Healthcare workers are at risk of coronavirus infection in the workplace because of human-to-human transmission and the contagious nature of viral infection. Thus, prevention and control strategies to reduce secondary infections among close contacts and healthcare workers are vital. Previously, international organizations such as the WHO and the Centers for Disease Control and Prevention (CDC) produced useful documents about effective strategies for preventing and treating viral infections including MERS-CoV, Ebola, SARS, and avian flu [15,16,17,18]. The WHO-based guidelines on the most effective preventive measures for health workers who have been exposed to a confirmed coronavirus patient in a healthcare facility are illustrated in Table 1 . Notably, the risk of contagion for health workers in nuclear medicine units is high because of the referral of non-symptomatic patients and inadequate protection equipment. The medical director and the security officer should have delivered the right infection control training and evidence-based framework for both patients and healthcare workers, based on the accepted prevention and protection guidelines. Health workers should wear PPE appropriate to their profession or specialty. This equipment consists of a mask (surgical and respiratory), gloves, gowns, shoes, head cover, and eye protection. If the PPE is reusable, it has to be correctly cleaned and decontaminated before and after each use. Details of PPE usage are elaborated next.
Surgical and respirators masks
There are two main types of masks, “surgical” and “respiratory.” The surgical masks protect against infectious agents transmitted via droplets of saliva or secretions from the upper respiratory tract. Nonetheless, protective or respiratory masks also protect against the inhalation of infectious agents transmitted by airborne paths. Individuals who must wear face masks include every person with respiratory symptoms such as sneezing, coughing, and difficulty breathing, people who are caregivers in their families, and healthcare employees who have been exposed to individuals with confirmed or suspected COVID-19. Surgical masks are disposable, while respirators can be reused by replacing the filter once it becomes full. These two types of masks should not be worn for more than three (for surgical mask) to eight (for respiratory mask) hours at a time, according to the manufacturers’ guidelines.
The respiratory mask prevents the wearer from inhaling aerosols, as well as mist or gases, which are health hazards. It also protects the person from airborne infectious pathogens such as coronavirus, SARS, or H1N1. In the USA, respirators are produced based on the NIOSH (National Institute for Occupational Safety and Health) standard protocols, which divide them into several classes according the degree of oil resistance: classes N, R, and P. On the other hand, European standard EN 149:2001 identifies three classes of disposable particulate respirators: FFP1, FFP2, and FFP3. Various types of respiratory masks are shown in Table 2 (http://emag.medicalexpo.com/which-masks-actually-protect-against-coronavirus/, http://www.safeticorp.com/data/train_img_normal/Respiratory_Protection.pdf, https://www.rogerwjones.co.uk/tsc28938-ffp1-disposable-mask-10) .
Therefore, for the contagious patient, a surgical mask must be worn as soon as contagion is suspected. For caregivers caring for a patient with confirmed or suspected coronavirus, SARS, or H1N1, it is imperative to wear a protective mask of at least classes FFP2 or FFP3 (classes N, R, or P in the USA) for the greatest filtration of particles and aerosols. N95 masks are the most favored mask for health workers in a COVID-19 infected situation (http://guide.medicalexpo.com/choosing-a-surgical-mask-or-respirator/) . These masks should be replaced when changing the bowl-shaped mold and the soiled filter. Before touching the mask, hands should be washed with soap and water for at least 20 s, then dried with a clean paper towel.
Gloves are made of different materials and differ according to the type of work undertaken. Patients, caregivers, and healthcare workers must use gloves to protect themselves from infections during examinations. Details of the most appropriate professional gloves for healthcare workers are summarized in Table 3 (https://avacaremedical.com/medical-gloves-guide, https://mercatormedical.eu/products/gloves) , along with their properties. The first stage in determining which type of gloves would be suitable is identifying the dangers and the corresponding hand protection measures. The best gloves for healthcare workers are, first, latex and, second, nitrile .
Wearing a face mask and gloves cannot definitely block infections in any of these circumstances and should be combined with other PPE and regimes, such as hand hygiene, maintaining a distance from people with symptoms, and respiratory hygiene (or cough etiquette). The correct order for donning and removing PPE is also important. The relevant steps are shown in Figs. 1 and 2 (https://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf). Perform hand hygiene immediately after removing all PPE.