PPE is commonly used in health care settings such as hospitals, long-term care homes, doctor’s offices and clinical labs. When used properly, PPE acts as a barrier between infectious materials such as viral and bacterial contaminants of your skin, mouth, nose, or eyes.
The barrier offered by the proper use of PPE has the potential to block transmission of contaminants from blood, body fluids, or respiratory secretions/droplets. PPE protects both workers and residents from exposure to infectious agents.
When PPE is combined with other important infection control practices such as hand washing, using alcohol-based hand sanitizers, and covering coughs and sneezes, it further reduces the spread of infection from one person to another.
Effective use of PPE also includes properly putting on, removing and disposing of contaminated PPE to prevent further exposure of infection to the worker and other people.
Types of PPE
Long-term care homes provide a variety of personal protective equipment for health care and support services workers ranging from gloves to eye protection. The type of PPE required for a specific task is determined by the activity being performed.
Contact and droplet precautions includes:
Putting on PPE might also be referred to as don or donning and removing PPE may be referred to as doff or doffing.
A surgical or procedure mask is worn to protect the mucous membranes of the mouth and nose when there is a possibility of exposure to respiratory droplets which may occur when a resident is sneezing or coughing or during procedures and care activities that may generate splashes or sprays of blood or body fluids.
A fabric mask is not proper PPE
A face shield, goggles or a facial mask with built-in eye protection is worn to protect the mucous membranes of the eyes when there is a possibility of exposure to respiratory droplets which may occur when a resident is sneezing or coughing.
Note that sunglasses or prescription eyeglasses are not acceptable eye protection.
The use of either a mask or eye protection without the other is not effective for the protection of the mucous membranes against respiratory droplets. Both must be used together.
Facial protection including a mask and eye protection should be used within two metres of a coughing resident. Facial protection should be available in every long-term care home and should be conveniently located for staff to access.
The mask should be changed immediately if it becomes wet or soiled.
Facial protection should be removed and discarded immediately after it is used into a hands-free waste receptacle while re-usable goggles must be cleaned and disinfected with a disinfectant before re-use.
Hand hygiene should be performed prior to putting on and removing facial protection to prevent contamination of the eyes, nose or mouth and again following removal of facial protection.
Medical grade gloves should be worn when in contact and providing care to residents and/or when handling items or touching surfaces visibly or potentially soiled with blood, body fluids, secretions or excretions.
Medical grade gloves should be available and conveniently located in long-term care homes for staff to use when necessary. Sandwich gloves and other non-medical grade gloves are not acceptable.
Gloves should also be worn if a worker has an open cut or abrasions on their hands.
Workers should not touch their face when wearing gloves.
If gloves are not used correctly, they become vehicles for disease transmission. For example, wearing the same pair of gloves to care for different residents.
Hand hygiene should occur immediately before and after the gloves are put on, taken off and disposed of in a proper hands-free receptacle.
Gloves are single-use PPE and should not be reused, cleaned with alcohol-based hand rub or washed.
Gowns are used to protect worker’s clothing or skin from splashes or sprays of blood, body fluids, secretion or excretions including respiratory droplets.
Gowns should be available and conveniently located for staff to access.
Gowns should be long-sleeved, wide enough to completely cover the worker, long enough to cover the individual from the neck to the mid-thigh and tied securely.
Gowns should be removed in a manner that will not contaminate the workers skin or clothing.
Gowns are single-use and should be disposed of in a hands-free waste receptacle.
The same gown should never be worn when going from resident to resident or between environments (e.g. accompanying a resident to the dining room).
Respirator (i.e. N95)
A respirator is worn to further protect the mucous membranes of the mouth and nose when there is a possibility of exposure to respiratory droplets when providing CPAP and/or open suctioning to residents with suspected, presumed or confirmed of highly contagious viruses such as COVID 19
Health care workers who may need to wear a respirator should be fit tested and receive appropriate training on how to wear the respirator. Fit testing refers to the use of specific methods to evaluate the fit of the appropriate make, model and size of respirator on an individual.
Health care workers must remain clean shaven to ensure a proper facial seal.
Proper hand hygiene should be performed prior to putting on a respirator.
Respirators should be carefully removed by the straps and discarded immediately after its use outside of the room where it was required, into a hands-free waste receptacle, followed by proper hand hygiene.
Health care workers should not touch the external surface of the respirator during use and disposal to further reduce possible exposure
The respirator should be changed if it becomes wet or soiled (from the wearer’s breathing or an external splash).
COVID-19 and PPE
The Ministry of Health requires that until further notice, all staff working in long-term care with or without confirmed cases of COVID-19, are required to wear a surgical/procedure mask regardless of task. The Ministry of Health and Long-Term Care guidelines state;
All staff and essential visitors must wear a surgical/procedure mask at all times (with the exception of breaks while remaining two metres away from other staff).
All healthcare workers who interact with residents, or who enter a resident area for any reason, should be provided with a minimum of two (2) surgical/procedure masks per day.
All other workers whose functions do not put them in contact with residents or resident areas should be provided a minimum of one (1) surgical/procedure mask per day.
Given COVID-19 is transmitted through direct contact and respiratory droplets, contact and droplet precautions must be used by health care and/or support services workers for all interactions within two meters of suspected, presumed or confirmed COVID-19 residents or their environment.
PPE should be put on immediately prior to interaction with a resident with a suspected, presumed or confirmed case of COVID-19 and/or working within their environment.
PPE should be removed immediately following contact with the resident and/or their environment.
Inappropriate or improper use of PPE may unintentionally put the resident and health care/support services workers at greater risk of exposure and transmission of a virus which is why it is incredibly important that PPE be put on and removed in a manner that minimizes the risk of self-contamination while following the proper sequence for donning and doffing of PPE.
PPE should be placed immediately in the waste receptacle outside the resident’s room.
As per the Ministry of Health and Long-Term Care, “All health care workers who are within two metres of suspected, presumed or confirmed COVID-19 patients shall have access to appropriate PPE. This will include access to: surgical/procedure masks, fit tested and approved N-95 respirators or approved equivalent or better protection, gloves, face shields with side protection (or goggles), impermeable or, at least, fluid resistant gowns.”
The Ministry of Health further requires that “The employers commit to provide all health care workers with information on safe utilization of all PPE and employees shall be appropriately trained to safely don and doff all of these supplies.”