A type IIR fluid resistant surgical mask should be worn when caring for a patient with a suspected/confirmed infectious agent spread by the droplet route.
Surgical masks worn by patients with suspected/confirmed infectious agents spread by the droplet or airborne routes, as a form of source control, should meet type II or IIR standards.
A face visor or goggles should be used in combination with a fluid resistant type IIR surgical mask when caring for symptomatic patients infected with droplet transmitted infectious agents.
A face visor or goggles should be used in combination with a fluid resistant FFP3 respirator when caring for symptomatic patients infected with an airborne transmitted infectious agent.
Eye/face protection should be worn
An apron/gown should be worn when caring for patients known or suspected to be colonised/infected with antibiotic resistant bacteria including contact with the patient’s environment.
Plastic aprons and/or fluid repellent gowns should be used in health and social care settings for protection against body fluid splash and spray.
A full body fluid repellent gown should be worn when conducting AGPs on patients known or suspected to be infected with a respiratory infectious agent.
Further information can be found in the Aprons/Gowns literature review.
PPE must still be used in accordance with SICPs when using Respiratory Protective Equipment. See Chapter 1.4 for PPE use for SICPs.
Further information on best practice for PPE use for TBPs can be found in Appendix 16.
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 micro-organisms) 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/HP staff is crucial and the precautionary principle should apply.
Respiratory Protective Equipment (RPE) i.e. FFP3 and facial protection, must be considered when a patient is admitted with a known/suspected infectious agent/disease spread wholly 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.
The following risk categorisation is the minimum requirement for staff groups that require FFP3 fit testing. NHS Boards can add to this for example where high risk units are present. This categorisation is inclusive of out of hours services.
National Priority Risk Categorisation for face fit testing with FFP3
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 i.e. 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 e.g. Medical receiving, Surgical, Midwifery and Speciality wards, all other ambulance transport staff.
In the event of an ‘Epidemic/Pandemic’ Local Board Assessment as per their preparedness plans will apply.
The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment e.g 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.
Further information can be found in the aerosol generating procedures literature review.
All tight fitting RPE i.e FFP3 respirators must be:
The poster below gives further information on compatibility of facial hair and FFP3 respirators and can be used when fit testing and fit checking.
Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website.
In the absence of an anteroom/lobby remove FFP3 respirators in a safe area (e.g. outside the isolation/cohort room/area).
All other PPE should be removed in the patient care area.
Powered respirator hoods are an alternative to FFP3 respirators for example when fit testing cannot be achieved.
Powered hoods must be:
FFP3 respirator or powered respirator hood:
Further information can be found in the Respiratory Protective Equipment (RPE) literature review and the Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence (IDHC) literature review.
Frameworks to support the assessing and recording of staff competency in PPE for HCID are available in the resources section of the NIPCM.