PPE for protection against SARS- CoV2
In routine dental practice gloves, face masks, eyewear, head cap are commonly used PPE. Due to ongoing pandemic situation, additional PPE are highly recommended to avoid transmission and cross contamination. There are several types of PPE of vivid qualities and price in the market. One must be cautious while choosing to buy PPEs. This article aims to give an insight on PPE required in dental practice, specifications and quality aspects.

Components of PPE
Gown/ Coverall suit
Head cap
Goggles
Full-face shield
Gloves
Shoe Covers
Specifications for PPE
Gloves
Nitrile/ Latex material
Appropriate size
Quality compliant with the below standards, or equivalent:
EU standard directive 93/42/EEC Class I, EN455
EU standard directive 89/686/EEC Category Ill, EN 374
ANSI/SEA 105-2011
ASTM D6319-10
Coverall/ Gowns

Impermeable to blood and body fluids
Single use is recommended
Avoid culturally unacceptable colors e.g. black
Light colors are preferable to better detect possible contamination Thumb/finger loops to anchor sleeves in place
Quality compliant with following standard
Meets or exceeds ISO 16603 class 3 exposure pressure, or equivalent
Option 1: fluid penetration resistant: EN 13795 high performance, or AAMI PB70 level 3 performance or above, or equivalent
Option 2: blood borne pathogens penetration resistant: AAMI PB70 level 4 performance, or (EN 14126-B) and partial body protection ( EN 13034 or EN 14605), or equivalent
Goggles

With transparent glasses, zero power, well fitting, covered from all sides with elastic band/or adjustable holder.
Good seal with the skin of the face
Flexible frame to easily fit all face contours without too much pressure
Covers the eyes and the surrounding areas and accommodates for prescription glasses
Fog and scratch resistant
Adjustable band to secure firmly so as not to become loose during clinical activity
Indirect venting to reduce fogging
May be re-usable (provided appropriate arrangements for decontamination are in place) or disposable
Quality compliant with the below standards, or equivalent:
EU standard directive 86/686/EEC, EN 166/2002
ANSI/SEA Z87.1-2010
Shoe Covers

Made up of the same fabric as of coverall
Should cover the entire shoe and reach above ankles
Face Shield

Made of clear plastic and provides good visibility to both the wearer and the patient
Adjustable band to attach firmly around the head and fit snuggly against the forehead
Fog resistant (preferable)
Completely covers the sides and length of the face
May be re-usable (made of material which can be cleaned and disinfected) or disposable
Quality compliant with the below standards, or equivalent:
EU standard directive 86/686/EEC, EN 166/2002
ANSI/SEA Z87.1-2010
Mask

Triple Layer Medical Mask
Three layered medical mask of non-woven material; ISI specifications or equivalent

Mask
Shape that will not collapse easily
High filtration efficiency
Quality compliant with standards for medical N95 respirator:
NIOSH N95, EN 149FFP2, or equivalent
Fluid resistance: minimum 80 mmHg pressure based on ASTM F1862, ISO 22609, or equivalent
Quality compliant with standards for particulate respirator that can be worn with full- face shield
Standard tests to evaluate the barrier effectiveness of protective gowns
These test methods are as follows:

Impact Penetration Test: measures the resistance of fabrics to penetration of water by spray impact (at 1 psi), as measured by weight gain of a blotter.
A lower number represents higher resistance.
Hydrostatic Pressure Test: Measures the resistance of fabrics to penetration of water under constantly increasing hydrostatic pressure (0.25-2.0 psi), measured as hydrostatic resistance (cm).
A higher number represents higher resistance.
Synthetic blood penetration resistance: Used to evaluate the resistance of materials to penetration by synthetic blood under conditions of continuous liquid contact and only applies to surgical drapes.
Results are reported on a pass or fail basis.
Blood borne pathogens penetration resistance: Measures the resistance of materials used in protective clothing to penetration by blood borne pathogens, using a surrogate microbe under conditions of continuous liquid contact.
Results are reported on a pass or fail basis.
Additional considerations on Personal protective equipments
Gowns

To protect the forearms when splash, spatter, blood and body fluids long sleeved arm is recommended
Protective clothing must be changed daily, whenever it becomes visibly soiled or as soon as possible if penetrated by blood or splatter.
Protective clothing should be removed before leaving the work area.
Dirty protective clothing should be placed in designated area for disposal or washing.
Task-specific gloves

Non-surgical, surgical, or heavy-duty utility gloves are worn by all healthcare professionals to prevent or reduce the risk of contaminating the hands with blood or body fluids and to prevent or reduce the risk of cross-infecting in the clinical process.

Gloves may not be washed because it can lead to wicking (penetration of liquids through undetectable holes in the gloves) and subsequent hand contamination.
Double gloving is acceptable for extensive oral surgical procedures.
Heavy-duty utility gloves are worn for all instrument, equipment, and environmental surface cleaning and disinfection.
Wearing gloves does not eliminate the need for hand hygiene.
Face masks

What is extended use ?

Wearing the same N95/FFP2 respirator/ masks for repeated close contact encounters with several patients, without removing the respirator between patient encounters.
Extended use is well suited to situations wherein multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards.
Recommended as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.
What is Reuse of face mask ?

Reuse – Using the same N95/FFP2 respirator for multiple encounters with patients but removing it (‘doffing’) after each encounter.
The respirator is stored in between encounters to be put on again (‘donned’) prior to the next encounter with a patient.
CDC recommends that a respirator classified as disposable can be reused by the same worker as long as it remains functional2 and is used in accordance with local infection control procedures.
Limited reuse has been recommended and widely used as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.
Final note
With the surge in demand several manufacturers have come up in production of PPEs. While making indigenous products is a positive sign, quality control and standard compliance is important aspect that needs attention. Healthcare professionals must thoroughly check the specifications and standards so that there is no breach of protocol during usage. More importantly,  PPEs are not alternative to basic preventive public health measures such as hand hygiene, respiratory etiquettes which must be followed at all times.