The below was originally published by Public Health England. You can find the full guidance by PHE on personal protective equipment here.
10. Recommended PPE types and rationale for use
10.1 Filtering face piece class 3 (FFP3) respirators
Respirators are used to prevent inhalation of small airborne particles arising from AGPs.
All respirators should:
- be well fitted, covering both nose and mouth
- not be allowed to dangle around the neck of the wearer after or between each use
- not be touched once put on
- be removed outside the patient room or cohort area or COVID-19 ward
Respirators can be single use or single session use (disposable) and fluid-resistant. Note that valved respirators are not fully fluid-resistant unless they are also ‘shrouded’. Valved, non-shrouded FFP3 respirators are not considered to be fluid resistant and therefore should be worn with a full face shield if blood or body fluid splashing is anticipated.
FFP3 respirators filter at least 99% of airborne particles. The HSE states that all staff who are required to wear an FFP3 respirator must be fit tested for the relevant model to ensure an adequate seal or fit (according to the manufacturers’ guidance). Fit checking (according to the manufacturers’ guidance) is necessary when a respirator is donned to ensure an adequate seal has been achieved.
Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website.
It is also important to ensure that facial hair does not cross the respirator sealing surface and if the respirator has an exhalation valve, hair within the sealed mask area should not impinge upon or contact the valve. See the Facial hair and FFP3 respirators guide.
Respirators should be compatible with other facial protection used (protective eyewear) so that this does not interfere with the seal of the respiratory protection.
Respirators are for single use or single session use (section 6) and then are to be discarded as healthcare (clinical) waste (hand hygiene must always be performed after disposal) or if re-usable cleaned accorded manufacturer’s instructions. It is important that the respirator maintains its fit, function and remains tolerable for the user.
The respirator should be discarded and replaced and NOT be subject to continued use in any of the following circumstances:
- is damaged
- is soiled (for example, with secretions, body fluids)
- is damp
- facial seal is compromised
- is uncomfortable
- is difficult to breathe through
The manufacturers’ guidance should be followed in regard to the maximum duration of use.
The HSE has stated that FFP2 and N95 respirators (filtering at least 94% and 95% of airborne particles respectively) offer protection against COVID-19 and may be used if FFP3 respirators are not available.
Other respirators can be utilised by individuals if they comply with HSE recommendations. Reusable respirators should be cleaned according to the manufacturer’s instructions.
10.2 Fluid resistant surgical masks
Fluid-resistant (Type IIR) surgical masks (FRSM) provide barrier protection against respiratory droplets reaching the mucosa of the mouth and nose. FRSMs should be well fitted and subject to the same level of care in use as respirators (section 10.1).
FRSMs are for single use or single session use (section 6) and then must be discarded. The FRSM should be discarded and replaced and NOT be subject to continued use in any of the circumstances outlined for respirators (section 10.1).
The protective effect of masks against severe acute respiratory syndrome (SARS) and other respiratory viral infections has been well established. There is no evidence that respirators add value over FRSMs for droplet protection when both are used with recommended wider PPE measures in clinical care, except in the context of AGPs.
Surgical masks should:
- cover both nose and mouth
- not be allowed to dangle around the neck after or between each use
- not be touched once put on
- be changed when they become moist or damaged
- be worn once and then discarded – hand hygiene must be performed after disposal
10.3 Eye and face protection
Eye and face protection provides protection against contamination to the eyes from respiratory droplets, aerosols arising from AGPs and from splashing of secretions (including respiratory secretions), blood, body fluids or excretions.
Eye and face protection can be achieved by the use of any one of the following:
- surgical mask with integrated visor
- full face shield or visor
- polycarbonate safety spectacles or equivalent
Regular corrective spectacles are not considered adequate eye protection.
While performing AGPs, a full-face shield or visor is recommended.
The same as for respirators and FRSMs, eye protection should: be well fitted; not be allowed to dangle after or between each use; not be touched once put on; be removed outside the patient room, cohort area or 2 metres away from possible or confirmed COVID-19 cases.
Disposable, single-use, eye and face protection is recommended for single or single session use (section 6) and then is to be discarded as healthcare (clinical) waste. However, re-usable eye and face protection is acceptable if decontaminated between single or single sessional use, according to the manufacturer’s instructions or local infection control policy.
It is important that the eye protection maintains its fit, function and remains tolerable for the user. Eye and face protection should be discarded and replaced and not be subject to continued use if damaged, soiled (for example, with secretions, body fluids) or uncomfortable.
10.4 Disposable aprons and gowns
Disposable plastic aprons must be worn to protect staff uniform or clothes from contamination when providing direct patient care and during environmental and equipment decontamination.
Disposable fluid repellent coveralls or long-sleeved gowns must be worn when a disposable plastic apron provides inadequate cover of staff uniform or clothes for the procedure or task being performed, and when there is a risk of splashing of body fluids such as during AGPs in higher risk areas or in operative procedures. If non-fluid-resistant gowns are used, a disposable plastic apron should be worn. If extensive splashing is anticipated then use of additional fluid repellent items may be appropriate.
Disposable aprons are subject to single use and must be disposed of immediately after completion of a procedure or task and after each patient contact as per SICPs. Hand hygiene should be practiced as per SICPs and extended to exposed forearms. Disposable fluid repellent coveralls or long-sleeved gowns are for single use or for single session use in certain circumstances (section 6) but should be discarded at the end of a session or earlier if damaged or soiled.
10.5 Disposable gloves
Disposable gloves must be worn when providing direct patient care and when exposure to blood and or other body fluids is anticipated or likely, including during equipment and environmental decontamination. Disposable gloves are subject to single use and must be disposed of immediately after completion of a procedure or task and after each patient contact, as per SICPs, followed by hand hygiene. Double gloving is not necessary.