1. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT

2. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment PROTECT patients PROTECT yourself

3. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Introduction The aim of this session is to give you an understanding of the correct and appropriate use of PPE Key topics to be covered –awareness of the potential risks associated with blood/body fluids infectious patients/clients pose to you –your responsibilities in reducing the risk of transmission of infection between patients/clients –how risk assessment can help you to select and to use the appropriate personal protective equipment –how to safely put on, remove and discard personal protective equipment

4. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Knowing what to wear To protect patients/clients and yourself, understand the risk associated with each activity you undertake within your job Personal protective equipment (PPE) is based upon –an assessment of the risk of transmission of micro-organisms to the patient/client, and the risk of contamination of staff clothing and skin by blood, body fluids, secretions or excretions Risk assessment provides a set of logical questions to help with sometimes confusing decisions

5. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Personal Protective Equipment (PPE) PPE is specialised clothing or equipment worn as protection against infectious materials Gloves Aprons and gowns Face protection –goggles, visors, face-shields, masks Other protective clothing –respiratory protective equipment, footwear

6. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment GLOVES

7. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Use of GLOVES Gloves are the most common type of PPE used within healthcare settings Gloves protect your hands from –contamination with organic matter and micro-organisms –chemicals that could adversely affect your skin Gloves reduce the risk of cross-infection by preventing the transfer of organisms from you to patients/clients, and from patients/clients to you

8. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Selection of GLOVES Glove selection can only be made after a full and informed risk assessment Understand potential hazards before making glove choice Be aware of the possibility of NRL allergy, and document cases NRL (or an acceptable alternative) must be worn for actual or potential contact with blood, or blood-stained body fluids Make sure gloves fit correctly Always use non-powdered gloves Never use polythene (plastic) gloves for clinical tasks

9. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Discarding GLOVES Gloves are single-use items, you should treat them as healthcare (clinical) waste or domestic waste in some settings Put on gloves immediately before an episode of patient/client contact or treatment, and remove gloves as soon as the activity is completed Never wash gloved hands Dispose of decontaminated gloves immediately Decontaminate hands after removing gloves The re-use of gloves has legal implications

10. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Do GLOVES leak? Do not take the integrity of gloves for granted – always decontaminate hands after glove use Evidence suggests gloves can leak when they appear undamaged Revised standards require gloves to perform to the same standard Hands are not necessarily clean because gloves have been worn Verify glove barrier properties with manufacturers Hands may also become contaminated during glove removal Double gloving should be considered for exposure prone procedures, or for procedures where there is a risk of glove puncture

11. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment APRONS and GOWNS

12. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment APRONS versus GOWNS No studies support the routine use of gowns in general or specialist clinical settings Plastic aprons are recommended for general use Gowns should be fluid repellent and used where there is potential for extensive splashing of blood, body fluids, secretions or excretions

13. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Use of APRONS Single-use fluid-repellent aprons protect clothing from contamination with blood, body fluids or micro-organisms Aprons are routine wear for many clinical and care activities when –there is potential direct contact with blood or body fluids –there is direct contact with an infectious patient/client and their environment –clothing is likely to become wet or soiled Long-sleeved impermeable aprons are available for episodes when there is a risk of extensive contamination where clothing is likely to become wet or soiled

14. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Discarding APRONS Use an apron for the task or episode intended, and then discard it immediately Plastic aprons are single-use Use for one procedure or episode of patient/client care Discard apron after use Dispose of as healthcare (clinical) or domestic waste

15. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Use of GOWNS Full-body fluid-repellent gowns must be worn when there is an extensive risk of splashing Sterile gowns that are impermeable to fluid protect staff from infectious materials and the patient/client from HAI Wear sterile gowns for –performing aseptic invasive procedures –during surgery

16. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Laundry of GOWNS Poly cotton reusable gowns have been the usual wear within the theatre environment Laundering of gowns can increase –bacterial penetration through gowns to patient/client –fluid penetration through gowns to staff Bacterial penetration is notably reduced in single-use gowns Surgical gowns are ‘medical devices’ (and must carry a CE mark)

17. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT group activity

18. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment FACE protection

19. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Types of EYE protection Predominantly worn to protect eyes from contamination by blood and body fluids or chemicals Goggles Visors Face-shields –single-use surgical face mask with integrated eye-shield

20. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Use of EYE protection Goggles, visors and face-shields protect eyes from splash/spray from blood/body fluids, from chemicals, and during aerosol-prone procedures Protect the mucous membrane of your eyes Use goggles for potential splashes Use visors or face-shields for –potential spraying/splattering of blood –aerosolisation of other potentially infectious material In cases of accidental exposure, use eye wash Protect eyes from chemicals when scrubbing instruments

21. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Decontaminating EYE protection Follow local policies for the cleaning and disinfection of multi-use eye protection Wash with detergent, rinse with hot water and dry thoroughly If contaminated with blood or body fluids –clean as above, then disinfect according to local policy Monitor multi-use items and replace when appropriate (for example, due to scratched lenses or loose elastic)

22. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Use of MASKS There is no evidence to suggest any clinical benefit from wearing surgical masks to protect patients/clients during routine ward procedures Wear a visor for splash-prone non-operating theatre procedures –child deliveries, dentistry, invasive procedures Surgical face masks must be worn in the operating theatre –for procedures involving the splashing of blood and body fluids –for procedures that pose a high risk of the patient/client acquiring a surgical site infection (SSI)

23. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Maximising MASKS The fit of the mask is very important to the efficiency of the mask Masks should fully cover the nose and the mouth To maximise protection from a face mask, ensure it is –close fitting –changed between operations or patients/clients –handled as little as possible –changed if it becomes wet

24. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Discarding MASKS Once removed, never re-use a mask Discard immediately after removing Treat as healthcare (clinical) waste

25. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment other forms of protection

26. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Respiratory protective equipment Certain respiratory diseases require additional precautions Specialised respiratory protective equipment includes dust mist respirators or filtering masks for use with: –multiple drug-resistant tuberculosis (MDRTB), drug-resistant tuberculosis (DRTB)

27. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Footwear The wearing of overshoes is unnecessary for routine or isolation nursing Overshoes are often hazardous Dedicated shoes are better for theatre and sterile services –always keep dedicated footwear clean Calf-length boots minimise the risk of exposure to blood-borne viruses

28. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT quiz

29. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment further study

30. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Improving compliance Information accepted understood applied saves lives

31. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Health and Safety legislation Health & Safety at Work Regulations (1999) Approved Code of Practice and Guidance Personal Protective Equipment at Work Regulations: Guidance on Regulations (1992) Control of Substances Hazardous to Health (COSHH) Regulations (2004)

32. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Core references  NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2003) Infection control: Prevention of healthcare-associated infection in primary and community care. Clinical Guideline [on-line]. London: NICE. Available at: www.nice.org.uk/page.aspx?o=71774 [Accessed March 2005].www.nice.org.uk/page.aspx?o=71774  PELLOWE C M, PRATT R J, LOVEDAY HP, HARPER P, ROBINSON N, JONES S R L J, (2004) The epic project. Updating the evidence-base for national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England: a report with recommendations. British Journal of Infection Control, December 2004, vol. 5, no. 6, (pp 10-16)  GARNER J S (1996) The Hospital Infection Control Practices Advisory Committee: Guidelines for Isolation Precautions in Hospitals. Infection Control Hospital Epidemiology, 17 (1), 53-80  CLARK L, SMITH W, YOUNG L (2002) Protective Clothing; Principles and Guidance. Bathgate, UK: Infection Control Nurses Association.  BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 1: specification for freedom from holes. BS-EN 455-1, British Standards Institution, London  BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 2: specification for physical properties. BS-EN 455-2. British Standards Institution, London  BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 3: requirements and testing for biological evaluation. BS-EN 455-3, British Standards Institution, London  UK HEALTH DEPARTMENTS (1998) Guidance for Clinical Health Care Workers. Protection Against Infection with Blood-borne Viruses. Recommendations of the Expert Advisory Group on AIDs and the Advisory Group on Hepatitis. London: The Stationery Office  HEALTH AND SAFETY EXECUTIVE (1992) Personal Protective Equipment at Work Regulations. (EEC Directive). London: The Stationery Office  DEPARTMENT OF HEALTH (1996) The Interdepartmental Working Group on Tuberculosis. The Prevention of Tuberculosis in the UK. Recommendations for the Prevention and Control of TB at Local Level. Department of Health. London:Stationery Office  UK HEALTH DEPARTMENTS (1998) Guidance for Clinical Health Care Workers: Protection Against Infection with Blood-borne Viruses. Recommendations of the Expert Advisory Group on Aids and the Advisory Group on Hepatitis. London: The Stationery Office  Health & Safety at Work Regulations (1999) Approved Code of Practice and Guidance  Personal Protective Equipment at Work Regulations: Guidance on Regulations (1992)  Control of Substances Hazardous to Health (COSHH) Regulations (2002)

33. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Further web sources www.sehd.gov.uk www.hse.gov.uk www.hpa.org.uk www.cdc.gov www.hps.scot.nhs.uk www.medical-devices.gov.uk www.healthcareA2Z.org

34. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT personal action planning

35. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Personal Protective Equipment PROTECT patients PROTECT yourself