All PPE should:

• be located close to the point of use
• be stored in a clean and dry area to prevent contamination until needed for use
• be within expiry dates
• be single-use only items unless specified as reusable by the manufacturer
• be checked for any damage or defects before donning
• be changed immediately after use and/or following completion of a procedure or task
• be disposed of after use into the correct waste stream
• not be worn inappropriately outside of care delivery for example, moving around corridors, at IT work stations or non-clinical areas

2.4.1   Gloves

Gloves should:

• not be worn as a substitute to hand hygiene

• 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, e.g. 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

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.

2.4.2  Aprons and Gowns

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

A disposable apron should be worn when in contact with a patient’s environment or when providing direct care to those suspected or confirmed to be colonised or infected with a transmissible infectious agent.

A fluid repellent gown should be used if excessive splashing or spraying is anticipated.

Resources

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

2.4.3  Eye and face protection

Eye and face protection should be worn:

• when there is an anticipated risk of splashing and/or spraying of blood or body fluids

Types of eye or face protection suitable for use include goggles, face shields or visors, and surgical face masks with integrated face shields. Prescription eyeglasses and contact lenses should not be considered a form of eye or face protection.

2.4.4  Fluid resistant surgical masks (FRSM)

Fluid resistant surgical masks should be:

• worn when a patient presents with symptoms indicative of a transmissible respiratory infection and the infectious agent has not yet been determined
• worn when caring for a patient with a suspected or confirmed R1 respiratory infection– see Appendix 15 for RPE options.
• donned prior to entry to, and for the duration within, areas containing patients who are suspected or confirmed to have an R1 respiratory infection
• worn by patients with a suspected or confirmed transmissible respiratory infection when a healthcare worker enters their room, whilst outside their room, and whilst being moved or transported to other departments, where it is clinically safe to do so and can be tolerated by the wearer.
• worn by healthcare workers, visitors and patients (where tolerated and does not compromise clinical care) during epidemics or periods of increasing or high rates of local transmission of respiratory infection within healthcare areas. Local health boards may undertake a risk assessment and advise extended use of FRSMs as part of a suite of control measures.  Local epidemiology should be used to inform the risk assessment.

FRSMs may be worn sessionally when providing care to a cohort of patients with the same confirmed respiratory infection.  Sessional use of a FRSM means that staff do not need to change these when moving between patients within the cohort however the FRSM should be changed if it becomes damaged or contaminated.  Other items of PPE should not be used sessionally and should be changed between procedures/tasks and patients as indicated.  

Transparent face masks may be used

• when there are communication barriers
• if they meet the specifications of BS EN 14683:2025  

2.4.5  Respiratory Protective Equipment (RPE)

RPE should be worn when caring for a person with a suspected or confirmed R2 or R3 respiratory infection.

RPE may be worn when caring for a person with a suspected or confirmed R1 respiratory infection if the staff member has been advised to do so by occupational health, GP, or another personal medical practitioner.

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

Staff may choose to wear RPE where FRSM is indicated for use when caring for a patient with a suspected or confirmed R1 respiratory infection, based on personal choice. Refer to Appendix 15.

RPE should never be worn by an infectious person as the respirator filters incoming air and not the air being expelled by the wearer.

There are two main types of respirators used within health and care settings in Scotland:

• tight-fitting respirators (FFP3) that require the wearer to be face fit tested, and to perform a fit check on each use
• loose fitting respirators (often referred to as powered hoods, powered respirators or PAPR)

 

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 RPE 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 face fit tested. 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 brand or 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.

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

Resources

Poster on Facial Hairstyles and Filtering Facepiece Respirators can be used when fit testing and fit checking

See Appendix 6 for donning and doffing advice.

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

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 should be:

• single-use (disposable) and fluid resistant
• the filter must be enclosed with the exterior and the belt decontaminated following the manufacturer’s instructions.

Donning and Doffing RPE

Donning (putting on)

• RPE should be checked for any damage or defects before donning.
• Donning RPE should be performed in line with manufacturer’s instructions.
• Hand hygiene should be performed before donning RPE
• If using an FFP3 respirator, a fit check should be performed once donned to ensure a tight seal has been achieved.
• RPE should be donned outside of the patient’s room or care area, or within an ante room.
• Once donned (and following fit check for FFP3 respirator use), the front of the RPE should not be touched.

Doffing (Removing)

• RPE must be removed after exiting the care area or room.
• Where worn with other items of PPE, RPE should be removed last.
• FFP3 respirators 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.

Further information can be found in the Respiratory Protective Equipment (RPE) literature review and the Personal Protective Equipment (PPE) for High Consequence Infectious Diseases (HCIDs) Literature review.

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	As per SICPs	As per SICPs	When there is an anticipated risk of splashing and/or spraying of blood or bodily fluids.	When caring for a person with suspected or confirmed respiratory infection and the infectious agent has not yet been determined. When caring for a person with suspected or confirmed R1 respiratory infection.	Worn when caring for a person with a suspected or confirmed R2 or R3 respiratory infection. Worn following a personal assessment (medical or choice) – see Appendix 15.

 

 

PPE for visitors

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

However, if visiting a patient with a suspected or confirmed respiratory infection, visitors may be offered a FRSM 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. Note: If the R2 or R3 infectious agent is a HCID, visiting must be discussed with your local IPCT.

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 checking 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.

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

TBP PPE summary table for visitors:

Gloves	Apron	FRSM	RPE	Eye or Face Protection
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. A gown may be used where excessive splashing or spraying may be anticipated.	Where splash or spray to nose or mouth is anticipated AND for the duration of a visit to a patient with suspected or confirmed respiratory infection. During essential visiting arrangements when the visitor has a suspected or confirmed transmissible respiratory infection.	When visiting someone who has a suspected or confirmed R2, R3 infection	Where splash or spray to the visitor's eyes/face is anticipated