Infection Control Series: A complete guide to Personal Protective Equipment (PPE)

In the first three parts of this infection control series, we have analysed several key points, including using the correct chemicals for the job, how the National Colour-Code system works and finally how to effective isolation measures.

Our next step is to look at Personal Protective Equipment and how care workers can ensure they are fully protected for each job they undertake.

Whenever you’re in a care environment, you should be wearing PPE as a way of maximising your own protection and of those around you.

1) Guidance for care workers working within one-metre plus distance that involves direct contact

While the government has relaxed the two-metre rule for the general UK population, where it is possible to keep two metres apart, people should. In the care sector, the government has put in place the following recommendations for when a carer is carrying out a task with a resident within a two-metre distance and involves direct contact:

Whether the resident you are caring for has symptoms or not, and includes all residents including those in the ‘extremely vulnerable’ group and those diagnosed with COVID-19.
Whenever you are within two metres of any resident who is coughing, even if you are not providing direct care to them.
To all direct care, for example: assisting with getting in/out of bed, feeding, dressing, bathing, grooming, toileting, applying dressings etc. and or when unintended contact with residents is likely (e.g. when caring for residents with challenging behaviour).

The below recommendations for PPE also assume that care workers are not undertaking aerosol-generating procedures (AGPs).

TOP TIP! PPE is only effective when combined with thorough hand hygiene and respiratory hygiene https://coronavirusresources.phe.gov.uk/hand-hygiene. It is advised that you also avoid touching your face with your hands. Face masks will help prevent you from doing this.

The below table outlines the pieces of PPE required depending on the situation the carers are engaging in:

2) Guidance for care workers not coming into direct contact with a resident

The above recommendations apply for tasks such as: performing meal rounds, medication rounds, prompting people to take their medicines, preparing food for residents who can feed themselves without assistance, or cleaning close to residents.

If practical, residents with respiratory symptoms should remain inside their room, they should be encouraged to follow good respiratory hygiene. If, however, they are unable to maintain two-metre distance from a coughing resident then recommendations outlined in point 1 should be followed.

3) Guidance for care workers working in communal areas that involves no direct contact, although potentially could be within two-metre distance

This guidance applies for tasks such as: working in dining rooms, lounges, corridors etc. If practical, residents with respiratory symptoms should remain inside their room, they should be encouraged to follow good respiratory hygiene.

If unable to maintain two-metre distance from a coughing resident then follow recommendations outlined in point 1.

A deeper look at how PPE combats COVID-19…

Surgical and face masks

While your mouth and nose are important, so are your eyes, which can face contamination from respiratory droplets, aerosols arising from AGPs and from splashing of secretions, blood, body fluids or excretions.

Eye and face protection can be achieved by the use of any one of:

a surgical mask with integrated visor
a full face shield or visor
polycarbonate safety spectacles or equivalent (Regular corrective spectacles are not considered adequate eye protection).

While performing aerosol-generating procedures, a full-face shield or visor is recommended and should follow the same fitting procedures as the respirators and fluid resistant surgical masks. The same disposable technique should be carried out as outlined in the What do you need to know about respirators section.

Disposable gloves

Disposable gloves must be worn when providing direct patient care and when exposure to blood and or other body fluids is anticipated or likely, including during equipment and environmental decontamination. Disposable gloves are subject to single use and must be disposed of immediately after completion of a procedure or task and after each patient contact, followed by hand hygiene.

PLEASE NOTE: Double gloving is NOT necessary and doesn’t deliver any added protection.

Disposable aprons and gowns

This apparatus must be worn to protect staff uniform or clothes from contamination when providing direct patient care and during environmental and equipment decontamination.

It is advised that disposable fluid repellent coveralls, or long-sleeved gowns, must be worn when a disposable plastic apron fails to provide adequate cover to staff uniform or clothes for the procedure or task being performed. The same applies for when there is a risk of splashing of body fluids.

Disposable aprons are subject to single-use and must be disposed of immediately after completion of a procedure or task and after each patient contact as per SICPs. The appropriate hand hygiene practises should be followed and extended to exposed forearms.

What do you need to know about respirators?

Respirators are used to prevent inhalation of small airborne particles arising from aerosol-generating procedures (AGPs). For effective use, all respirators should:

be well-fitted, fully covering both nose and mouth
not be allowed to dangle around the neck of the wearer after or between each use
not be touched once put on
be removed once a patient has been fully attended to and you are outside their room and at a safe distance

Valved respirators are not fully fluid-resistant unless they are also ‘shrouded’ and therefore should be worn with a full face shield, if blood or body fluid splashing is anticipated. As part of this, it is also essential to make sure that facial hair does not cross the respirator sealing surface and if the respirator has an exhalation valve, hair within the sealed mask area should not impinge upon or contact the valve.

IMPORTANT NOTE: Respirators are for single use or single session use and then are to be discarded as healthcare (clinical) waste. The necessary hand hygiene must always be performed after disposal (a full overview of this can be found in section 5).

If, however, it is reusable, it should be cleaned in accordance with the manufacturer’s instructions.

It is important that the respirator maintains its fit, function and remains tolerable for the user. The respirator should be discarded and replaced and NOT be subject to continued use if the following happens:

it is damaged or soiled (for example, with secretions, body fluids)
it becomes damp
the facial seal is compromised
it is uncomfortable or is difficult to breathe through

Fluid resistant surgical masks

Fluid-resistant (Type IIR) surgical masks (FRSM) provide barrier protection against respiratory droplets reaching the mouth and nose. Fluid-resistant surgical masks, however, are single use or single session only. They must be discarded appropriately straight after, not subjected to continued use under any circumstances.

The protective effect of masks against severe acute respiratory syndrome (SARS) and other respiratory viral infections has been well established. There is no evidence that respirators add value over FRSMs for droplet protection when both are used with recommended wider PPE measures in clinical care, except in the context of AGPs.

Further information about the use of PPE in care homes can be found here.

Can I re-use PPE equipment?

Whilst most PPE items are for once only use, certain PPE items are manufactured to be re-usable. This most commonly applies to eye/face protection items i.e. goggles or visors. Re-usable items should be clearly marked as such and identified in advance by your organisation/manager.

Re-usable PPE items may be used providing they are appropriately cleaned or stored between uses, according to the manufacturer’s instructions or local infection control policy. Your manager will advise you where this applies.

A PPE partner you can trust

Our PPE items are made with protection and infection control in mind. Your staff can continue with their daily tasks safely, and you don’t need to worry about quality. We have everything you need to keep protected, and if you can’t find it, just let us know. We’ll be happy to help. Find out more here.