PPE is also required during the application of TBPs when undertaking care tasks, or entering a resident’s room who has a suspected or known infection.

All PPE must be:

• located close to the point of use
• stored in a clean and dry area to prevent contamination until needed for use
• within manufacturer’s expiry dates
• single-use only items unless specified as reusable by the manufacturer

• checked for any damage or defects before donning

• changed immediately after individual use and/or following completion of a procedure or task
• disposed of after use into the correct waste stream
• not be worn inappropriately outside of care delivery for example, moving around corridors.

 

• PPE for visitors

Gloves

Gloves are a single-use item and should be donned immediately prior to any exposure risks and doffed immediately after each use or upon completion of a task.

Gloves should:

• be worn when exposure to blood, body fluids, (including but not limited to secretions and/or excretions), non-intact skin, lesions and/or vesicles, mucous membranes, hazardous drugs, and chemicals for example cleaning agents, is anticipated/likely
• never be worn inappropriately in situations such as to go between residents, move around a care area, work at IT workstations
• be changed if a perforation or puncture is suspected or identified
• be appropriate for use, fit for purpose and well-fitting
• never be decontaminated with hand rub

Resources

For appropriate glove use and selection see the glove selection chart provided in Appendix 5. 

 

Further information can be found in the Gloves literature review.

 

 

Aprons/gowns

An apron should be worn:

• when providing direct care for the individual resident 
• when undertaking tasks within the resident’s room

A fluid repellent gown may be used when more coverage is required, for example if the resident has scabies.

 

Further information can be found in the Aprons/Gowns literature review.

 

Eye and face protection

Eye and face protection should be used:

• whenever there is an anticipated risk of splashing or spraying from any blood or bodily fluids
• in combination with the appropriate mask, when providing care for a resident who has a suspected or confirmed respiratory infection

Types of eye or face protection suitable for use include goggles, face shields or visors, and surgical face masks with integrated face shields.

Note: When used in combination with an FFP3 respirator (see RPE), the mask and eye/face protection require to be compatible, so that the eye/ face protection does not interfere with the seal of the respirator.

Note: Prescription eyeglasses and contact lenses should not be considered a form of eye or face protection.

 

You can find out more information about infectious agents and precautions required in Appendix 11.

 

Fluid resistant surgical face masks (FRSM)

Fluid-resistant surgical masks should be worn:

• when a resident has symptoms suggestive of a transmissible respiratory infection (including on admission or transfer) and the infectious agent has not yet been determined
• upon entry to, and for the duration they are within, areas containing residents who are suspected or confirmed to have an R1 respiratory infection
  • individuals may choose to wear RPE instead of a type IIR fluid resistant surgical face mask, based on personal choice – see Appendix 15 for the mask selection algorithm.

• by residents suspected or confirmed to have a transmissible respiratory infection whilst out with their own room, and if they are being moved or transported elsewhere. A risk assessment should always be by clinical staff as to whether the mask can be tolerated by the resident, and if it would compromise their care, capacity or wellbeing

Transparent face masks may be considered for use when there are communication barriers, however they must meet the specifications of BS EN 14683:2025.

Read Appendix 11 for details of the type of precautions, optimal resident placement, isolation requirements and any respiratory precautions required.

 

Respiratory Protective Equipment (RPE)

The use of FFP3s is governed by health and safety regulations. It is the responsibility of the Care Home Provider to ensure that staff have been fit tested for the use of FFP3, if their role may require use, to ensure the required protection is provided.

The Health and Safety Executive (HSE) provides information regarding fitting and fit checking of RPE.

Respiratory protective equipment (RPE) should be worn when caring for a resident who has a suspected or confirmed R2 or R3 respiratory infection.

When caring for a resident with a suspected R1 respiratory infection, RPE may be worn by individuals who have been advised to do so by occupational health, their GP, or medical practitioner.

Individuals may choose to wear RPE where FRSM is indicated for use when caring for a resident with a suspected or confirmed R1 respiratory infection, based on personal choice. Refer to the mask algorithm.

Note: As RPE filters incoming air to the wearer and not the air that is expelled by the wearer, they should not be used by anyone suspected or confirmed to be infectious.

There are 2 main types of respirators used within health and care settings in Scotland. These are:

• tight-fitting respirators (FFP3) that require face-fit testing and fit-checking on each use
• loose fitting respirators (often referred to as powered hoods, powered respirators or PAPR)

Respirators with unshrouded valves are not considered to be fluid resistant. Where there is a risk of contamination with blood or body fluids additional PPE should be worn, such as full-face shield/visor.

Other elements of PPE should still be used in accordance with SICPs when using Respiratory Protective Equipment. See Chapter 1.4 for PPE use for SICPs. 

Filtering Face Piece 3 (FFP3) Respirators

RPE should be changed after each use. Other indications that a change is required include:

• if breathing becomes difficult
• if the respirator becomes wet or moist
• if the respirator is damaged or contaminated

FFP3 respirators with unshrouded valves are not considered to be fluid resistant. Where there is a risk of splash contamination for the wearer with blood or body fluids additional PPE should be worn, such as a full face shield/visor.

Valved FFP3 respirators should not be worn when a sterile field is required. An MHRA safety alert can be viewed. 

FFP3 respirators should be compatible with other facial protection used, for instance eye protection, so that this does not interfere with the seal of the respiratory protection.

The wearer should be clean shaven and free of any jewellery or piercings to support effective fit testing by ensuring a smooth surface area for a seal. The Facial Hairstyles and Filtering Facepiece Respirators poster gives further information on compatibility of facial hair and FFP3 respirators and can be used when fit testing and fit checking.

Fit Testing

All tight-fitting RPE (for instance FFP3 respirators) must be fit tested to an individuals face prior to use.

Face fit testing should be:

• conducted by a competent fit tester as outlined by British and International Standards BS ISO 16975-3: 2017
• recorded for each individual, including mask brand, style, model and size
• repeated if changing brand, style, model and size
• repeated following reported or observed changes to the wearer’s face that could impair the seal (for example, due to weight loss or gain, dental or cosmetic work)

Fit checking

A fit check should be performed each time tight fitting RPE is donned, to ensure a tight seal has been achieved. A fit check is not a substitute for fit testing.

If a fit test or check fails, then the RPE should be adjusted and fit test/check repeated. If a tight seal cannot be achieved, then other types of RPE that offer equivalent protection may be considered.

Individuals should not undertake tasks where RPE is required if a fit test or check has failed and alternative RPE is unavailable.

Donning (putting on)

• Donning (putting on) RPE should be done in line with manufacturer’s instructions. RPE should be checked for any damage or defects before donning.
• Hand hygiene should be performed before donning RPE and, once on, the front of the RPE should not be touched.
• A fit check should be performed once donned to ensure a tight seal has been achieved.
• RPE should be donned outside of the resident’s room or designated care area.

Doffing (removing)

• RPE must be removed after exiting the resident’s room
• Where worn with other items of PPE, RPE must be removed last.
• RPE should be removed using only the straps to minimise contact with the outside surface.
• Hand hygiene should be performed before and after removal of RPE.

See Appendix 6 for donning and doffing advice.

RPE should be changed after each use. Other indications that a change in respirator is required include:

• if breathing becomes difficult
• if the respirator becomes wet or moist
• if the respirator becomes damaged or is obviously contaminated

A poster containing information on compatibility of facial hair and FFP3 respirators can be used when fit testing and fit checking.

 

Further information regarding fitting and fit checking of respirators can be found from the Health and Safety Executive

 

Powered respirator hoods

Powered respirator hoods are an alternative to FFP3 respirators for example when fit testing cannot be undertaken or achieved.

Where feasible, reusable components (for example, powered hoods and helmets) should be issued for individual use.

Powered hoods:

• must be configured according to manufacturer’s instructions
• must be single use (disposable) and fluid resistant
• filter must be enclosed with the exterior and the belt able to withstand disinfection

Donning

• RPE should be checked for any damage or defects before donning.
• Hand hygiene should be performed before donning a powered respirator and, once on, the exterior should not be touched.
• A powered respirator should be donned outside of the patient’s room or care area, or within an ante room.

Doffing

• Powered respirators must be removed after exiting the care area or room.
• Where worn with other items of PPE, a powered respirator must be removed last.
• Hand hygiene should be performed before and after removal of the powered respirator.

PPE should always be used in line with SICPs and as below as part of TBPs.

TBP PPE summary table

Gloves	Aprons	Gowns	Eye/Face protection	Fluid Resistant Surgical Masks (FRSM)	Respiratory Protective Equipment (RPE)
As per SICPs.	When in contact with a residents environment or when providing direct care to those with suspected or confirmed infection or colonisation with a transmissible infectious agent.	When excessive splashing or spraying is anticipated.	When there is an anticipated risk of splashing and/or spraying of blood or bodily fluids. When caring for a resident with a suspected or confirmed respiratory infection in combination with the appropriate mask.	When caring for a resident with suspected or confirmed respiratory infection and the infectious agent has not yet been determined. When caring for a resident with suspected or confirmed R1 respiratory infection.	Worn when caring for a resident with a suspected or confirmed R2 or R3 respiratory infection. Worn following a personal assessment (medical or choice) – see mask selection algorithm.

 

 

PPE for visitors

Visitors do not routinely require PPE unless they are providing direct care to the resident they are visiting.

However, if visiting a resident with a suspected or confirmed respiratory infection, visitors may be offered a fluid-resistant surgical mask to wear for the duration of the visit. Consideration should be given to providing visitors with RPE when visiting a patient with a suspected or confirmed infection caused by a category R2 or R3 respiratory infectious agent.

If the need for PPE is identified, staff should provide advice on its correct use. This must include fit testing for FFP3 (if required), advice on fit testing and appropriate donning and doffing for all PPE.

If, following an explanation of potential risks, a visitor declines to wear PPE when it is offered, then this should be respected, and the visit should not be refused. PPE use by visitors cannot be enforced and there is no expectation that staff monitor PPE use amongst visitors.

PPE use for care home visitors

Gloves	Apron	Surgical Face Mask (type IIR)	RPE	Eye or Face Protection
If providing or participating in direct care activities which may expose the visitor to blood and/or body fluids, for instance assisted toileting or feeding.	If providing or participating in direct care activities which may expose the visitor to blood and/or body fluids, or which results in direct contact	Where splash or spray to nose or mouth is anticipated AND for the duration of a visit to a resident with suspected or confirmed respiratory infection. During essential visiting arrangements when the visitor has a suspected or confirmed transmissible respiratory infection.	When visiting a resident who has a suspected or confirmed R2, R3 respiratory infection.	Where splash or spray to the visitor’s nose or mouth is anticipated, in addition to a face mask.