Personal protective equipment (PPE): respiratory protective equipment (RPE)

Personal Protective Equipment (PPE) must still be used in accordance with SICPs when using Respiratory Protective Equipment (RPE). See Chapter 1.4 for PPE use for SICPs.

Where it is not reasonably practicable to prevent exposure to a substance hazardous to health (as may be the case where healthcare workers are caring for patients with suspected or known airborne pathogens), the hazard must be adequately controlled by applying protection measures appropriate to the activity and consistent with the assessment of risk.

If the hazard is unknown the clinical judgement and expertise of IPC staff is crucial and the precautionary principle should apply.

Respiratory Protective Equipment (RPE) ie, a filtering face piece (FFP) must be considered when a patient is admitted with a known/suspected infectious agent/disease spread wholly or partly by the airborne route and when carrying out aerosol generating procedures (AGPs) on patients with a known/suspected infectious agent spread wholly or partly by the airborne or droplet route.

Staff in primary care/outpatient settings or care homes would not normally be required to wear an FFP3 for routine care unless an AGP is being performed when staff should wear a fit tested, FFP3 respirator.

The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment eg task being undertaken, the presenting symptoms, the infectious state of the patient, risk of acquisition and the availability of treatment.

For a list of organisms spread wholly or partly by the airborne (aerosol) or droplet routes see Appendix 11.

National Priority Risk Categorisation for fit testing with FFP3

The following risk categorisation is the minimum requirement for staff groups that require FFP3 fit testing. Healthcare organisations can add to this, for example where there are high risk units. This categorisation is inclusive of out of hours services

Level 1 – Preparedness for business as usual

Staff in clinical areas most likely to provide care to patients who present at healthcare facilities with an infectious pathogen spread by the airborne route; and/or undertake aerosol generating procedures ie, A&E, ICU, paediatrics, respiratory, infectious diseases, anaesthesia, theatres, chest physiotherapists, Special Operations Response Team (Ambulance), A&E, ambulance staff, bronchoscopy staff, resuscitation teams, mortuary staff.

Level 2 – Preparedness in the event of emerging threat

Staff in clinical setting likely to provide care to patients admitted to hospital in the event of an emerging threat eg Medical receiving, Surgical, Midwifery and Specialty wards, all other ambulance transport staff. In the event of an ‘Epidemic/Pandemic’ Local Assessment as per organizations preparedness plans apply.

FFP3 respirator or powered respirator hood:

  • may be considered for use by visitors if there has been no previous exposure to the infected person or infectious agent; but
  • must never be worn by an infectious patient(s) due to the nature of the respirator filtration of incoming air not expelled air
  • powered respirator hoods are an alternative to tight-fitting FFP3 respirators for example when fit testing cannot be achieved
  • powered hoods can be single use (disposable) or reusable (with a decontamination schedule, see note) and must be fluid resistant; the filter must be enclosed with the exterior and the belt able to withstand disinfection with 10,000ppm
  • valved respirators are not suitable for use when sterility over the surgical field is required (unless they are shrouded) and this must be assessed locally, eg

All tight fitting RPE ie, FFP3 respirators must be:

  • single-use (disposable) and fluid-resistant
  • fit tested on all healthcare staff who may be required to wear a respirator to ensure an adequate seal/fit according to the manufacturers’ guidance
  • fit checked (according to the manufacturers’ guidance) every time a respirator is donned to ensure an adequate seal has been achieved
  • compatible with other facial protection used ie protective eyewear so that this does not interfere with the seal of the respiratory protection. Regular corrective spectacles are not considered adequate eye

For any facial hair, the hair must not cross or interfere with the respirator sealing surface. If the respirator has an exhalation valve, hair within the sealed mask area should not impinge upon or contact the valve. You must pass a face fit test for any tight-fitting respiratory protective equipment that you need to use for work activities. Examples of facial hair styles that are compatible with FFP3 respirators can be found in the website.

Please note: reusable respirators including PAPR can be utilised by individuals if they comply with HSE recommendations. These should be decontaminated and maintained according to manufacturer’s instructions.

Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website at: protective-equipment/basics.htm

Removal (doffing) of PPE

  • In the absence of an anteroom/lobby remove FFP3 respirators and eye/face protection in a safe area (eg outside the isolation/cohort room/area).
  • All other PPE should be removed in the patient care

For the recommended method of putting on and removing PPE, see UKHSA guides.

Further information can be found in Respiratory Protective Equipment (RPE) literature review and PPE for Infectious Diseases of High Consequence (IDHC) literature review.

Manual contents

Chapter 1: Standard infection control precautions (SICPs)

Chapter 2: Transmission based precautions (TBPs)


Download a PDF copy of the National infection prevention and control manual for England