LANDSTUHL, Germany - While COVID-19 has normalized six feet of distance between employees at most workspaces, healthcare personnel are required to work closely with patients, making them one of the most vulnerable clusters of essential workers during the pandemic.To ensure patient and staff safety and minimize the spread of COVID-19, Landstuhl Regional Medical Center implemented protocols for different levels of Personnel Protective Equipment, and the donning and doffing - putting on and taking off - of PPE.“The use of proper PPE, not just with COVID-19 patients, is vital as it not only helps reduce infections in providers, but also the spread of viruses and bacteria to other patients,” said U.S. Army Maj. Nathan Boyer, medical director of LRMC’s Intensive Care Unit.Last month, Boyer, a pulmonary and critical care physician by trade, was charged with establishing LRMC’s COVID-19 ICU, where the protection of staff and other patients was central for a successful and efficient COVID-19 response operation.“The virus spreads quickly and easily, and requires the utmost attention to detail by our staff when it comes to donning and doffing PPE,” said Boyer. “I would be devastated if one of my teammates contracted COVID-19 from a patient in the ward as a result of improper donning and doffing of PPE. We have control over our own actions and implementation of our PPE protocols and I know the whole team takes it very seriously.”Personal protective equipment, as defined by the Occupational Safety and Health Administration, is “specialized clothing or equipment, worn by an employee for protection against infectious materials.”At LRMC, that list of equipment ranges from N95 masks to Powered Air Purifying Respirator systems with full environmental suits. Four tiers of protective postures exist, with current COVID operations requiring adherence to the third highest level.While the Centers for Disease Control and Prevention’s control strategies, known as the Hierarchy of Controls, recommends physically removing a hazard as the most effective infectious disease prevention method, it’s not typically an option in healthcare settings. The CDC does recommend reducing exposure to transmissible respiratory pathogens through engineering and administrative controls, such as isolating individuals and changing the way people work, in addition to the use of PPE.To better prepare staff to treat patients diagnosed with COVID-19, U.S. Air Force Lt. Col. Brent Feldt, an Ear, Nose and Throat surgeon at LRMC, assisted with the development of donning and doffing procedures for PPE during COVID operations.According to Feldt, many physicians infected with COVID-19 at healthcare facilities were ophthalmologists, ENT specialists, dentists, and oral surgeons, because of their proximity to a patient’s eyes, nose and mouth.“This caused me to become very interested in how to help decrease our exposure to COVID-19 and keep ourselves and our patients safe,” explained Feldt, a native of Hoxie, Kansas.LRMC’s current PPE protocol aligns with the Centers for Disease Control and Prevention suggestion for face protection, goggles and mask or face shield, gloves, gown or coverall, head cover, and rubber boots, for personnel providing direct care to COVID-19 patients.While PPE protects staff and patients from contamination, further prevention of the virus is being practiced throughout LRMC and its six subordinate Army Health Clinics through decreased seating in waiting rooms, physical distancing requirements during patient encounters, utilizing virtual health capabilities, screening every patient entering the hospital and requiring the use of face masks within the hospital.In addition to previous infectious disease control and prevention efforts at LRMC, several new processes have been developed with COVID-19 in mind. These processes enable staff members to continue delivering high-quality health care to beneficiaries while ensuring their safety and protection.