Personal Protective Equipment
The initial risk assessment of whether PPE is required is based on the risk of Transmission of infectious agents to and from the patient. In healthcare, Personal Protective Equipment (PPE), e.g. gloves, aprons, long-sleeved gowns, Fluid-resistant surgical masks (FRSM), eye goggles, face visors and respirators (FFP3), create a barrier between health workers and infectious agents from the patient and also reduce the risk of transmitting microorganisms from health workers to the patient(s). In addition, PPE may sometimes be used by the patient’s family/visitors if they provide direct patient care (e.g. assisting the patient with toileting). In these circumstances, carers must be fully inducted using PPE and Hand Hygiene.
- The choice of PPE should be based on a risk assessment of potential exposure to blood, body fluids and infectious agents.
- PPE should be available at the point of use in acute and community healthcare settings.
- PPE for health workers providing care in the community and domiciliary care providers must be transported in a clean receptacle.
- Users should receive practical training on the correct use and disposal of PPE after use into the correct waste stream, e.g. domestic waste, offensive (non-infectious) or clinical waste (see.2.9 Management of Healthcare Waste)
- Inappropriate use of PPE can increase the risk of transmitting infections and put people at risk of acquiring an infection.
- PPE are single-use only unless specified by the manufacturer. Reusable PPE, such as non-disposable goggles/face shields/visors, must be decontaminated after each use according to the manufacturer’s instructions.
- Discarded PPE if damaged or contaminated.
- Changed PPE immediately after each patient and/or after completing a procedure or task.
- Store PPE in a clean, dry area to prevent contamination until required. Expiry dates must adhere to.
Refer to the poster for a guide to the appropriate use of PPE for standard Personal Protective Equipment (PPE)
Guide to donning and doffing PPE: Droplet Precautions
https://www.england.nhs.uk/wp-content/uploads/2022/09/nipc-manual-appendix-6-Donning-and-doffing.pdf
Legislative requirement
- Employers must provide the appropriate PPE to protect employees against infection risks associated with their work [Health and Safety at Work Act 1974]. Employees are responsible for wearing the appropriate PPE to protect themselves from possible exposure to infectious agents.
- Employers should provide and maintain accurate training records on the appropriate use of PPE.
- Employees should attend mandatory IPC training and know how to use PPE.
Environmental impact
- To minimise environmental impact, avoid overuse or inappropriate use of PPE. For example, PPE is not required if exposure to blood or body fluids, mucous membranes, or non-intact skin is not
Gloves
Gloves should be worn when exposed to blood and/or body fluids, secretions or excretions and when handling contaminated items and equipment. Inappropriate use of gloves is common among health workers. Therefore, all health workers should understand the rationale for glove use and assess the potential risk of each task (Refer to the flow chart on Glove use and Selection).
- Use well-fitting gloves by choosing the correct size.
- Changed glove immediately after each patient and/or after completing a procedure/task, i.e. between patients and for different procedures on the same patient.
- They should be changed if a perforation or puncture is suspected.
- Remove gloves immediately after use, and perform hand hygiene. Failure to perform hand hygiene can effectively increase the risk of cross-infection in healthcare. Therefore, hand hygiene should always be performed after removing gloves.
- Gloves are single-use items and should not be washed or re-used and decontaminated using ABHR or soap between use.
- Double gloving is not recommended for routine clinical care. However, it may be required for some exposure-prone procedures, e.g. orthopaedic and gynaecological operations, when attending major trauma incidents or as part of additional precautions for high-consequence infectious disease
- Gloves should be stored on a clean, dry surface or in a wall-mounted unit in their original packaging.
- Health workers should not carry gloves in their clothes/uniform pockets.
Types of Glove
- Latex: Latex gloves are widely used in healthcare as they are close-fitting. They should be non-powdered and have the lowest level of extractable protein available. Health workers should not wear latex gloves if they have a latex allergy. Similarly, an alternative should be used when caring for a patient sensitive to latex.
- Nitrile Gloves: Nitrile gloves are gloves for use where a latex-free environment is required. They are resistant to various chemicals and solvents.
- Neoprene Glove: Neoprene is a synthetic rubber compound. They can be used for individuals who are sensitive to latex. They are resistant to various chemicals and solvents.
- Vinyl: They are loose-fitting and unsuitable for procedures that require manual dexterity. As a result, the use of vinyl gloves in healthcare is limited.
Aprons and Gowns
Disposable plastic aprons and gowns are designed to protect uniforms/clothing from soiling during direct patient care. In the majority of cases, plastic aprons will be appropriate. A long-sleeved fluid-repellent gown should be used where extensive contamination by blood and/or body fluids is anticipated or when the patient requires a significant amount of direct care with close skin-to-skin contact.
Plastic Aprons
The inappropriate use of plastic aprons is common among health workers. Therefore, all health workers should understand the rationale for plastic apron use and assess the potential risk of each task. Therefore they should not be worn routinely during shifts.
- Aprons should be stored in a clean area, and wall-mounted storage units are available.
- The storage units should be cleaned regularly.
- They should be used to protect uniforms/clothing from soiling during direct patient care.
- They must be changed between patients and/or after completing a procedure or task.
- Care should be taken when removing plastic aprons using ties and not touching the outer surface. The apron should be folded/rolled inwardly in a ball before disposal into a waste bin.
- Changed aprons between patients and removed immediately after completing a procedure or task, and discarded immediately after use.
- Hand hygiene should always be performed after removing aprons and gloves.
Full-body gowns or Fluid-Resistant Coveralls
- Sterile gowns are required for an aseptic procedure. For example, in an operating theatre for surgical procedures, for insertion of central venous catheters, spinal, epidural and caudal procedures, etc.).
- A long-sleeved fluid-repellent gown or fluid-resistant coveralls should be used where extensive contamination by blood and/or body fluids is anticipated or when the patient requires a significant amount of direct care with close skin-to-skin contact.
- They should be stored in a clean area, and the storage units should be cleaned regularly.
- They must be changed between patients and/or after completing a procedure or task.
- Care should be taken when removing gowns and coveralls by not touching the outer surface. They should be folded/rolled inwardly in a ball before disposal into a waste bin.
- Changed gown or coveralls between patients and removed immediately after completing a procedure or task, and discarded immediately after use.
- Hand hygiene should always be performed after removing gowns or coveralls and gloves.
Eye or Face Protection (use of Visors)
They should be worn if blood and/or body fluid contamination to the eyes or face is anticipated or likely, e.g. by members of the surgical theatre team and always during aerosol-generating procedures. Personal glasses are not a suitable substitute as they do not provide complete protection.
- Eye and face can be protected by wearing either goggles or a visor.
- They must cover the entire face area, and not be impeded by accessories such as piercings or false eyelashes.
- They must not be touched when worn.
- They should be changed if visibly soiled.
- They should be removed using earpieces/headbands to avoid touching potentially contaminated front surfaces.
- Hand hygiene should always be performed after removing the eye and/or full face protection.
- They should be disposed of after use if single-use or placed into a receptacle for reprocessing decontaminated as per the manufacturer’s guidelines.
Fluid-Resistant Surgical Face Masks (FRSM)
Surgical face masks are required as a means of source control. They protect the patient from the wearer during sterile procedures such as surgery and to protect the wearer when there is a risk of splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa of the nose, mouth and respiratory tract. Therefore, they should be well-fitting fully covering the mouth and nose. The manufacturers’ instructions must be followed to ensure effective fit and protection. They must be worn by:
- All members of the surgical team in the operating theatre to ensure proper covering of the nose and mouth.
- If blood and body fluids splashes are anticipated, they can be replaced with a full face visor.
- If splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated or likely (Type IIR: see Note below)).
- Worn to protect patients from the operator as a source of infection, e.g. when performing surgical procedures, epidurals, lumbar punctures or inserting a central vascular catheter.
- They should be stored in their original packaging before use, and care should be taken to avoid contamination.
- They should be removed or changed at the end of a procedure/task, and should be removed using the ties/strings and disposed of as clinical waste.
- They should not be left attached around the wearer’s neck following use.
- If the mask’s integrity is breached, e.g. from moisture build-up after extended use or from gross contamination with blood or body fluids
following manufacturers’ specific instructions.
Note: Type I surgical masks have at least 95% bacterial filtration rates, Type II has at least 98%, and Type IIR has additional splash resistance. Therefore, Type II is not classed as a Fluid-Resistant Surgical Face Mask (FRSM).
For Respiratory protective equipment (RPE) Respirators (FFP3 ), refer to Transmission Based Precautions
Footwear
- They should be visibly clean, non-slip,well-maintained, and support and cover the entire foot to avoid contamination with blood and body fluids or potential injury from sharps.
- They should be removed before leaving a care area where dedicated footwear is used, e.g. theatre. These areas must have a schedule with assigned responsibilities for decontaminating footwear.
Headwear
Headwear is not routinely required in clinical areas unless part of theatre attire or to prevent contamination of the environment, such as in clean rooms. They must be well-fitting, completely cover the hair, and worn in theatre settings and clean rooms (central sterile/decontamination units, etc.).
- They must be changed or disposed of between clinical procedures/lists or tasks and if contaminated with blood and/or body fluids.
- They must be removed before leaving the theatre or clean room.
- Individuals with facial hair must also cover this in areas where headwear is required, e.g. wear a snood. It should be well-fitting and completely cover the hair.
- They should be changed or disposed of between clinical procedures/lists or tasks and if contaminated with blood and/or body fluids.
Note: Headwear worn for religious reasons, such as turbans, kippot veils, and headscarves, must not compromise patient care and safety. These must be washed and/or changed daily or immediately if contaminated and comply with additional attire in theatres etc.
Posters: UKHSA Posters on Guide to donning and doffing of PPE
Reference
Personal Protective Equipment at Work. Using PPE to control risks at work. Health and Safety Executive.
https://www.hse.gov.uk/ppe/index.htm
Literature Review
- Personal Protective Equipment (PPE) Aprons/Gowns. NHS Health Service Scotland: January 2021.
- Personal Protective Equipment (PPE) Eye/Face Protection. NHS Health Service Scotland: February 2020.
https://www.nipcm.hps.scot.nhs.uk/media/1666/2020-02-sicp-lr-eyewear-v21.pdf
- Personal Protective Equipment (PPE) Footwear. NHS Health Service Scotland: 5 August 2021.
https://www.nipcm.hps.scot.nhs.uk/media/1901/2021-07-22-ppe-footwear-v30-final.pdf
- Personal Protective Equipment (PPE): Gloves. NHS Health Service Scotland: 8 June 2022.
https://www.nipcm.hps.scot.nhs.uk/media/1882/2022-05-30-ppe-gloves-review-v40.pdf
- Personal Protective Equipment (PPE): Headwear. NHS Health Service Scotland: 18 August 2021.
https://www.nipcm.hps.scot.nhs.uk/media/1669/2021-08-18-sicp-lr-headwear-v3.pdf
