B. PPE- Personal protection equipment comprise of face masks, gloves, gowns/aprons, face shields and caps.
Barrier precautions such as masks and respirators are regarded as the last line of defence against viral transmission secondary to hand washing and other hygiene measures. In the case of laser/IPL treatments, proper eye protection is imperative and should not be ignored. Resources detailing correct methods of donning and doffing of PPE are freely available.11
Face masks and Respirators
Face masks protect against aerosol spread from inside out. They are tested in the direction of expiration (from inside to outside). They offer minimal protection to the wearer from inhalation of droplets. Face masks can simply be classified as surgical and non-surgical. Surgical masks worn by the practitioner protect the patient and the environment (air, surfaces, equipment, surgical site). If worn by patients, they prevent contamination of the patients’ surroundings and environment. Standard surgical masks offer no protection to the practitioner undertaking laser procedures. If available, surgical masks or 3 ply cotton masks should be offered to patients undergoing non facial laser procedures.
Filtering facepiece respirators (FFP), which are sometimes called disposable respirators protect from aerosol inhalation. FFP are tested in the direction of inspiration (from outside to inside). The tests take into account the efficiency of the filter and leakage to the face. FFP are subject to various regulatory standards around the world. FFP2 and FFP3 conform to EU standard EN149:2001. The FFP3 standard is often considered broadly equivalent to the US N99 standard and Chinese KN99 standard. The FFP2 standard is often considered broadly equivalent to the US N95 standard and Chinese KN95 standard.
Respirators are often more comfortable for the wearer when fitted with a valve exhalation feature, but this feature has the effect of elevating wearer safety over that of patients and others in the vicinity, and therefore is generally discouraged. 12
The World Health Organisation recommends that health care workers should wear a particulate respirator at least as protective as a N95/ FFP2, or equivalent, when performing aerosol generating procedures on patients suspected or confirmed of being infected with COVID-19.13
The BMLA also recommends that until proven otherwise, all patients should be considered suspected of being infected with COVID-19. All practitioners should wear N95 respirators as a minimum when undertaking any laser or IPL procedures. This should in addition be complemented by a reusable cleanable face shield. For all
above-clavicle procedures, where risk of exposure to patient generated respiratory aerosol is higher; where available, FFP3 respirators should be used instead (for more information on FFP2 vs. FFP3 respirators, see https://www.finder.com/uk/ffp2-vs-ffp3-face-masks).
Practitioners should be fit-tested for all respirators and should receive PPE training comprising of proper hand hygiene practices, correct fit, donning and doffing to avoid cross-contamination.14
Concerns about availability and costs of respirators should be taken into account. Unlike surgical masks which are single use (3-8 hours maximum); FFP can be reusable or disposable. While the BMLA does not recommend extended use or reuse of disposable FFPs; when availability is an issue and, if unavoidable, it may be possible to extend the life of single use FFPs. The use of reusable, cleanable face shields may enhance the life of single use FFPs. Thorough decontamination and safe storage of FFP is incumbent upon the user and is beyond the scope of this guidance. Practices ranging from UV radiation (260 – 285 nm), 70ºC dry heat, 70% ethanol and vaporized hydrogen peroxide (VHP) can reduce SARS-CoV-2 on N95 respirator with VHP treatment exhibiting the best combination of rapid inactivation of SARS-CoV-2 and preservation of N95 respirator integrity.15,16