Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Pandemic Protective Wear for Healthcare Personnel

J.M. Subashini 1, M.Tech Scholar
Dr.S.Kavitha 2, Assistant Professor III
Department of Fashion Technology,
Kumaraguru College of Technology
Coimbatore, Tamilnadu, India.

Abstract:- The protective wear for the healthcare workers are themselves ill or being absent due to the
persons is their life-saving equipment as they are the concern about the efficiency of PPE, it is difficult to face
one who is working on the frontline delivering care to pandemic situation to reduce death rate. The increased
the patients during the time of influenza pandemic. importance on healthcare PPE and the related challenges
Globally the pandemic influenza affect number of predicted during an influenza pandemic requires early
people, in which the most important consideration is attention to ensuring the safety and efficiency of PPE
made for protecting the health of the health care products and their use [4].
personnel. The vital aspect of planning to prevent and
control the pandemic influenza being affecting the Several organisations have provided proper guidance
health care personnel are by the use of Personal on PPE which includes The World Health Organization,
Protective Equipment (PPE) which consist of the Public Health England, The European Society of Intensive
coverall/gowns (with or without aprons), mask, gloves, Care Medicine and Society of Critical Care Medicine and
goggles, face-shield, headcover and shoe cover that will The European Centre for Disease Control [1]. These
be used by the healthcare personnel in their day to day organisations states that, the airborne precautions contains
patient care duties. In this paper, a review has been fit-tested and fit checked high filtration long-sleeved fluid-
made on understanding the risk on the healthcare repellent gown, mask, gloves and goggles or visor.
workers, as they have a high risk of getting transmitted
of the virus through various mode of transmission. The II. UNDERSTANDING THE RISK OF PANDMIC
paper discusses views for design and engineering the INFLUENZA TO HEALTHCARE PERSONNEL
effective PPE which includes the different components
of PPE used by healthcare workers, and its The World Health Organization have been warning
characteristics which enhance the safety of the that severe and mounting troubles the global supply of
healthcare personnel. personal protective equipment (PPE) causes through panic
buying, rising demand, misuse and putting lives at risk
I. INTRODUCTION from a various disease like the new coronavirus and other
infectious diseases [2,4]. Healthcare workers should make
The health care workers are the one who stands on the sure of on their personal protective equipment to safeguard
front line providing treatment to the patients during the themselves from being infected and infecting others [1].
time of influenza pandemic and inhibiting further spread of The fluids can transmit the virus that causes infection or
disease. As the world prepares to face the pandemic colonization which include multi-drug resistant
influenza, many research are being made for protecting the organisms(MDROs) such as Enterobacteriaceae,
health of the health care personnel by providing the proper Methicillin-resistant Staphylococcus aureus (MRSA) and
Personal Protective Equipment (PPE) which consist of the Acinetobacterspp; also the risk of transmission includes
coverall/gowns (with or without aprons), mask, gloves, bloodborne viruses, noroviruses and respiratory viruses
goggles, face-shield, headcover and shoe cover that will [13]. Healthcare workers should be more aware of risk of a
provide proper prevention for the healthcare workers in new pandemic, especially in the recent outbreaks and the
their day to day patient care responsibilities [1]. Also, it is fact that many of the healthcare workers are being affected
more important to have proper training and equipping the day to day facing many difficulties physically and mentally
health care workers with the personal protective equipment working in a stressful conditions in saving lives of many
to protect the healthcare workers from infecting their people [14]. A study has been reported that about 2-15% of
families and patient. The droplet and contact routes are the the healthcare workers are colonized or been infected with
major source of transmission of the virus in a pandemic. MRSA which shows the risk of healthcare workers
When smaller respiratory particles circulate in the air for acquiring micro-organism because of workplace exposures
prolonged periods (generally <5 µm) the airborne [15].
transmission occurs [2]. The outbreaks of the serious
pandemic like COVID 19 which is the most current There are four possible modes of virus transmission
dangerous disaster globally, have highlighted the which are; Direct contact, Indirect contact, Droplet,
prominence of protecting healthcare workers from Airborne explained in fig. 1.
infectious agents. During the pandemic, if the healthcare

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig 1:- Possible modes of virus transmission

In the resent pandemic of COVID 19, Italy has healthcare workers confirmed positive for the virus [16].
reported the death of health care workers by category. The The statistical data report is shown below in fig 2.
report has the data available for 16179 out of 16991

Fig 2:- Statistical report on HCW died in Nation of Italy during COVID 19 pandemic

In order to protect the health care workers from III. DESIGNING AND ENGINEERING EFFECTIVE
infecting, PPE act as the barrier between infectious PPE
particles such as bacterial and viral contaminations passing
through the skin, mouth, nose, or eyes (mucous The methodology used for design and development of
membranes) [15]. The barriers have the capability to block PPE generally incorporates three phases which are
transmission of contaminants from blood, body fluid, or associated with the product life cycle of PPE are the
respiratory secretion and prevent the doctors and other analysis of user requirement; understanding the design; and
frontline healthcare personnel being affected by these user evaluation and standardization [1]. The four main key
deadly diseases. factors such as degree of production, comfort, regulation
and cost, mainly influence the design and development of
PPE.

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The polyethylene film enhance the degree of and strength. The various forms of synthetic fibers are used
protection required for the protective clothing, such as as the basic raw material for manufacturing of disposable
surgical gown, without substantial additional expense, but isolation gowns. Polypropylene (PP) spun-bond fabric,
at a significant loss of comfort for the user. On the other Spun bond melt-blown fabric and spun lace fabric are
hand, a high degree of protection and comfort can be mostly used in manufacturing of disposable drapes, gowns
achieved by using a breathable, impervious, nonwoven and covers [3]. The weight of the fabric for gowns ranges
material with much higher cost [2]. Due to exist of different 35-50 GSM fabric, for Caps it range from 12-25 GSM, for
manufacturing technologies and materials in this generation masks it is in the range of 25-40 GSM and for spun-bond
we can change any of the design factor, and develop the fabric the weight of the fabric is typically 25-40 GSM is
product to achieve ultimately the requirements of the end- used. By using particular fibre types, bonding process and
user. The effectiveness of design and developments of fabric finishes either by chemical or physical treatments,
different components of personal protective equipment are the desired properties of the fabric used can be achieved.
explained briefly; Reusable (multi-use) gowns can be tumble washed after
each use. These reusable coverall/ gowns are usually made
A. Effective Design and materials used for an isolated of 100% cotton, 100% polyester, or polyester/cotton blend
Coverall/ Gowns fabrics. The fabrics structure used are mostly woven plain
Coverall/gowns are usually designed to prevent the weave structure with lighter weight fabric, which are
torso of healthcare workers from exposure to the pandemic chemically finished and pressed through rollers to create
virus. Coveralls which typically provide all-round the liquid barrier properties to the fabric. The durability of
protection over 360-degree of the human body. They were the reusable garments generally can be for 50 or more
designed in such a way to cover the whole body, from head washing and drying cycles. Surgical Gown features like
to feet, but sometimes the design of these medical or blood-resistant, water-resistant, alcohol-resistant, liquid
isolation gowns may failed to provide a continuous whole- filter abilities, and anti-static, breathable. This high-quality
body protection as they may have possible openings in the surgical gown which is sterilized provides reliable and
backside or coverage only upto mid-calf only [5]. So that it selective blood or any other liquid. Cotton cuff gives
is necessary to use appropriate protective clothing with doctors comfort during operation [9].
proper fastness provided to wear, elastic fittings in waist
and ankle and ample crotch which provide complete close A study has been done to determine if the laboratory
fittings and create a barrier to eliminate the droplet gown for healthcare workers maintained infectivity on the
transmitted that are capable to spread the disease, thus surface of PPE, where they deposited the influenza virus
protecting healthcare workers working nearby (within 1 over the surface of the coverall for three samples and left
meter) [25]. for 1h,8h and 24h, and hemagglutination (HA) and 50%
tissue culture infective dose (TCID50)/mL were measured.
The nonwoven material are used to construct the The result shows that the HA titer of this influenza virus
disposable isolation gowns which are discarded after a did not decrease in any of the material tested even after
single use. They are also made with the combination of 24h. This indicates that the PPE used by the healthcare
material that offers high protection to liquid barrier, such as workers in case of exposure to secretion and droplets
plastic films [4]. The technologies used to produce the containing viruses spread by patients can prevent cross
nonwoven fabric which includes thermal bonding, chemical infection [8].
bonding, or mechanical bonding to provide better integrity

Fig 3:- Design of PPE Coverall

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
B. Effective Design for developing PPE Masks around the nose and the face. N-95 respirator mask is a 4
Respiratory viruses that affect mainly the upper and layer mask consist of an outer layer of spun-bond
lower respiratory tracts of human beings, so that protecting polypropylene nonwoven material, second layer of
the airway transmission of droplets and aerosols is cellulose or polyester, third layer of melt-blown
important prevents human infection. Contamination of polypropylene which act as a filtering material and an
mucous membranes of mouth and nose present in the innermost (fourth) layer of spun-bound polypropylene
infective droplets or through a contaminated hand also nonwoven material [18].
allows the virus to enter the host [15]. Hence the airborne
and droplet precautions using masks are most essential for Also, in N-95 mask a hydrophilic plastic substance is
healthcare workers while treating the patient. Generally two coated to the active outer layer whereas, copper and zinc
types of masks were recommended for healthcare personnel are coated in the second inner layer. These two layers make
working in hospital or community settings, liable to their the influenza virus to get inactivate using different
work environment are N-95 Respirator mask and Triple mechanisms of action which creates a negatively charged
layer medical mask, where N-95 respirator mask are only particle so that when the particle tries to attack it creates a
preferable for the frontline healthcare works who are negative charge and destroy it which is the mechanism
treating the patients very closely [12]. behind N95 respirators [18].

An N95 mask or N95 respirator is a particulate A study has been made to evaluate the value of the
filtering respirator that is standardized by the National surgical mask used by the frontline workers were three
Institute for Occupational Safety and Health (NIOSH), lower-level studies has reported that a surgical mask can
means that it filters at least 95% of airborne particles. The protect the workers from the occupational acquisition of
N95 respirator mask is a flat folded, convex-shaped mask respiratory infections when combined with the hand
with elastic head-loops made up of polyamide/spandex to hygiene [10]. In another study concluded that the surgical
secure the mask firmly to the user. A flexible aluminium mask for the visitors controls the concurrent infections in
strip is fixed to the mask above the nose part to seal tightly the workplace [11].

Fig 4:- Layers of N95 mask and different designs of N95 mask

C. Effective Design and material for PPE Gloves leakage rates associated with a decrease in durability [17].
The medical gloves used by health care workers helps
to protect them from cross infections while they are treating Moreover, the guidelines provided by the healthcare
the patients. Mostly medical gloves are made from sectors mentioned that they prefers nitrile gloves over latex
copolymers and rubber material which are latex, nitrile, gloves because they resist chemicals which includes certain
polyvinyl chloride and neoprene. They may be non- disinfectants agents like chlorine. Also, latex has high rate
powdered, or powdered with corn starch to lubricate the of allergies and cause contact allergies dermatitis among
gloves, and making it easier to put on hands. A study has healthcare workers. However, in unavailability of nitrile
been made to compare the efficiency of prevention of these gloves latex gloves can be used. Also, non-powdered
types of gloves. On a total of 200 gloves tested, it is gloves are mostly preferred to powdered gloves while
evaluated that latex and nitrile gloves provides good barrier treating the virus affected patients [5].
characteristics whereas vinyl exhibited higher in use

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig 5:- Different types of gloves used

It is most important to change gloves after treating E. Effective design and material used for Goggles and face
each patient and must use proper hand hygiene procedures shield
after removal so that it helps the healthcare workers to In medical professions, the threat of random airborne
minimize the risk of virus transmission [19]. fluids and particles is frequently present. For this reason,
proper eye and faceguard is important. Many doctors,
D. Effective design and materials used for Shoe cover and nurses and hygienists choose lightweight safety eyewear
headcover with wraparound anti-fog lenses [24].The lenses or
Impermeable fabric which are used for making windows are made from various materials such as
coverall is the suitable material for making shoe covers polycarbonate, acetate, polyethylene terephthalate glycol
which facilitate better protection and decontamination. (PETG)and polyvinyl chloride [23].
Moreover, these shoe covers are disposable one time use
and made of polypropylene or polyethylene fibres with an The goggles used should have zero power with
elastic attached to fit to secure the shoe cover above the transparent glasses, must be well-fitted and should cover all
ankle level [5]. A statement has been made that shoe covers sides with an elastic band or adjustable holder [22]. They
are not an important part of PPE and no evidence has been must be easily fit with all face lines without any pressure
found to describe the effectiveness of shoe covers. A study with the flexible frame.
has been made in which a positive swab for SARS-CoV-2
was obtained from shoe cover which determines a risk of The face shield is usually made of clear plastic which
splashing from infected persons so that more research is gives good visibility to both the doctors and the patient.
needed on shoe cover as an important component of PPE Face shield provides barriers to expelled aerosols of body
[20]. fluids which are commonly used as the alternative for
goggles or sometimes worn above the goggles which
Coveralls usually cover the head, but wearing a provides high protection to the face [24]. They are secured
separate headcover is used for high prevention. Headcover with an adjustable band to support firmly over the head and
makes covering from head to neck that can provide a fit closely against the forehead to make complete cover to
complete coverage of their hair to fit inside the headcover the side and length of the face. [21]. A report has been
while providing clinical care to the patients [6]. These made that about 96% and 92% risk is reduced by using the
headcovers are disposable one made up of polypropylene face shield while treating the patient immediately after they
fibres using spun-bond technique cough [24].

Fig 6:- Front and side view of the Face shield

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Components of Characteristics Design and fit Figure Quality standards
PPE
Gloves ● Non-sterile ● Outer gloves ● EU standard
● Powder free preferably should reach the directive 93/42/EEC Class I,
mid-forearm and should be EN 455.
minimum 280 mm of total ● ASTM D6319-10
length ● ANSI/SEA 105-
2011

Coverall ● Resistant to ● Thumb/finger loops to ● Meets or exceeds

blood and body fluid anchor sleeves in place ISO 16603 class 3 exposure
● Single use ● Adjustable neck pressure, or equivalent
● Light colours closures with tape foe
are preferable to better close fitting.
detect possible
contamination

Goggles ● With zero power, ● Flexible frame to ● EU standard

transparent glasses, well- easily fit all face contours directive 86/686/EEC,EN
fitting and should without too much pressure 166/2002
covered from all sides ● Adjustable band ● ANSI/SEA Z87.1-
with elastic band/ or provided to firmly secure 2010
adjustable holder. so as not to become loose
● Must have good during clinical activity
seal and good fitting with
the face
● Fog and scratch
resistance
N-95 Mask ● Shape that will ● Elastic head-loops ● NIOSH N95,
not easily collapse to firmly secure the mask EN149 FFP2, or equivalent
● High filtration to face, and a flexible ● ASTM F1862, ISO
efficiency aluminium strip positioned 22609, or equivalent
● Good above the nose for a close-
breathability, with an fitting seal around the nose
expiratory valve and face

Shoe Covers ● Made up of ● Must cover the

same fabric as of entire shoe and should
Coverall reach above the ankle level

Face shield ● Made up of ● Completely ● EU standard

clear plastic material covers the sides and length directive 86/686/EEC, EN
which provides good of the face 166/2002
visibility to the user. ● Adjustable band ● ANSI/SEA Z87.1-
● Fog resistant to support firmly around 2010
● May be re- the head and fit snuggly
usable or disposable against the forehead

Table 1:- Components, characteristics, design and quality standard of PPE

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Volume 5, Issue 5, May – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. CONCLUSION [9]. Jaques PA, Gao P, Kilinc-Balci S, et al. Evaluation of
gowns and coveralls used by medical personnel
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they are safely working with PPE. Thus in this paper, the [10]. Nishiura H, Kuratsuji T, Quy T, et al: Rapidawareness
components used for protecting the healthcare workers and transmission of severe acuterespiratory syndrome
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how they are designed and the material used for PPE. Hyg2005;73:17–25
However, more effective and wearable PPE products may [11]. Christie CDC, Glover AM, Wilke MJ, et
arise in future with the help of evolving technology so that al:Containment of pertussis in the regional pe-diatric
more designs and development of the product to highly hospital during the greater Cincinnati epidemic of
safeguard the healthcare workers will exist. 1993. Infect ContHospEp 1995;16:556 –563
[12]. Gralton J, McLaws ML. Protecting healthcare workers
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