Before undertaking any care task or procedure staff should assess any likely exposure to blood and/or body fluids and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.

All PPE should be:

• located close to the point of use;
• stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to);
• single-use only items unless specified by the manufacturer;
• changed immediately after each patient and/or following completion of a procedure or task; and
• disposed of after use into the correct waste stream i.e. healthcare waste or domestic waste.

Reusable PPE items, e.g. non-disposable goggles/face shields/visors must have a decontamination schedule with responsibility assigned.

Further information on best practice for PPE use for SICPs can be found in Appendix 16.

Gloves must:

• be worn when exposure to blood, body fluids, (including but not limited to secretions and/or excretions), non-intact skin, lesions and/or vesicles, mucous membranes, hazardous drugs and chemicals, e.g. cleaning agents is anticipated/likely. (Scottish National Blood Transfusion Service (SNBTS) adopt practices that differ from those stated in the National Infection Prevention and Control Manual);
• Gloves are a single-use item and should be donned immediately prior to exposure risk and should be changed immediately after each use or upon completion of a task;
• never be worn inappropriately in situations such as; to go between patients, move around a care area, work at IT workstations;
• be changed if a perforation or puncture is suspected or identified;
• be appropriate for use, fit for purpose and well-fitting;
• not be worn as a substitute to hand hygiene.

Double gloving is only recommended during some Exposure Prone Procedures (EPPs) e.g. orthopaedic and gynaecological operations or when attending major trauma incidents and when caring for a patient with a suspected or known High Consequence Infectious disease.  Double gloving is not necessary at any other time.

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/likely
• when in direct care contact with a patient or their immediate environment e.g providing toileting support or changing bed linen;
  and
• changed between patients and following completion of a procedure or task.

Full body gowns/Fluid repellent coveralls must be:

• worn when there is a risk of extensive splashing of blood and/or other body fluids e.g. in the operating theatre;
  
  
• worn when a disposable apron provides inadequate cover for the procedure/task being performed;
  
  
• changed between patients and immediately after completion of a procedure or task.

The choice of apron or gown is based on a risk assessment and anticipated level of body fluid exposure. Routine sessional use of gowns/aprons is not permitted.

Sterile surgical gowns must be:

• worn by all scrubbed members of the operating theatre surgical team;
• worn for insertion of central venous catheters, insertion of peripherally inserted central catheters, insertion of pulmonary artery catheters and spinal, epidural and caudal procedures.

Reusable gowns must:

• not be worn in the operating theatre environment or for aseptic surgical procedures;
• be appropriately processed between uses based on manufacturer’s instructions.

If hand hygiene with soap and water is required, this should not be performed whilst wearing an apron/gown in line with a risk of apron/gown contamination; hand hygiene using ABHR is acceptable.

Further information can be found in the Aprons/Gowns literature review.

Eye/face protection must:

• be worn if blood and/or body fluid contamination to the eyes/face is anticipated/likely  and always during Aerosol Generating Procedures.
  
  
• be worn by all scrubbed members of the surgical team for all surgical procedures;
  
  
• not be impeded by accessories such as piercings/false eyelashes;
  
  
• not be touched when worn;
  
  
• cover the full peri-orbital region and wrap around the sides of the face;
  
  
• be removed or changed in accordance with manufacturer’s instructions, if vision is compromised through contamination with blood or body fluids, if the integrity of the equipment is compromised, at the end of a clinical procedure/task and/or prior to leaving the dedicated clinical area.

Regular corrective spectacles and safety spectacles are not considered eye protection.

Further information can be found in the eye/face protection literature review.

Fluid Resistant Type IIR surgical face masks must be:

• worn by a patient known or suspected to be infected with a micro-organism spread by the droplet or airborne route when leaving their room or when moving between clinical areas including transfers by portering staff and ambulance services.

• worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated/likely;
  (as part of SICPs a full face visor may be used as an alternative to fluid resistant Type IIR surgical face masks to protect against splash or spray.)

• worn in combination with a full face shield, integrated half face shield or goggles for AGPs on non-infectious patients;
  
  
• worn to protect patients from the operator as a source of infection when performing invasive spinal procedures such as myelography, lumbar puncture and spinal anaesthesia ,inserting a Central Vascular Catheter (CVC), performing intra-articular (joint) injections;
  
  
• worn by all scrubbed members of the theatre surgical team for all surgical procedures;
  
  
• worn by non-scrubbed members of the theatre surgical team if deemed necessary following a risk assessment of exposure to blood and/or body fluids;
  
  
• well fitting and fit for purpose (fully covering the mouth and nose);
  
  
• removed or changed;
  • at the end of a procedure/task;
  • if the integrity of the mask is breached, e.g. from moisture build-up after extended use or from gross contamination with blood or body fluids;
    and
  • in accordance with specific manufacturers’ instructions.

Transparent face masks

Transparent face masks may be used to aide communication with patients in some settings

Transparent face masks must;

• meet the specification standards of the Transparent face mask technical specification (Department of Health and Social Care - November 2021);and 
• have been approved by the UK Transparent Mask review group for use within health and social care settings 
• only be worn in areas where Fluid Resistant Type IIR surgical face masks are used as personal protective equipment.

Further information can be found in:

• aerosol generating procedures literature review
• surgical face masks literature review
• section 2.4 of the NIPCM
• appendix 11 of the NIPCM

During the ongoing COVID-19 pandemic please also refer to the Scottish Government Extended Use of Facemask Guidance. The extended use of facemask guidance is not considered an element of SICPs but an additional mitigation measure applied in response to the ongoing COVID-19 pandemic response.

Footwear must be:

• non-slip, impervious, clean 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 e.g. theatre. Employees must clean and decontaminate footwear upon removal and when visibly soiled with blood and/or body fluids following manufacturers recommended instructions for cleaning and disinfection
• dedicated for use in settings such as theatres and stored in a designated area when not in use
• Footwear found to be defective should be repaired or replaced before further use.
• Overshoes/shoe covers should not be used in the general health and care environment.

Further information can be found in the footwear literature review.

Headwear must be:

• worn in theatre settings/restricted and semi-restricted areas;
• worn as PPE for procedures where splashing/spraying of body fluids is anticipated, and as source control when performing clean/aseptic procedures where risk of infection is deemed to be high.
• well fitting and completely cover the hair;
• changed/disposed of at the end of a single clinical procedure/task; or at the end of a theatre session (for sessional use); immediately if contaminated with blood and/or body fluids;
• removed before leaving the theatre/clean room.

Further information can be found in the headwear literature review

For the recommended method of putting on and removing PPE see video below and Appendix 6.

COVID-19 - the correct order for donning, doffing and disposal of PPE for HCWs in a primary care setting from NHS National Services Scotland on Vimeo.

 

Sessional use of PPE

Typically, sessional use of any PPE is not permitted within health and care settings at any time as it may be associated with transmission of infection within health and care settings. 

Due to the much wider and frequent use of FRSMs eye/face protection (where required) by HCWs during the ongoing COVID-19 pandemic and during periods of increased respiratory activity in health and care settings both as part of service user direct care delivery and extended use of facemasks guidance, sessional use of FRSMs and eye/face protection is permitted at this time.

This means that FRSMs and eye/face protection (where required) can be used moving between service users and for a period of time where a HCW is undertaking duties in an environment where there is exposure to patients with suspected or confirmed respiratory infection.  A session ends when the healthcare worker leaves the clinical setting or exposure environment.  When using FRSMs and eye/face protection sessionally it is important to note the following;

• FRSMs/FFP3/Eye/Face protection must be replaced if visibly contaminated, wet, damaged, uncomfortable, when moving between patients with suspected or confirmed respiratory infection and those without.
• FRSMs must be replaced following procedures where splash/spray is generated
• HCWs must not touch their FRSM, eye/face protection or FFP3 respirator whilst in situ. If they inadvertently do so, they must perform hand hygiene immediately afterwards

The above measures in conjunction with safe donning and doffing of PPE ensure the safety of the HCW and the service user.

No other PPE is permitted to be worn sessionally moving between service users or care tasks.  This includes gloves, aprons and gowns.

PPE for Visitors

PPE may be offered to visitors to protect them from acquiring a transmissible infection.  If a visitor declines to wear PPE when it is offered then this should be respected and the visit must not be refused.  PPE use by visitors can not be enforced and there is no expectation that staff monitor PPE use amongst visitors. Below is the PPE which should be worn where it is appropriate to do so and when the visitor chooses to do so.

Visitors do not routinely require PPE unless they are providing direct care to the individual they are visiting.  In line with extended use of face mask guidance, visitors are strongly recommended to continue to wear a face covering when visiting a healthcare setting.  Should they arrive without one, they can be provided with a FRSM. 

The table below provides a guide to PPE for use by visitors if delivering direct care. 

IPC Precaution	Gloves	Apron	Face covering/mask	Eye/Face Protection
Standard Infection Control Precautions (SICPs)	Not required*1	Not required*2	Where splash/spray to nose/mouth is anticipated during direct care Encourage the use of face covering (or provide with Type IIR FRSM if visitor arrives without a face covering) in line with Extended use of face masks guidance	Not required*3
Transmission Based Precautions (TBPs)	Not required*1	Not required*2	If within 2 metres of service user with suspected or known respiratory infection Encourage the use of face covering (or provide with Type IIR FRSM if visitor arrives without a face covering) in line with Extended use of face masks guidance	If within 2 metres of service user with suspected or known respiratory infection

*1 unless providing direct care which may expose the visitor to blood and/or body fluids i.e. toileting.

*2 unless providing care resulting in direct contact with the service user, their environment or blood and/or body fluid exposure i.e. toileting, bed bath.

*3 Unless providing direct care and splashing/spraying is anticipated