What does PPE stand for?

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You may be hearing a widely-used term nowadays called PPE. Here’s what PPE stands for:

(PPE)  is an abbreviation for Personal Protective Equipment.                   

Personal protective equipment in the healthcare field is used for infection control. PPE acts as a significant barrier between infectious materials and the skin, eyes, mouth or nose.

This barrier has the possibility to block the transmission of contaminants from bodily fluids, blood or respiratory secretions to the person that wears it so this barrier decreases any chance of touching and being exposed to germs.

PPE also helps to protect those people at a high risk of picking up infections, such as those with a medical condition, as an example immunodeficiency, from being exposed to potentially infectious materials brought in by doctors, nurses or visitors.

PPE is designed as disposable clothing (gloves, masks, eye protectors and other clothing) so it can be effectively removed and disposed of immediately after wear, in specific waste containers, to protect others from exposure to germs.

History of personal protective equipment:                                    

Surgical gloves have an interesting history. As far back as the mid-18th century, doctors recognized the need to protect their hands from potentially transferable diseases. Physicians started thinking and reached to sheep intestine segments to cover their hands, while others used gloves made of leather, silk, or cotton.                                                  

In 1844, Charles Goodyear developed a process for the vulcanization of rubber, that rubber could be used for gloves.  In 1899, Caroline Hampton, the surgical scrub nurse for Dr. William Halsted, had severe inflammation of the skin on her hands as a result of the antiseptics used at the time. Halsted commissioned the Goodyear Rubber Company to make the world’s first thin rubber gloves used in medicine as a result of his volition to protect the hands of his nurse and future wife.                                                                                                              

Like early medical gloves, surgical face masks were at first very simple. In the late 19th century, they were nothing more than one or more layers of gauze placed over a person’s nose and/or mouth. It wasn’t until after the 1920s that newer and better masks were developed, and people started to truly understand the importance of having medical personal masks around sick patients and during surgery.                                             

Beside gloves and masks, scrubs are often the most recognizable PPE found in medical care. Before the 1900s, surgical clothes as caps and gowns were not really used. Until about 1914, all of the surgical clothes worn by doctors and nurses were white in color. However, considering that hospital surroundings walls were white also, it was believed that an all-white-clad room and staff combined with bright operating lights created too much eye strain. So by the time the 1960s rolled around, different shadows of scrubs were used, first green, then blue, and now a wide variety of colors in to help reduce eye fatigue.                                      

Levels of PPE:

Personal protective equipment is classified into four divisions based on the degree of protection.

  • Level A protection should be worn when the highest level of respiratory, eye, skin and mucous membrane protection is needed. A typical Level A ensemble includes:
    • Positive pressure (pressure demand), self contained breathing apparatus (SCBA) (NIOSH approved), or positive-pressure supplied air respirator with escape SCBA.
    • Fully encapsulating chemical protective suit.
    • Gloves, inner, chemical resistant.
    • Gloves, outer, chemical resistant.
    • Boots, chemical resistant, steel toe and shank; (depending on suit boot structure, worn over or under suit boot.)
  • Level B protection should be selected when the highest level of respiratory protection is needed, but a lower level of skin and eye protection is needed. Level B protection is indicated when Identified or suspected hazards requiring maximal respiratory protection present, during working in atmospheres containing less than 19.5% oxygen. A typical Level B ensemble includes:
    • Positive-pressure (pressure-demand), self-contained breathing apparatus (NIOSH approved), or positive-pressure supplied air respirator with escape SCBA.
    • Chemical resistant clothing (overalls and long-sleeved jacket, coveralls, hooded two-piece chemical splash suit, disposable chemical resistant coveralls.)
    • Gloves, outer, chemical resistant.
    • Gloves, inner, chemical resistant.
    • Boots, outer, chemical resistant, steel toe and shank.
  • Level C protection should be selected when hazards have been identified, Hazards will not be absorbed by or adversely affect exposed skin.


All criteria for using an air purifying respirator are met (i.e., concentrations of all airborne contaminants are known, appropriate filters are available, oxygen levels are appropriate). A typical Level C ensemble includes:

  • Full-face, or half-mask, air-purifying respirator (NIOSH approved).
  • Chemical resistant clothing (one piece coverall, hooded two piece chemical splash suit, chemical resistant hood and apron, disposable chemical resistant coveralls.)
  • Gloves, outer, chemical resistant.
  • Gloves, inner, chemical resistant.
  • Boots, steel toe and shank, chemical resistant.
  • Level D protection is primarily a work uniform and is used for disturbance contamination only. It requires only coveralls and safety shoes/boots. Other PPE is based upon the situation (types of gloves, etc.). It should not be worn on any site where respiratory or skin risks exist.

PPE and its crucial role during outbreaks:

During an infectious disease outbreak, boost infection control measures are the best line of defense against disease transmission among health care workers.                                                                                                          

The use of Personal Protective Equipment (PPE) is one such measure, occurring beside other important precautions, including hand hygiene, environmental cleaning, boost education, and antimicrobial management efforts (collectively, “transmission-based precautions”).       

PPE  has a crucial role in controlling outbreaks. As an evidence there is a meta-analysis of 6 case-control studies from the SARS outbreak of 2003, which disproportionately infected healthcare workers, suggested that hand washing and PPE were effective in preventing disease transmission. Hand washing alone reduced transmission by 55%, wearing gloves reduced it by 57%, and wearing face masks reduced it by 68%; the accumulative effect of hand washing, masks, gloves, and gowns reduced transmission by 91%.                                                                             

 A cohort study of health care workers exposed to H1N1 influenza A in 2009 found that use of a face mask or an N95 respirator was associated with negative viral serology indicating non infected status.                          

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