Before undertaking any procedure, staff should assess any likely exposure to blood and/or other body fluids, non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects adequately against the risks associated with the procedure. The principles of PPE use set out below are important to ensure that PPE is used correctly to ensure patient and staff safety. Avoiding overuse or inappropriate use of PPE is a key principle that ensures this is risk-based and minimizes its environmental impact. Where appropriate, consideration should be given to the environmental impact of sustainable or reusable PPE options versus single-use PPE while adhering to the principles below.
All PPE must be:
- located close to the point of use. PPE for healthcare professionals providing care in the community and domiciliary care providers must be transported in a clean receptacle
- stored to prevent contamination in a clean, dry area until required (expiry dates must be adhered to)
- single-use only unless specified by the manufacturer
- changed immediately after each patient and/or after completing a procedure or task
- disposed of after use into the correct waste stream, eg domestic waste, offensive (non-infectious) or clinical waste
- discarded if damaged or
NB Reusable PPE such as non-disposable goggles/face shields/visors, must be decontaminated after each use according to manufacturer’s instruction.
Gloves must be:
- worn when exposure to blood and/or other body fluids, non-intact skin or mucous membranes is anticipated or likely
- changed immediately after each patient and/or after completing a procedure/task even on the same patient
- changed if a perforation or puncture is suspected
- appropriate for use, fit for purpose and well-fitting
- never decontaminated with ABHR or soap between
NB Double gloving is NOT recommended for routine clinical care. However, it may be required for some exposure prone procedures, eg orthopaedic and gynaecological operations, when attending major trauma incidents or as part of additional precautions for high consequence infectious disease management.
Gloves are not required to carry out near patient administrative tasks, eg when using the telephone, using a computer or tablet, writing in the patient chart; giving oral medications; distributing or collecting patient dietary trays. For appropriate glove use and selection, see Appendix 5.
Further information can be found in the gloves literature review.
Aprons must be:
- worn to protect uniform or clothes when contamination is anticipated or likely, eg when in direct care contact with a
- changed between patients and/or after completing a procedure or
Full body gowns or fluid-resistant coveralls must be:
- worn when there is a risk of extensive splashing of blood and/or body fluids, eg operating theatre, ITU
- worn when a disposable apron provides inadequate cover for the procedure or task being performed
- changed between patients and removed immediately after completing a procedure or task
- Further information can be found in the aprons/gowns literature
Eye or face protection (including full-face visors) must:
- be worn if blood and/or body fluid contamination to the eyes or face is anticipated or likely, eg by members of the surgical theatre team and always during aerosol generating procedures; regular corrective spectacles are not considered eye protection
- not be impeded by accessories such as piercings or false eyelashes
- not be touched when being worn.
- Further information can be found in the eye/face protection literature
Fluid resistant surgical face mask (FRSM):
Surgical face masks are required:
- as a means of source control, eg to protect the patient from the wearer during sterile procedures such as surgery, and
- to protect the wearer when there is a risk splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory.
FRSM must be:
- worn if a full-face visor is not available for spraying or splashing
- worn with eye protection if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated or likely (Type IIR)
- worn to protect patients from the operator as a source of infection, eg when performing surgical procedures or epidurals or inserting a central vascular catheter (CVC) (Type II or Type IIR)
- well-fitting and fit for purpose, fully covering the mouth and nose (manufacturers’ instructions must be followed to ensure effective fit and protection)
- removed or changed:
- at the end of a procedure/task
- if the mask’s integrity is breached, eg from moisture build-up after extended use or from gross contamination with blood or body fluids
- in accordance with manufacturers’ specific instructions.
Further information can be found in the surgical face masks literature review.
Footwear must be:
- visibly clean, non-slip and well-maintained, and support and cover the entire foot to avoid contamination with blood or other body fluids or potential injury from sharps
- removed before leaving a care area where dedicated footwear is used, eg theatre; these areas must have a decontamination schedule with responsibility.
Further information can be found in the footwear literature review
Headwear is not routinely required in clinical areas unless part of theatre attire or to prevent contamination of the environment such as in clean rooms.
Headwear must be:
- worn in theatre settings and clean rooms, eg central decontamination unit
- well-fitting and completely cover the hair
- changed or disposed of between clinical procedures/lists or tasks and if contaminated with blood and/or body fluids
- removed before leaving the theatre or clean room
- individuals with facial hair must also cover this in areas where headwear is required, eg wear a
NB Headwear worn for religious reasons such as turbans, kippot veil, headscarves is permitted providing patient care and safety is not compromised. These must be washed and/or changed daily or immediately if contaminated and comply with additional attire in theatres etc.
Further information can be found in the headwear literature review.
For the recommended method of putting on and removing PPE, see UKHSA guides.
- Patient placement
- Hand hygiene
- Respiratory and cough hygiene
- Personal protective equipment (PPE)
- Safe management of care equipment
- Safe management of the care environment
- Safe management of linen
- Safe management of blood and body fluid spillages
- Safe disposal of waste (including sharps)
- Occupational safety: prevention of exposure (including sharps injuries)
- Patient placement/assessment of infection risk
- Safe management of patient care equipment in an isolation room/cohort area
- Safe management of the care environment
- Personal protective equipment (PPE): respiratory protective equipment (RPE)
- Aerosol generating procedures
- Infection prevention and control when caring for the deceased