Personal Protective Equipment Requirements for Front Line Workers in India

The Indian government has boosted the domestic manufacturing of Personal Protective Equipment (PPE) to meet the increasing demand amid the ongoing shortage of PPE for health workers. While over 60,000 PPE kits have been sent to hospitals across the nation as per government order, there are still not enough.  The Indian government has categorised health workers and support staff based on the risk factor of their work and specified their PPE requirements so that everyone is covered.

Risk categorisation

High risk
Healthcare workers who are at a high risk of contracting the infection get the full PPE kit. These are the people who attend to severely ill passengers at Airport Health Organisation (APHO) facility. It also includes paramedics who help transport a severe acute respiratory infection (‎‎‎SARI) patient to a hospital, managing their care while in transit and doctors who attend to them in the emergency rooms. They are at high risk as they perform aerosol-generating procedures. Others at high risk include laboratory attendants who collect, transport and test samples; and those who handle the bodies of the deceased, such as the ICU attendant who packs the body to be moved to the mortuary and the doctor who performs the autopsy (if required).

Moderate risk
Doctors and nurses who conduct interviews, preliminary clinical examination and triage patients are at moderate risk and should wear N-95 masks and gloves. It also applies to the following categories of people:

1. (i) help desk/registration counter attendants who provide patients with information.
2. (ii) those who manage the temperature recording station and record temperature with a hand-held thermal recorder in hospitals.
3. (iii) nurses and paramedics in the hospital waiting areas who interact with patients.
4. (iv) staff attending to masked stable patients in the isolation rooms.
5. (v) the sanitation staff.

These individuals maintain a minimum distance of one metre when interacting with patients. In most cases, there are no aerosol-generating procedures, but they can be anticipated, such as those working in the emergency rooms. Paramedics who transport patients who are not on any assisted ventilation and healthcare staff working at quarantine facilities who clinically examine symptomatic persons come under this category. In a community setting, doctors at supervisory level conducting field investigation and clinical examination need to also follow these precautions.

Low risk
Frontline workers at points of entry into the country who provide information to travellers work in the immigration counters, customs and airport security and check temperatures are at low risk. They need only to wear a triple-layer medical mask, gloves and maintain a minimum distance of one metre. Others are paramedics who drive the ambulance while transporting a patient and help shift patients to the emergency room; hospital staff transporting a dead body to the mortuary; Accredited Social Health Activist (ASHA)/Anganwadi and other field staff; and healthcare staff working at quarantine facilities who monitor health and record temperature. Visitors with young children and older outpatients and caretakers of admitted patients need to wear a triple-layer medical mask, practice hand hygiene and maintain a distance of one metre.

Compliance is vital

Presently, we have 104 domestic manufacturers who are producing more than one lakh PPE kits every day in India. Each component of the PPE should comply with the international standard or their equivalent and manufacturers need to periodically check the standards issued by the health ministry. All items to be supplied need to be furnish a certificate of analysis from national/ international organisations/labs indicating conformity to standards. All this will ensure that those healthcare workers at the frontlines of the battle with COVID-19 can continue doing their job without having to worry about their health and wellbeing.