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This revised guidance concerns use of personal protective equipment (PPE) by health and social care workers, in the context of the current COVID-19 pandemic. It supersedes previous PPE guidance. This guidance relates solely to considerations of PPE, represents one section of infection prevention and control guidance for COVID-19 and should be used in conjunction with local policies. Refer to further guidance and resources.

This summary does not contain information on:

  • PPE guidance in healthcare contexts outside of primary care and community pharmacy
  • recommended PPE types and rationale for use
  • best practice in use of PPE and hand hygiene
  • patient use of PPE

For information on these areas, please refer to the full guideline.

SettingContextDisposable glovesDisposable plastic apronDisposable fluid-repellent coverall/gownSurgical maskFluid-resistant (Type IIR) surgical maskFiltering face piece respiratorEye/face protection[A]

Any setting

Performing an aerosol generating procedure[B] on a possible or confirmed case[C]

single use[D]

_

single use[D]

_

_

single use[D]

single use[D]

Primary care, ambulatory care, and other non emergency outpatient and other clinical settings e.g. optometry, dental, maternity, mental health

 

Direct patient care—possible or confirmed case(s)[C] (within 2 metres)

single use[D]

single use[D]

_

_

single or sessional use[D],[E]

single or sessional use[D],[E]

Working in reception/communal area with possible or confirmed case(s)[C] and unable to maintain 2 metres social distance[F]

 

_

_

_

_

sessional use[E]

_

_

Individual’s own home (current place of residence)

Direct care to any member of the household where any member of the household is a possible or confirmed case[C],[G]

 

single use[D]

single use[D]

_

_

single or sessional use[D],[E]

_

risk assess signle or sessional use[D],[E],[H]

Direct care or visit to any individuals in the extremely vulnerable group or where a member of the household is within the extremely vulnerable group undergoing shielding[I]

 

single use[D]

single use[D]

_

single use[D]

_ _ _
 

Home birth where any member of the household is a possible or confirmed case[C],[G]

 

single use[D]

single use[D]

single use[D]

_

single or sessional use[D],[E]

_

single or sessional use[D],[E]

Community and social care, care home, mental health inpatients and other overnight care facilities e.g. learning disability, hospices, prison healthcare

 

Facility with possible or confirmed case(s)[C] – and direct resident care (within 2 metres)

 

single use[D]

single use[D]

_

_

sessional use[E]

_

risk assess sessional use[E],[H]

Any setting

Collection of nasopharyngeal swab(s)

single use[D]

single or sessional use[D],[E] 

_

_

single or sessional use[D],[E]

_

single or sessional use[D],[E]

[A] This may be single or reusable face/eye protection/full face visor or goggles.

[B] The list of aerosol generating procedures (AGPs) is included in section 8.1 at: www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe. (Note APGs are undergoing a further review at present) 

[C] A case is any individual meeting case definition for a possible or confirmed case: www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection

[D] Single use refers to disposal of PPE or decontamination of reusable items e.g. eye protection or respirator, after each patient and/or following completion of a procedure, task, or session; dispose or decontaminate reusable items after each patient contact as per Standard Infection Control Precautions (SICPs). 

[E] A single session refers to a period of time where a health care worker is undertaking duties in a specific care setting/exposure environment e.g. on a ward round; providing ongoing care for inpatients. A session ends when the health care worker leaves the care setting/exposure environment. Sessional use should always be risk assessed and considered where there are high rates of hospital cases. PPE should be disposed of after each session or earlier if damaged, soiled, or uncomfortable. 

[F] Non clinical staff should maintain 2m social distancing, through marking out a controlled distance; sessional use should always be risk assessed and considered where there are high rates of community cases. 

[G] Initial risk assessment should take place by phone prior to entering the premises or at 2 metres social distance on entering; where the health or social care worker assesses that an individual is symptomatic with suspected/confirmed cases appropriate PPE should be put on prior to providing care. 

[H] Risk assessed use refers to utilising PPE when there is an anticipated/likely risk of contamination with splashes, droplets or blood or body fluids. 

[I] For explanation of shielding and definition of extremely vulnerable groups see guidance: www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Safe ways for working for all health and care workers

  • Staff should be trained on donning and doffing PPE. Videos are available for showing how to don and doff PPE for AGPs and how to don and doff PPE for non-AGPs
  • Staff should know what PPE they should wear for each setting and context
  • Staff should have access to the PPE that protects them for the appropriate setting and context
  • Gloves and aprons are subject to single use as per SICPs with disposal after each patient or resident contact
  • Fluid repellent surgical mask and eye protection can be used for a session of work rather than a single patient or resident contact
  • Gowns or coveralls can be worn for a session of work in higher risk areas
  • Hand hygiene should be practiced and extended to exposed forearms, after removing any element of PPE
  • All staff should adhere to social distancing (2 metres) wherever possible, particularly if not wearing PPE and in non-clinical areas, for example during work breaks and when in communal areas
  • Staff should take regular breaks and rest periods; consider staggering staff breaks to limit the density of healthcare workers in specific areas

Sessional use of PPE

Aprons and gloves are subject to single use as per Standard Infection Control Precautions (SICPs), with disposal and hand hygiene after each patient contact. Respirators, fluid-resistant (Type IIR) surgical masks (FRSM), eye protection and disposable fluid repellent coveralls or long-sleeved disposable fluid repellent gowns can be subject to single sessional use in circumstances outlined in the full guideline.

A single session refers to a period of time where a health and social care worker is undertaking duties in a specific clinical care setting or exposure environment. For example, a session might comprise a ward round, or taking observations of several patients in a cohort bay or ward. A session ends when the health and social care worker leaves the clinical care setting or exposure environment. Once the PPE has been removed it should be disposed of safely. The duration of a single session will vary depending on the clinical activity being undertaken.

While generally considered good practice, there is no evidence to show that discarding disposable respirators, facemasks or eye protection in between each patient reduces the risk of infection transmission to the health and social care worker or the patient. Indeed, frequent handling of this equipment to discard and replace it could theoretically increase risk of exposure in high demand environments, for example, by leading to increasing face touching during removal. The rationale for recommending sessional use in certain circumstances is therefore to reduce risk of inadvertent indirect transmission, as well as to facilitate delivery of efficient clinical care.

PPE should not be subject to continued use if damaged, soiled, compromised, uncomfortable or in other circumstances outlined in section 10 of the full guideline, and a session should be ended. While the duration of a session is not specified here, the duration of use of PPE items should not exceed manufacturer instructions. Appropriateness of single versus sessional use is dependent on the nature of the task or activity being undertaken and the local context.

Risk assessment

For common contexts where health and social care workers are providing care to patients and individuals who are known to be possible or confirmed COVID-19 cases, PPE recommendations are specified. Attempts should be made, where appropriate, to ascertain whether a patient or individual meets the case definition for a possible or confirmed case of COVID-19 before the care episode. Refer to the current COVID-19 case definition.

Initial risk assessment where possible should take place by phone, other remote triage, prior to entering the premises or clinical area or at 2 metres social distance on entering. Where the health or social care worker assesses that an individual is symptomatic and meets the case definition, appropriate PPE should be put on prior to providing care.

Where the potential risk to health and social care workers cannot be established prior to face-to-face assessment or delivery of care (within 2 metres), the recommendation is for health and social care workers in any setting to have access to and where required wear aprons, FRSMs, eye protection and gloves.

Health and social care workers should consider the need for contact and droplet precautions based on the nature of care or task being undertaken. Risk assessment on the use of eye protection, for example, should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the care episode. Sessional use of FRSMs and eye protection is indicated if there is perceived to be close or prolonged interaction with patients in a context of sustained community COVID-19 transmission.

Ultimately, where staff consider there is a risk to themselves or the individuals they are caring for they should wear a fluid repellent surgical mask with or without eye protection, as determined by the individual staff member for the episode of care or single session.

Risk assessment at organisational level requires that organisations consider healthcare-associated COVID-19 risk at local level and according to the local context. Organisational risk assessment and local guidance should not replace or reduce the ability of the health and social care worker to use appropriate PPE while providing care to patients or residents.

Local acute provider risk assessment may assist in determining higher risk areas and identify specific areas of a hospital where sessional use of PPE is required (for example, certain wards, clinical areas).

PPE guidance by healthcare context

Primary care, ambulatory care and other non-emergency outpatient clinical settings

For primary care, ambulatory care and other non-emergency outpatient settings (including hospital outpatient clinics) plastic aprons, FRSMs, eye protection and gloves should be used for any direct care of possible and confirmed cases. Such PPE may be indicated for work in such settings regardless of case status, subject to local risk assessment.

For health and social care workers working in reception and communal areas but not involved in direct patient care, every effort should be made to maintain social distancing of 2 metres. Where this is not practical use of FRSM is recommended.

The principles described in this guidance apply to all health and social settings. PPE guidance is provided for primary, community and social care in Table 1.

Further guidance for primary care in England is provided separately by Public Health England (www.gov.uk/government/publications/wn-cov-guidance-for-primary-care).

Guidance and standard operating procedures for COVID-19 are also provided by NHS England (www.england.nhs.uk/coronavirus/primary-care/general-practice/).

Further information on primary care for Scotland (www.hps.scot.nhs.uk/web-resources-container/covid-19-guidance-for-primary-care/) and social care settings in Scotland (www.hps.scot.nhs.uk/web-resources-container/covid-19-information-and-guidance-for-social-or-community-care-and-residential-settings/).

Further information for Northern Ireland (www.pha.site/coronavirus).

Pharmacy

If social distancing of 2 metres is maintained there is no indication for PPE in a pharmacy setting. If social distancing is not maintained, though, direct care is not provided, sessional use of FRSM is recommended for contact with members of the public with possible or confirmed cases of COVID-19. For pharmacists working in other contexts (such as inpatient areas), refer to the full guideline.

Collection of nasopharyngeal swab(s)

For collection of nasopharyngeal swabs (for example, for COVID-19 diagnostic purposes), plastic aprons, FRSMs, eye protection and gloves should be used.

Care to vulnerable groups undergoing shielding

For delivery of care to any individual meeting criteria for shielding (vulnerable groups) in any setting, as a minimum, single use disposable plastic aprons, gloves and surgical mask must be worn for the protection of the patient. If the individual is encountered in any context described or if meets case definition then additional PPE should be applied as per recommendations stated by context and or risk assessment.