Introduction
The aim of using personal protective equipment (PPE) is to protect against health or safety risks at work. The epic3 (Loveday et al, 2014) evidence-based guidelines on infection prevention and control state that selection of PPE should be based on an assessment of the:
Risk of transmission of micro-organisms to the patient or carer;
Risk of contamination of the health professional’s clothing or skin by the patient’s blood or body fluid or respired aerosols or droplets;
Suitability of the equipment for the proposed use - does it fit, is it CE marked, do PPE items fit together?
Before using PPE, staff should be educated and their competence assessed in the assessment of risk, and selection and use of PPE, as well as the use of standard precautions. It is important to assess whether the selected PPE will be effective - for example, staff using respirators will need to be “fit tested” to ensure Disposable Face Masks are a correct and safe fit (NHS England and Public Health England, 2013a).
Using unfamiliar PPE can increase the risk of self-contamination due to lack of skill and confusion in the correct removal method. PPE should not be used, nor tasks undertaken that require its use, until staff are confident and competent in doing so.
When should PPE be used?
Gloves
Disposable Gloves are single-use items and should be used for invasive procedures including contact with sterile sites, non-intact skin or mucous membranes, and for all activities that have been assessed as carrying a risk of exposure to blood, body fluid or infectious respired aerosols or droplets. They must be put on immediately before an episode of patient contact or treatment; they must not be used to open doors and collect equipment before patient contact.
Gloves should be:
Used when handling sharps or contaminated devices (Loveday et al, 2014) - micro-organisms can survive on objects, or “fomites”, and become a risk for transmission of infection;
Removed as soon as the episode of care is completed - hands must be decontaminated immediately after glove removal;
Changed when soiled - they must not be washed or decontaminated with alcohol products between procedures and should be changed between caring for different patients.
Since the effect of alcohol hand gels on PE Gloves material has not been tested, the integrity of gloves decontaminated in this way cannot be guaranteed.
Aprons and gowns
Aprons are single-use items and must be worn when in close contact with patients, materials or equipment that pose a risk of contamination with blood or body fluids (Loveday et al, 2014). Fluid-repellent Disposable Gowns must be worn when there is an extensive risk of the splashing of blood or body fluid onto the skin or clothing of health workers.
Staff should ensure aprons/gowns are:
Changed when visibly soiled - although it takes some time for fluid to seep through fluid-repellent Isolation Gowns (strikethrough), they are not waterproof;
Worn for one procedure or episode of patient care only.
Non-disposable PPE should be sent for appropriate decontamination (Loveday et al, 2014).
Masks
Fluid-repellent Medical Face Masks and eye protection should be worn:
When there is a risk of blood or body fluid splashing onto the eyes and face of the health worker;
To protect against respired infectious aerosols/droplets (Loveday et al, 2014).
Appropriate respiratory PPE should be chosen according to a risk assessment that takes account of the infective micro-organism, anticipated activity and duration of exposure. Respiratory PPE must fit the user correctly and staff must be trained in how to use and adjust it in accordance with Health and Safety Executive (2012)regulations. Staff should not use FFP3 respirators unless fit tested as safe. Figs 1 and 2 outline factors influencing the choice of single-use Protective Masks for use when treating patients who have respiratory infections.
Footwear
Wellington boots or water-repellent boots should be worn when there is a risk of blood/body fluid splashes, leaks or large spillages, such as oesophageal bleeds and in the operating theatre. If protective Disposable Shoe Cover is required, consider the following:
Hands become contaminated from touching and pulling on footwear from whatever has splashed onto its surface or been picked up on the sole during a patient care episode;
If you remove footwear and stand in the same space, your feet will be contaminated. Have a “dirty” area for footwear removal and a “clean” one where nobody walks in contaminated footwear;
There is little evidence of gross infection transmission from the floor surface unless there are large spillages of infected material so protective footwear is not usually required;
Where possible, protective footwear should be single-use. If re-used, follow the manufacturers’ instructions to decontaminate. Depending on the contamination 10,000ppm chlorine agent should be used.
Head protection
Hair nets and Disposable Caps are single-use items and prevent shedding from the wearer’s hair onto the patient, as well as acting as a barrier protecting hair from inadvertent hand contact and loose hair falling forward. All strings from masks and visors should be placed over hair protection - this allows them to be removed after a procedure without contaminating the hair.
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