What are 4 types of PPE used in healthcare?

Aprons and Gowns

Disposable plastic aprons and gowns are designed to protect uniforms and clothing from soiling during direct patient care. In the majority of cases, plastic aprons will be appropriate. A long-sleeved fluid-repellent gown should be used where extensive contamination by blood and/or body fluids is anticipated or when the patient requires a significant amount of direct care with close skin-to-skin contact.

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Plastic Aprons

The inappropriate use of plastic aprons is common among health workers. Therefore, all health workers should understand the rationale for plastic apron use and assess the potential risk of each task. Therefore, they should not be worn routinely during shifts.

• Aprons should be stored in a clean area, and wall-mounted storage units are available.
• The storage units should be cleaned regularly.

• They should be used to protect uniforms/clothing from soiling during direct patient care.
• They must be changed between patients and/or after completing a procedure or task.
• Care should be taken when removing plastic aprons using ties and not touching the outer surface. The apron should be folded/rolled inwardly into a ball before disposal into a waste bin.
• Change aprons between patients and, removed them immediately after completing a procedure or task, and discarded them immediately after use.
• Hand hygiene should always be performed after removing aprons and gloves.

Full-body gowns or Fluid-Resistant Coveralls

• Sterile gowns are required for an aseptic procedure. For example, in an operating theatre for surgical procedures, for insertion of central venous catheters, spinal, epidural and caudal procedures. 
• A long-sleeved fluid-repellent gown or fluid-resistant coveralls should be used where extensive contamination by blood and/or body fluids is anticipated or when the patient requires a significant amount of direct care with close skin-to-skin contact.
• They should be stored in a clean area, and the storage units should be cleaned regularly.

• They must be changed between patients and/or after completing a procedure or task.
• Care should be taken when removing gowns and coveralls by not touching the outer surface. They should be folded/rolled inwardly in a ball before disposal into a waste bin.
• Changed gown or coveralls between patients and removed immediately after completing a procedure or task, and discarded immediately after use.
• Hand hygiene should always be performed after removing gowns or coveralls and gloves.

 

 

PPE products you might need in the care home:&#; gloves&#; aprons&#; masks&#; eye protection

See PPE for visitors

Deciding which PPE to use

Before doing any procedure or task staff should risk 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 in a clean and dry area to prevent contamination until needed for use
• within expiry dates
• single-use only items unless specified by the manufacturer
• changed immediately after individual use and/or following completion of a procedure or task
• disposed of after use into the correct waste stream, this means healthcare waste or domestic waste

Reusable PPE items, for example non-disposable goggles, face shields and visors, should have a decontamination schedule with responsibility assigned.

Read further information on best practice for PPE in Appendix 15.

 

Donning (putting on) personal protective equipment (PPE) 

The order for putting on PPE is:

1. apron or gown
2. surgical mask
3. eye protection (where required)
4. gloves

Doffing (taking off) personal protective equipment (PPE) 

It is important that PPE is removed in the correct order.

The order for taking off PPE is:

1. gloves
2. apron or gown
3. eye protection (if worn)
4. surgical mask

Note:

Always carry out hand hygiene immediately after taking off PPE.

All PPE should be removed before leaving the area and disposed of as healthcare waste

Resources

A video demonstrating the order for donning and doffing PPE is available. 

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

 

A poster showing the order for putting on and removing PPE is available to print.

 

Select image for full size version

Gloves

Gloves should be:

• worn when it is likely or anticipated that you will be exposed to blood,  body fluids (including but not limited to secretions and/or excretions), non-intact skin, mucous membranes, lesions and/or vesicles, hazardous drugs, and chemicals for example cleaning agents
• single-use and should be donned (put on) immediately prior to exposure risk and should be doffed (taken off) immediately after each use or upon completion of a task
• appropriate for use, fit for purpose and well-fitting. The glove selection chart can help you select the correct gloves
• changed if damaged or a perforation or puncture is suspected

 

Note:

Using gloves reduces the risk of contamination but does not remove all risk.

Gloves should not be used instead of carrying out hand hygiene.

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Gloves should not be worn inappropriately in situations such as to go between residents, move around a care area or whilst at workstations (on the   or computer).

Gloves should never be decontaminated or cleaned with hand rub or by washing with cleaning products.

 

Use the glove selection chart to support you to select the correct glove type.

Select image for full size version

Aprons and gowns

Aprons should be:

• worn by care staff when there is a risk of clothing being contaminated with blood or other body fluids
• worn during direct care, for example oral hygiene, bed-making or when undertaking the decontamination of equipment
• changed between residents and following completion of a procedure or task

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

Eye/face protection

Eye/face protection (including full face visors) should:

• be worn if blood and/or body fluid contamination to the eyes/face is expected/likely and always during aerosol generating procedures (AGPs)

Note:

Eye/face protection (including visors) should not be touched when worn.

Facial accessories such as piercings or false eyelashes should not be worn when using eye/face protection.

Regular glasses or safety glasses are not considered eye protection.

Fluid Resistant Type IIR surgical face masks (FRSM)

Fluid Resistant Type IIR surgical face masks should be:

• worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is expected/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)
• well-fitting, fully covering the mouth and nose and fit for purpose. Manufacturer&#;s instructions should be followed to ensure effective fit/protection
• removed or changed:
  • at the end of a procedure/task
  • if the mask is damaged or there is a build up from moisture after prolonged use or from gross contamination with blood or body fluids 
  • following specific manufacturers&#; instructions

If you are using droplet precautions, you should always wear a Type IIR surgical face mask as well as the full-face visor (droplet precautions will be discussed further in Chapter 2 Transmission Based Precautions).

Transparent face masks

Transparent face masks may be used to aid communication with residents where required.

Transparent face masks should:

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

and

• have been approved 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

Read the aerosol generating procedures literature review and surgical face masks literature review for further information regarding the evidence base.

 

 

See appendix 11 for further information.

 

PPE for visitors 

At times, 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 visitor should not be refused entry to the care home. PPE use by visitors cannot be enforced and there is no expectation that staff monitor PPE use amongst visitors. Below is the PPE which should be worn where it is appropriate to do so and when the visitor chooses to do so.

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

Table 1 is a guide to PPE for use by visitors if delivering direct care.

Table 1: PPE for use by visitors

IPC Precaution Gloves Apron/Gown Face covering/mask Eye/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 toileting. Not required unless providing care resulting in direct contact with the resident, 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 Not required unless providing direct care and splashing/spraying is anticipated. Transmission Based Precautions (TBPs) Not required unless providing direct care which may expose the visitor to blood and/or body fluids, for instance toileting. Not required unless providing care resulting in direct contact with the resident, their environment or blood and/or body fluid exposure, for instance toileting, bed bath.

 

If within 2 metres of resident with suspected or known respiratory infection If within 2 metres of resident with suspected or known respiratory infection

Read the PPE literature reviews to find out more information about the evidence base for PPE use.

 

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