**8. Personal protective equipment**

Personal protective equipment (PPE) is equipment specially designed to protect the HW or other employees who wear it to improve their personal safety against infectious materials. There are various PPE components including masks, gloves, gowns, goggles, face shields, disposable hair caps, and shoe covers [27].

GI endoscopy units have to define the policies in which PPE should be worn during certain exposure. In low-risk exposure, which has no direct contact with contaminated devices, body fluid, and other infectious substances, HW should wear minimum components of PPE (mask, gown, and glove). However, in the high-risk procedure, which has direct contact with a contaminated device, body fluid, and needs direct treatment, HW must wear the full component of PPE. Every personnel has to understand how to do PPE donning and doffing appropriately [27, 28]. Personal protective equipment will be effective if supported with other preventive actions, such as physical distancing, hand wash, and disinfection of medical equipment [26].

When performing GIE in suspected or confirmed COVID-19 patients, the involved HW should wear level 3 biosafety PPE. Those are N95 masks, coverall suits, hair caps, face shields, double gloves, and boots. Prolonged use of N95 for up to 4 hours is tolerable. Level 2 biosafety PPE is recommended to wear for endoscopic staff who performed negative or low-risk COVID-19. The equipment for level 2 includes an N95/FFP2/FFP3 mask, disposable waterproof gown, goggles, caps, and shoe covers. All HWs should be educated to wear proper PPE according to standards to minimize infection because the infection potentially occurs during donning and doffing PPE [9, 29].

In a study related to PPE in GIE procedure, most HW implemented proper hygiene, yet they are not educated enough to perform PPE donning and doffing [13]. The HWs have to discard used PPE properly to the waste container and continue with washing hands and other open body parts after the procedure is done [28].
