A mask may be rated "ASTM Level 1, 2 or 3," with the highest performance rated Level 3. But note that not all masks in the marketplace are ASTM-rated.

Procedure masks

Used for performing patient procedures, or when patients are in isolation, to protect them from potential contaminants. Procedure masks are used to protect both patients and staff from the transfer of respiratory secretions or other fluids or debris. They are used for "respiratory etiquette" to prevent people from spreading germs via talking, coughing or sneezing. Procedure masks have ear loops for quick donning and can be worn without a surgical cap.

Surgical masks

Used inside the operating room or during other sterile procedure areas, these types of masks help protect the patient environment from contamination. They also help protect the clinician from contaminated fluid or debris generated during the procedure. Surgical masks have ties so they can be adjusted for fit, and are tied over top of a surgical or bouffant cap.

These masks cover the user's nose and mouth and provide a physical barrier to fluids and particulate materials (ASTM Level 1, 2, 3). The mask meets certain fluid barrier protection standards and FDA Class I or Class II flammability tests.

Filtering face-piece respirators (FFR)

A disposable half-face-piece, non-powered, air-purifying particulate respirator intended for use to cover the nose and mouth of the wearer to help reduce wearer exposure to pathogenic biological airborne particulates. They are certified by NIOSH, an agency of the CDC, to filter out at least 95% of particulates .3 microns in size; thus, an N95 FFR filters 95% of .3 micron particulates (the N stands for NIOSH).

There are seven classes of filters for NIOSH-approved filtering face-piece respirators available. Ninety-five percent is the minimal level of filtration that will be approved by NIOSH. The N, R and P designations describe the filter's oil resistance:

• N95: Filters at least 95% of airborne particles; not resistant to oil
• N99: Filters at least 99% of airborne particles; not resistant to oil
• N100: Filters at least 99.97% of airborne particles; not resistant to oil
• R95: Filters at least 95% of airborne particles; somewhat resistant to oil
• P95: Filters at least 95% of airborne particles; strongly resistant to oil
• P99: Filters at least 99% of airborne particles; strongly resistant to oil
• P100: Filters at least 99.7% of airborne particles; strongly resistant to oil

N95 respirators

An FFR offers protection from particulate materials at an N95 filtration efficiency level; also called a medical respirator.

Surgical N95 respirators

A NIOSH-approved N95 respirator has also been cleared by the Food and Drug Administration (FDA) as a surgical mask.

Particulate-filtering face-piece respirators (PFFR)

This type of air-purifying respirator protects by filtering particles out of the air the user is breathing.

Hand sanitizers

Hand hygiene is an important part of infection prevention, including during COVID-19. Practicing hand hygiene, which includes the use of alcohol-based hand rub or hand-washing, is a simple yet effective way to help prevent the spread of pathogens and infections in healthcare settings.

The Center for Disease Control & Prevention (CDC) recommends alcohol-based hand sanitizer at 60% ethanol or 70% isopropyl to kill COVID-19. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and are effective in the absence of a sink.

Personal protective gowns

There are various types of protective gowns, including surgical and isolation – or procedure – gowns. Gowns are rated according to their AAMI level, which indicates how a gown performs against a series of barrier performance criteria and ranges from one to four, with level 4 providing the highest barrier to fluids and microorganisms.

AAMI ratings do not specify what type of gown should be used during a procedure. Facilities are responsible for choosing the right level of gown protection for their staff.

AAMI ratings for different levels of protection:

• Level 1: Minimal fluid barrier protection gowns are used for daily patient care when there is little to no risk of fluid exposure. These gowns are generally not used in the operating room
• Level 2: Minimal to low fluid barrier protection gowns are used when there is a slight risk of fluid exposure. These gowns can be used for minimally invasive surgical procedures such as removing lumps and bumps
• Level 3: Moderate fluid barrier protection gowns are used for the widest range of surgical procedures where the risk of fluid exposure is moderate
• Level 4: Highest fluid and microbial barrier protection gowns provide protection against bloodborne pathogens in critical zones (from the chest to the knees) and for long, fluid-intensive procedures. (This level was strengthened by the FDA in 2016 and requires documentation of additional testing by gown manufacturers

The highest barrier protection is in the primary “critical zones” of the gown, in the front and on the sleeves, where direct contact with blood, body fluids and other infectious material is likely to occur. Higher-level gowns have larger critical zones and the sleeves and seams are fully sealed, not sewn, to prevent fluid penetration.

AAMI level 2 isolation or procedure gowns may be appropriate for minimally-invasive or in-office procedures where fluid impact is expected to be low; whereas level 3 gowns are used for a wide range of surgeries where the risk is moderate and level 4 gowns are best for high-fluid and lengthy procedures when the risk is higher.

What type of gown is appropriate for my facility?

• Post-acute caregivers generally wear isolation gowns Association for the Advancement of Medical Instrumentation® (AAMI) 1 or II. Each facility to complete risk assessment to determine level of protection
• Home care staff may wear gowns of a lower level of protection to protect their clothing or scrubs. If there is a risk of fluid splash – during wound irrigation, for example – they may use aprons or more water-resistant gowns
• Housekeeping staff may opt for lower level gowns with NO rating to AAMI 1 during cleaning and disinfection
• Physician offices may use procedure gowns for simple procedures or COVID testing, but each facility will determine the fluid risk
• Surgical gowns are used at any risk level and be rated AAMI 1-4, but procedures with high fluid exposure generally use AAMI level 3 with or without fabric reinforcement or AAMI level 4 with fabric/poly reinforcement. The reinforcement – or critical zone – includes the area from the chest to the knees and from the wrist to elbows with sonic welded sleeves
• Urgent care centers use higher protection level AAMI 2-3 gowns depending on the degree of fluid exposure

Medical gloves

In general medical gloves consist of exam gloves, surgical gloves and chemotherapy cloves.

Exam gloves are generally less tight-fitting for easy donning and removal, come in fewer sizes, and can be worn on either hand.

Typically, surgical gloves are sterile, packaged in pairs and “handed” with left and right gloves in each pair. They can be made of many materials, including nitrile, neoprene, polyisoprene and latex. They come in many sizes and surgeons sometimes double-glove for extra protection from viral contamination or in procedures that involve heavy instruments, like orthopedics.

Chemotherapy gloves must be tested to resist a range of highly toxic hazardous drugs, according to ASTM testing. As users are often required to double-glove to prevent cross-contamination, chemo gloves come in under-glove and outer-glove combinations.

How to choose an exam glove: Types, usage & recommendations >

Unless otherwise noted, the recommendations in this document were obtained from www.fda.gov/medical-devices/personal-protective-equipment-infection-control/medical-gowns.

Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.

© 2021 McKesson Medical-Surgical Inc.