When to use personal protective equipment

Standard use

Personal protective equipment is designed and issued for a particular purpose in a protected environment and should not be worn outside that area.

Personal protective equipment is used in areas where there is high risk of contamination (eg masks and sterile gowns worn in areas where surgical procedures are performed, or a nonsterile gown and gloves worn while cleaning a spill of blood or other body substance) and must be removed before leaving the area.

Gowns must be removed after contact with the patient (and replaced, if necessary), before contact with the next patient. Even where there is a lower risk of contamination, protective clothing that has been in contact with patients must not be worn outside the designated area. For example, scrub suits worn for surgical procedures are not worn outside of the designated area (this does not apply to a scrub suit worn as a uniform or as preferred work attire).

During outbreaks

Personal protective equipment is also used routinely when there is a risk of infection (eg during an epidemic or pandemic).

Usage in these circumstances may differ from standard use. Some items may be worn for longer than normally recommended (see Extended use of personal protective equipment).

During a disease outbreak, health departments will issue guidance on which items of personal protective equipment should be worn in which clinical situations, according to an expert risk assessment based on the relevant pathogen.

The risk assessment and the type of clinical activity determine whether to wear gloves and which type are needed. Gloves must be worn in line with:

• standard and surgical aseptic technique (see Aseptic technique)
• standard and transmission-based precautions (see Levels of precaution).

Correct fit and type of gloves are essential to their effectiveness in infection prevention and control.

When gloves are worn with other personal protective equipment, they are put on last and removed first.

Types of gloves

Sterile surgical gloves are used for some standard procedures and all surgical aseptic procedures and contact with sterile fields or equipment. Compared with standard gloves (eg examination gloves), these type of gloves:

• are more protective – even in thickness with low risk of defects in the material
• enable superior dexterity – necessary for performing procedures and reducing the risk of sharp injury.

Clean (nonsterile) single-use examination gloves are used for procedures that do not require surgical asepsis, procedures where there is a risk of exposure to patient blood or body substances, and procedures where there is contact with non-intact skin and mucous membranes (eg venipuncture, vaginal or rectal examination) and minor procedures.

Nonsterile gloves are available in a range of materials such as natural rubber latex and synthetic materials (eg vinyl, nitrile, or neoprene). Latex gloves enable the wearer to maintain dexterity, but sensitivity and allergy can occur. Practices could document which staff members and patients have latex allergy and provide alternative glove types.

General-purpose utility gloves (eg kitchen gloves) are used for activities that do not involve patient care, such as cleaning surfaces.

Heavy-duty, puncture- and chemical-resistant gloves must be used for instrument cleaning. These gloves can be reused after washing and drying.

Fitting protective gloves

When wearing gloves with a long-sleeved gown, ensure that gloves extend at least 5 cm past the gown cuffs or sleeves.

Changing gloves

Sterile or nonsterile gloves must be changed:

• after contact with each patient
• between procedures on the same patient
• if they are damaged during a procedure
• after finishing the procedure or task
• before handling notes, computer keyboards or telephones.

Removing and disposing of protective gloves

Correct handling of used gloves (sterile or nonsterile disposable gloves) is important to reduce the risk of infection to the staff member. Remove gloves inside out and hold by the cuff edge to minimise contamination of hands (Figure 3.1. Method for putting on and removing gloves). Dispose of gloves into the appropriate waste stream as soon as they are removed. Cleanse hands after removing gloves (see 2. Hand hygiene).

Figure 3.1 Method for putting on and removing gloves

Figure 3.1

Method for putting on and removing gloves

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Table 3.2. Method for putting on and removing gloves

Latex sensitivity/allergy

Most people can safely wear latex surgical gloves. However, occupational use of latex gloves is associated with both non-allergic irritant dermatitis and allergy: allergic contact dermatitis, and systemic (immediate hypersensitivity) reactions.³

Non-allergic irritant dermatitis is the most common reaction to gloves. It causes rough, dry and scaly skin, sometimes with weeping sores.⁴

Latex allergy is a reaction to proteins in latex rubber. Latex allergy can develop over time with frequent exposure to latex proteins, and mostly affects nurses, doctors, dentists and patients who have had multiple operations. Powdered latex gloves should not be used as they increase the risk of allergy.

Allergic contact dermatitis is the most common allergic reaction to latex. It causes a rough, dry scaly rash, sometimes with weeping sores, on the hands and where the gloved hands have touched other body parts such as the face. Allergic contact dermatitis usually appears 12–46 hours after contact with latex.⁴

Latex allergy can also cause a more severe allergic reaction characterised by an itchy red rash within minutes of exposure, which can be accompanied by itchy red eyes, runny nose and sneezing, and occasionally asthma.⁵ Very severe or life-threatening allergic reactions (anaphylaxis) to latex are rare.⁶

Healthcare professionals with atopic dermatitis and eczema on their hands appear to be at greater risk of becoming sensitised to latex proteins, indicating that careful attention to hand care (hand washing technique and barrier protection) is important to minimise risk.³

If latex sensitivity/allergy has occurred or if latex allergy is suspected, the staff member must undergo medical assessment. Implement risk management strategies such as latex-free work areas.

There is no risk of latex allergy with the use of nonlatex gloves such as those made from nitrile or neoprene. These gloves must be used when treating patients with latex allergies and by staff with latex allergies.

Use eye protection, such as goggles and safety glasses, when performing procedures where there is a risk of splashing or spraying of blood or body substances (eg surgical procedures, venipuncture, cleaning of reusable medical equipment) or respiratory droplets from multiple angles. Face shields provide additional face and mouth protection against splash contact.

Safety glasses, masks with visors and full face shields are less effective than goggles for protecting the eyes from airborne transmission due to gaps around the eyes.

Personal glasses, such as prescription spectacles, are not acceptable personal protective equipment due to gaps around the eyes. Eye protection must be worn over spectacles. Prescription glasses with an inner plastic shield and side protection can also be purchased.

Goggles and face shields must be clear, antifogging, distortion free, close-fitting and, ideally, closed at the sides. Goggles or face shields are fitted over the top of regular prescription glasses, if worn. Newer styles of goggles fit over prescription glasses with minimal gaps.

When wearing goggles or a face shield, it is important not to touch the goggles or face shield. If touching occurs, hand hygiene is required before recommencing a task.

Care is needed when removing and disposing of eye protection:

• Take care to remove using the stems only.
• If disposable, discard into the appropriate waste stream.
• If reusable, wash with soap and water and dry, then use disinfectant selected for the most likely pathogens, allowing the required wet contact time before drying.
• Store covered to avoid contamination, for example in a large paper bag.

Correct handling of used protective eyewear/face shields is important in preventing the risk of infection to staff.

Aprons or gowns must be worn by staff when there is a risk of contamination of skin or clothing with blood, body substances, secretions or excretions other than sweat (eg when performing surgical excisions or throat/nasal swabs when there is risk of infection). The type of apron or gown must be appropriate to the task and the degree of risk.

Wear aprons and gowns for a single procedure or episode of patient care (unless extended use is directed), and remove them in the area where the episode of care takes place.

When wearing a gown or apron, do not touch the outside of the front or sleeves.

Cleanse hands after removing the gown or apron (see Hand hygiene).

Aprons

Single-use plastic aprons are suitable for general use when there is a risk that clothing may be exposed to blood or body substances during low-risk procedures, and where there is a low risk of contamination to the arms. Aprons can be worn during contact precautions.

Gowns

Gowns are worn to protect skin and prevent soiling of clothing. The choice of gown depends on the activity. For example, a full body gown (in combination with other personal protective equipment) must be worn when there is a possibility of extensive splashing of blood or other body substances such as vomitus or uncontrolled faecal matter, or as advised by national or state and territory health authorities during an infectious disease outbreak with contact and droplet modes of transmission.

Sterile gowns are also worn during some surgical procedures, as part of surgical aseptic technique to protect the surgical site.

Types of gowns

Gown designs include disposable or reusable, short-sleeved or long-sleeved, and with fabric or elasticised cuffs. They are secured at the back and cross one side over the other at the back to prevent a gap. Sterile pre-packaged gowns are available.

Putting on a protective gown

Put on the gown with the opening at the back. Secure the tapes at the back, with the two sides of the gown overlapping before tied, to prevent the gown opening and clothes becoming contaminated.

Removing aprons and gowns

Remove aprons and gowns in a manner that prevents contamination of clothing or skin. Undo fasteners or ties (without snapping ties) and remove the gown inside-out, taking care not to touch the outside of the gown. Roll the gown to mid-point.

If disposable, dispose of it into the appropriate waste stream.

If reusable, place the gown into a designated linen container so it can be washed and dried appropriately before reuse.

Use masks when there is a risk of droplet or airborne transmission of infection by breathing.

They can also be worn by patients to prevent droplet or airborne transmission.  Droplet and airborne modes of transmission are closely interrelated because the relevant infectious matter represents a continuum from large droplets to small particles. Infection prevention and control strategies for these modes overlap substantially. While some experts consider them as one mode of transmission, this guideline retains the distinction between droplet and airborne transmission for consistency with current national guidelines.

It may be appropriate for children to wear appropriately fitted masks in some situations. Monitor oxygen saturation if clinically necessary.

The following precautions apply when wearing any type of mask:

• Ensure the mask completely covers the nose and mouth and does not gape.
• Do not touch the mask after putting it on.
• Remove and replace the mask if it becomes wet or soiled.
• Do not wear a mask around your neck.
• Do not reapply a mask after it has been removed.
• Perform standard hand hygiene after touching or disposing of a mask.

Mask types include:

• surgical masks
• standard filtering P2/N95 respirators (also called filtering face-piece respirators, particulate filter respirators, face filters)
• surgical filtering respirators.

The correct type of mask must be chosen according to the situation.

Masks with elastic loops have a use-by date as the elastic perishes with time: masks past their use-by date must be replaced, even if unused.

Separate inner frames (also called support frames or mask brackets), designed to prevent the mask material touching the nose and lips, must not be used with any type of mask.

Surgical masks

A surgical mask is intended to prevent the release of potential contaminants from the wearer into their immediate environment. It also protects the wearer’s mouth and nose from large droplets, sprays and splashes of body substances.

Surgical masks can provide some protection to staff and patients where there is a risk of disease transmission by respiratory particles, but (unlike filtering respirators) they are not designed to filter out a high proportion of infectious particles in the surrounding air.

Masks are for single use, for one procedure or episode of patient care, except in extended use (see Extended use of personal protective equipment). A mask is removed and replaced if it becomes wet or soiled, or if the user has touched the front of the mask.

Fitting a surgical mask

Surgical masks have ties/tapes to be tied at the back of the head or elastic ear loops.

To be effective, masks must be fitted correctly. Hands should be cleansed with alcohol-based handrub or liquid soap and water before putting on a mask.

Fit a surgical mask correctly by following these steps:

• Apply the mask by tying the tapes above and below the ears, or placing the elastic loops around the ears.
• Open out the folds of the mask so that the mask covers the mouth and nose comfortably.
• Mould (do not pinch) the area over the bridge of the nose to produce a snug, comfortable fit.

Do not cross the loops at the sides or a gap may form and allow contaminated air in.

If a gap forms because the mask is too large, use a smaller size.

Beards should be avoided because they compromise mask fitting.

Removing and disposing of a surgical mask

Correct handling of used masks is important to prevent the risk of infection of the staff member and patients. When removing a mask with ear loops, remove both loops and pull mask away and down. When removing a mask with tapes or ties, undo or break the tape under the ears first, then lift the top tape over the head.

Dispose of the mask as soon as possible into the appropriate waste stream.

P2/N95 masks

P2/N95 masks (filtering masks; also called filtering face-piece respirators or particulate-filter respirators) are special masks designed to form a very close seal around the nose and mouth, protecting the wearer from exposure to airborne particles including pathogenic biological airborne particulates such as viruses and bacteria.

P2/N95 masks include standard (non-fluid-impermeable) and surgical fluid-impermeable types. Only Therapeutic Goods Administration-registered P2/N95 filtering respirators must be used, to ensure they comply with current relevant standards.²

Use filtering respirators with band straps. (Those with ear loops are not appropriate for health care). They must be fitted correctly to be effective, and wearers must be appropriately trained in their use. Practices should ensure that staff performing high-risk duties are fit-tested and can perform a fit check correctly before each use.

Filtering respirators may be required during respiratory disease outbreaks or when performing aerosol-generating procedures (eg spirometry) and discarded after each patient or procedure.

Once a mask is in place, do not touch the front of the mask, nor pull the mask down intermittently.

See also Extended use of personal protective equipment.

Fit-testing and fit-checking a P2/N95 mask

Employers should ensure that their employees are able to wear a filtering respirator correctly.

A fit test identifies the correct size and style of P2/N95 mask suitable for an individual. Ideally, testing should be performed at the start of employment for staff working in clinical areas where there is a significant risk of respiratory-related droplet and/or airborne transmission.  Droplet and airborne modes of transmission are closely interrelated because the relevant infectious matter represents a continuum from large droplets to small particles. Infection prevention and control strategies for these modes overlap substantially. While some experts consider them as one mode of transmission, this guideline retains the distinction between droplet and airborne transmission for consistency with current national guidelines. of infectious agents has been identified or could develop.

Fit testing may need to be repeated if the person’s face shape changes or when there is a change in the range of mask types available from the practice’s supplier.

Beards should be avoided because they compromise mask fitting.

Fit checking must be performed every time a P2/N95 mask is put on. Fit checks ensure the mask is sealed over the bridge of the nose and mouth and that there are no gaps between the mask and face. Fit checking must be performed according to the manufacturer’s instructions. Staff members are encouraged to observe each other’s mask fitting and immediately advise of any problem with correct fit.

Note: In office-based practices it may be difficult to ensure that the optimal size and style of mask for each individual staff member, as identified by fit-testing, is always available. Regardless of whether a supply of the ideal mask type for each staff member can be obtained, careful ongoing fit-checking is essential.

Removing and disposing of a P2/N95 mask

Correct handling of used masks is important to prevent the risk of infection to the staff member and patient. When removing the mask, handle only the straps/bands.

The correct removal technique depends on the design. For ‘duckbill’-shaped or cup-shaped respirators, hold both tapes together and lift over the head. For flat-fronted (flat-fold) respirators, lift over the bottom tape, without touching the front of the mask, and let it hang. Then grasp the upper tape and it pull over the head so the whole mask comes away.

Dispose of the mask into the appropriate waste stream.

Enclosed footwear must be worn to protect against injury if sharps or contaminated material are inadvertently dropped.

Disposable foot covers are not required during outbreaks, with the exception of very specific infectious diseases. However, staff managing spills (eg when a patient has gastroenteritis) may choose to wear them.