Before undertaking any care task or procedure staff should assess any likely exposure to blood and/or body fluids and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.

All PPE should be:

• located close to the point of use
• stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to)
• single-use only items unless specified by the manufacturer, for example reusable items such as non-disposable goggles, face shields or visors
• changed immediately after each patient and/or following completion of a procedure or task
• disposed of after use into the correct waste stream, that is  healthcare waste or domestic waste

Reusable PPE 

Reusable PPE items, for example non-disposable goggles, face shields or visors must be cleaned/decontaminated once removed or placed within a designated container for subsequent cleaning/decontamination with decontamination schedules in place and responsibility assigned.

Reusable PPE must be cleaned/decontaminated as per manufacturers instructions or in line with local policies or procedures.

Resources

Further information on best practice for PPE use for SICPs can be found in Appendix 15.

PPE for visitors

Gloves must:

• 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. (Scottish National Blood Transfusion Service (SNBTS) adopt practices that differ from those stated in the National Infection Prevention and Control Manual)
  • Gloves are a single-use item and should be donned immediately prior to exposure risk and should be changed immediately after each use or upon completion of a task;
• never be worn inappropriately in situations such as to go between patients, 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
• not be worn as a substitute to hand hygiene.

Double gloving is only recommended during some Exposure Prone Procedures (EPPs), for example orthopaedic and gynaecological operations or when attending major trauma incidents and when caring for a patient with a suspected or known High Consequence Infectious disease.  Double gloving is not necessary at any other time.

Resources

For appropriate glove use and selection see Appendix 5.

Further information can be found in the Gloves literature review.

Aprons must be:

• worn to protect uniform or clothes when contamination is anticipated/likely
• worn when in direct care contact with a patient or their immediate environment, for example providing toileting support or changing bed linen
• changed between patients and following completion of a procedure or task

Full body gowns/fluid repellent coveralls must be:

• worn when there is a risk of extensive splashing of blood and/or other body fluids, for example in the operating theatre
• worn when a disposable apron provides inadequate cover for the procedure/task being performed
• changed between patients and immediately after completion of a procedure or task

The choice of apron or gown is based on a risk assessment and anticipated level of body fluid exposure. Routine sessional use of gowns/aprons is not permitted.

Sterile surgical gowns must be:

• worn by all scrubbed members of the operating theatre surgical team
• worn for insertion of central venous catheters, insertion of peripherally inserted central catheters, insertion of pulmonary artery catheters and spinal, epidural and caudal procedures

Reusable gowns must:

• not be worn in the operating theatre environment or for aseptic surgical procedures
• be appropriately processed between uses based on manufacturer’s instructions

If hand hygiene with soap and water is required, this should not be performed whilst wearing an apron/gown in line with a risk of apron/gown contamination; hand hygiene using ABHR is acceptable.

Resources

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

Eye/face protection must:

• be worn when there is an anticipated risk of splashing or spraying of blood or bodily fluids and always during Aerosol Generating Procedures
• be compatible with other items of PPE and worn in accordance with manufacturer’s instructions
• not be touched when worn or worn around the neck or on top of the head when not in use
• provide adequate protection from the risks of the task being undertaken
• be removed or changed when vision is impaired due to visible soiling or contamination or damage, when task complete and exposure risk has ended or immediately before leaving the work area

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

Resources

Further information can be found in the eye/face protection literature review.

Fluid Resistant Type IIR surgical face masks must be:

• worn by a patient known or suspected to be infected with a micro-organism spread by the droplet or airborne route when leaving their room or when moving between clinical areas including transfers by portering staff and ambulance services
• worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated/likely. (As part of SICPs a full-face visor may be used as an alternative to fluid resistant Type IIR surgical face masks to protect against splash or spray)
• worn in combination with a full-face shield, integrated half face shield or goggles for AGPs on non-infectious patients

• worn to protect patients from the operator as a source of infection when performing invasive spinal procedures such as myelography, lumbar puncture and spinal anaesthesia, inserting a Central Vascular Catheter (CVC), performing intra-articular (joint) injections
• worn by all scrubbed members of the theatre surgical team for all surgical procedures
• worn by non-scrubbed members of the theatre surgical team if deemed necessary following a risk assessment of exposure to blood and/or body fluids
• well fitting and fit for purpose (fully covering the mouth and nose)
• removed or changed:
  • at the end of a procedure/task
  • if the integrity of the mask is breached, e.g. from moisture build-up after prolonged use or from gross contamination with blood or body fluids
  • in accordance with specific manufacturers’ instructions

Transparent face masks

Transparent face masks may be used to aide communication with patients in some settings.

Transparent face masks must:

• meet the specification standards of the Transparent face mask technical specification

and 

• have been approved by the UK Transparent Mask review group for use within health and social care settings 
• only be worn in areas where Fluid Resistant Type IIR surgical face masks are used as personal protective equipment.

Resources

Further information can be found in:

• aerosol generating procedures literature review
• surgical face masks literature review
• section 2.4 of the NIPCM
• appendix 11 of the NIPCM

Footwear must be:

• non-slip, impervious, clean and well maintained, and support and cover the entire foot to avoid contamination with blood or other body fluids or potential injury from sharps
• removed before leaving a care area where dedicated footwear is used, for example theatre. Employees must clean and decontaminate footwear upon removal and when visibly soiled with blood and/or body fluids following manufacturers recommended instructions for cleaning and disinfection
• dedicated for use in settings such as theatres and stored in a designated area when not in use

Footwear found to be defective should be repaired or replaced before further use.

Overshoes/shoe covers should not be used in the general health and care environment.

Resources 

Further information can be found in the footwear literature review.

Headwear must be:

• worn in theatre settings/restricted and semi-restricted areas
• worn as PPE for procedures where splashing/spraying of body fluids is anticipated, and as source control when performing clean/aseptic procedures where risk of infection is deemed to be high
• well-fitting and completely cover the hair
• changed/disposed of at the end of a single clinical procedure/task or at the end of a theatre session (for sessional use): immediately if contaminated with blood and/or body fluids
• removed before leaving the theatre/clean room.

Resources

Further information can be found in the headwear literature review

For the recommended method of putting on and removing PPE see video below and Appendix 6.

The correct order for donning, doffing and disposal of PPE for healthcare workers  from NHS National Services Scotland on Vimeo.

PPE for visitors

PPE may be offered to visitors to protect them from acquiring a transmissible infection. 

If a visitor declines to wear PPE when it is offered then this should be respected and the visit must not be refused.  PPE use by visitors cannot be enforced and there is no expectation that staff monitor PPE use amongst visitors. However, if staff or visitors identify the need for PPE, advice on its correct use should be provided by staff.

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

The table below shows the PPE which should be worn where appropriate and when the visitor chooses to do so.

 

IPC Precaution	Gloves	Apron	Face covering/mask	Eye/Face Protection
Standard Infection Control Precautions (SICPs)	Not required*1	Not required*2	Where splash/spray to nose/mouth is anticipated during direct care	Where splash/spray to eyes/face is anticipated during direct care
Transmission Based Precautions (TBPs)	Not required*1	Not required*2	If within 2 metres of service user with suspected or known respiratory infection	If within 2 metres of service user with suspected or known respiratory infection

*1 unless providing direct care which may expose the visitor to blood and/or body fluids i.e. toileting.

*2 unless providing care resulting in direct contact with the service user, their environment or blood and/or body fluid exposure i.e. toileting, bed bath.