The only way to get through one more conversation about PPE is to be re-inspired. How about Fred Astaire singing “Putting on the Ritz”? Or if you want a campier version, you can watch Gene Wilder and Peter Boyle in Young Frankenstein (jump out of it before the end which is a bit chaotic). Now that we’re ready to get dressed up, let’s look at what we’ve got PPE-wise.

Masks:
We’re using a small stash of N95 masks we bought years ago when we were doing a lot of painting. (This might be the one time that having chemical sensitivities has seemed to pay off.) We are reusing them by putting them in paper bags, marked with the date so we can keep them there for 3 days between uses.

We also have homemade masks that we are using around town ourselves and to have on hand at our practice space in case clients forget theirs. (Recently, the few clients we’re seeing are all coming prepared.) To address the risk created by ‘voids’ in the masks–places that gap where air escapes–we are using nylons on top of them as recommend by CDC and WHO. Here’s Richard modeling the new style!

Eye protection:
We’ve ordered goggles that seal, but not ones that need to go over our glasses. (Looking at the options, be mindful that lots of goggles advertise ‘anti-fog’ capacity. This means they have venting to reduce condensation; that venting becomes a risk factor in this instance.) We’re waiting for them to arrive, so we’ll see how they fit. It may take a few tries to get something that suits us.

For clients’ eye protection when they are on the table, we’re going to use hand cloths, folded over. They’ll be easy to place and to wash between uses. They won’t provide a complete seal, but if the client has their eyes closed underneath the cloth their body accomplishes that.

Gloves:
While simply touching COVID-19 poses no risk of infection through the skin, we want to be more cautious if we have cuts or openings on our hands. OSHA and other agencies haven’t given guidance about 1 versus 2 layers, except in medical/work situations where likelihood of tearing is high. That’s not us.

Some folks are counseling to use gloves while working on the feet or relatively dirty areas. Then you can take them off before working on other areas of their body without needing to clean your hands yet again. This can give you more flexibility about the sequence of how you move from one body area to another. I figure I’ll experiment with this once it’s sandal season.

For many of us, we are accustomed to using gloves for intraoral work. If you choose to do intraoral work now, remember that inherently it poses a much higher risk because the client must remove their mask. You’ll need to take this on a case by case basis–and only do the bare minimum needed. It’s not the time to go all out doing everything that’s possible.

Gowns/aprons:
The gist of this is to have a clean layer of clothing for each client. Rather than invest in new wardrobes, we’ve decided to bring a change of layers: Hawaiian shirts, long t-shirts and/or sun dresses (for me!). Clearly we’ll be doing more laundry anyhow, so we might as well.

Something to consider: how far up your arms do you contact the client; does their body touch your torso (say with an arm ROM)? Remember to account for all those surfaces. For reaching under the client, I tend to go under the sheet — I may expand that practice to more areas of the body. We’ve also discovered that the hand towel we’re using to cover our head extension on our table can be used as a layer. Here’s me working on Richard’s head through the hand towel.

Donning and Doffing:
First of all, when have we used these words except in Christmas carols? To learn about this, there are several good videos on line. One day, it will become habitual, but not yet. Every few days I watch one, just to refresh my understanding and skills. I’m getting better and more consistent about this.

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To round out this subject, it would be easy to list an epidemic/biohazard/pandemic movie. Rather than that, I’m going to give a BIG SHOUT OUT to my brother, Tom. He’s one of a team of engineers working for GE Health to produce ventilators. Alongside tripling production of the high-end and mid-range ventilators, they are working on adapting simpler ‘transport ventilators’ for mass production. (Think of the kind of ventilators used on helicopters.) They’re taking a plan from a small company that’s produced about 150 ventilators a year–and upscaling it to be produced by Ford at the rate of 10,000/week. Not an easy task.

So, to honor them, I’ll suggest one of his favorite science movies: Apollo 13. Remember the part where the engineers on the ground need to design an air scrubber out of supplies on board? “You, my friend, are a steely-eyed missile man.” Love you, bro.