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
• checked for any damage or defects before donning
• changed immediately after each patient and/or following completion of a procedure or task
• disposed of after use into the correct healthcare waste stream

Routine sessional use of PPE is not permitted.

Reusable PPE 

Reusable PPE items, for example launderable gowns, 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.

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
  • 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 (HCID). 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 and gowns

The type of apron or gown used in health and care settings should be selected based on the task being undertaken and the anticipated levels of body fluid exposure.

Aprons or gowns should not be worn routinely.

Aprons should be:

• disposable
• fluid resistant
• worn to protect uniform or clothes when contamination with blood, body fluids, chemicals, or cleaning products is likely or when handling used or infectious linen
• 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

Gowns should be:

• single-use for the task being undertaken
• full-body, long-sleeved, fluid-repellent (either disposable or single-use launderable)
• worn when there is a risk of extensive splashing or extensive contamination with blood or other body fluids
• worn when a disposable apron provides inadequate cover for the procedure/task being undertaken
• changed between patients and immediately after completion of a procedure or task
• considered as part of source control PPE when in close contact with or caring for a patient in protective isolation

Sterile surgical gowns must be:

• worn to prevent contamination of a sterile field during invasive procedures requiring sterile techniques or surgery
• worn by all scrubbed members of the operating theatre surgical team

Launderable gowns:

• should be used for one task or care episode and then be sent for laundering or reprocessing
• should be reprocessed according to the manufacturer’s instructions, including the suggested number of reprocessing cycles and useful life of barrier materials, provided by the manufacturer
• are not be worn in the operating theatre environment or for aseptic surgical procedures

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 hand rub is acceptable.

A process should be in place for tracking the number of reprocessing cycles and monitoring the quality of reusable gowns to detect any form of deterioration in integrity.

Hand hygiene should be undertaken, if required, using hand rub when wearing an apron or gown. If hands are visibly contaminated and hand hygiene using soap and water must be undertaken while wearing a gown or apron, contamination from water sources must be considered and changing of the apron or gown may be required.

Resources

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

Eye/face protection should:

• be worn when there is an anticipated risk of splashing or spraying of blood or body fluids 
• 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

Types of eye or face protection suitable for use include goggles, face shields or visors, and surgical face masks with integrated face shields. Prescription glasses and contact lenses are not considered eye or face protection

Resources

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

Fluid resistant surgical face masks (FRSM) should be:

• worn if splashing or spraying of blood or body fluids onto the nose and mouth is anticipated or likely
• worn by healthcare workers to protect patients when preparing equipment for, and performing invasive medical procedures requiring a sterile field such as intra-articular (joint) injections, central venous catheter insertion, and invasive spinal procedures (such as myelography, lumbar puncture and spinal anaesthesia)
• worn by all scrubbed members of the theatre surgical team during 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
• worn by healthcare workers when providing care to severely immunocompromised patients where protective isolation is indicated, as determined by the clinical team
• worn by severely immunocompromised patients whenever outwith protective isolation, if they can be tolerated by the wearer and do not compromise clinical care
• well fitting (fully covering the mouth and nose) with an integral nose clip or wire and an easily identifiable inner and outer surface 

FRSMs should be removed or changed:

• at the end of a clinical procedure or healthcare task
• between patient contact
• if the integrity of the FRSM is breached because it is damaged, damp, wet, soiled or visibly contaminated with blood or body fluids

Transparent face masks

Transparent face masks may be used when there are communication barriers, if they meet the specifications of BS EN 14683:2025.

Resources

Further information can be found in:

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

Footwear should be:

• slip resistant and easy to clean and maintain
• comfortable, soft soled and low heeled with closed toes
• able to protect the foot against spills, potential injury from sharps and contamination
• worn before entering and removed before leaving a care area where dedicated footwear is used, for example theatres. Where dedicated footwear is required, it should not be worn outwith these areas

Employees should clean dedicated footwear daily when in use, if contaminated, and in accordance with local policy or as per manufacturer’s instructions.

Footwear should be replaced when their protective functions are compromised and disposed of in accordance with local waste management protocols

Overshoes or shoe protectors are not generally used within health and care environments. Where their use is required, they should be discarded after each use in accordance with waste management protocols.

Resources 

Further information can be found in the footwear literature review.

Headwear

Should be:

• worn in theatre settings or restricted and semi-restricted areas
• worn as PPE for procedures where splashing or spraying of blood or body fluids is anticipated
• well-fitting and completely cover the hair

If worn for religious or cultural reasons should be clean, risk assessed locally and changed in accordance with local uniform policy.

Should be donned:

• before entering restricted areas, for example theatres
• immediately before the procedure or activity at the point of donning other PPE

Should be removed or changed:

• when visibly soiled or contaminated with blood or body fluids
• prior to leaving the dedicated clinical area
• at the end of a single clinical procedure or task
• at the end of a theatre session when worn sessionally

Disposable headwear should be discarded immediately after use in the appropriate waste stream.

Reusable headwear

• Local risk assessment should inform the use of reusable (launderable) headwear.
• Reusable headwear that is visibly soiled and/or contaminated with blood or body fluids should be processed through a healthcare accredited laundry facility.

Resources

Further information can be found in the headwear literature review

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

SICPs PPE summary table 

Gloves	Aprons	Gowns	Eye/Face protection	Fluid Resistant Surgical Masks (FRSM)	Respiratory Protective Equipment (RPE)
When it is anticipated that there is a risk of  contact with or exposure to blood, body fluids, secretions, excretions, non-intact skin or mucous membranes or contaminated surfaces. Use gloves in accordance with Appendix 5 – Glove use and selection.	When in direct care contact with a service user or their immediate environment.	When there is a risk of extensive splashing of blood and/or other body fluids. Worn when a disposable apron provides inadequate cover for the procedure or task being performed.	When there is an anticipated risk of splashing and/or spraying of blood or body fluids.	When splashing or spraying of blood, body fluids, secretions, or excretions onto the respiratory mucosa (nose and mouth) is anticipated/likely.	Not required as part of SICPs.

PPE for visitors

Visitors are not routinely required to wear PPE unless they are providing direct care to the individual they are visiting.

If the need for PPE is identified, staff should provide advice on its correct use.

If, following an explanation of potential risks, a visitor declines to wear PPE when offered, then this should be respected, and the visit must not be refused. There is no expectation for staff to monitor the use of PPE by visitors. The table below shows the PPE which should be worn where appropriate and when the visitor chooses to do so. 

 

IPC Precaution	Gloves	Apron	FRSM	Eye or Face Protection
Standard Infection Control Precautions (SICPs)	Not required unless providing direct care which may expose the visitor to blood and/or body fluids, for instance assisted toileting or feeding.	Not required, unless providing care resulting in direct contact with the service user, their environment or blood and/or body fluid exposure, for instance toileting, bed bath	Where splash/spray to nose/mouth is anticipated during direct care.  When visiting a patient who is severely immunocompromised that requires protective isolation	Where splash/spray to eyes/face is anticipated during direct care