Personal protective equipment
Personal protective equipment (PPE) refers to any clothing or equipment worn or used by individuals to protect themselves from various hazards in the workplace or other environments. It is designed to minimise the risk of injury, illness or infection.
Article by Peter Ellis
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Purpose
Personal protective equipment (PPE) refers to any clothing or equipment worn or used by individuals to protect themselves from various hazards in the workplace or other environments. It is designed to minimise the risk of injury, illness or infection. Nurses should consider the use of personal protective equipment in situations where:
The nurse must understand whether a particular procedure or interaction with a patient requires the use of personal protective equipment and use it appropriately (Nursing and Midwifery Council, 2018). Such decisions will be informed by local policy, practice and a good risk assessment.
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Assessment
Personal protective equipment and effective hand hygiene form the cornerstone of standard infection control precautions and its use must be considered when the nurse may come into contact with:
- blood or blood products
- bodily fluids
- bodily waste products
- broken skin
- mucous membranes
- infected body parts
- people who are, or who may be, carrying an infection which may be:
- airborne
- blood borne
- contained in any other bodily fluid or tissue
- people who are susceptible to infection, such as people who are immunocompromised
The nurse needs to assess whether by being exposed to the individual, or the individual being exposed to them, there is a risk of the transmission of infection.
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Equipment
The personal protective equipment the nurse will use will depend on the nature of the exposure (National Institute for Health and Care Excellence, 2023). For example, an airborne threat of infection would indicate the need for a face mask and potentially a respirator, with a visor to protect from inhalation or the entry of the pathogen through the eyes. On the other hand, blood borne risks may indicate the need for an apron and gloves.
In more specialised or extreme situations, personal protective equipment might include the use of a surgical gown, shoe covers, medical cap, respirator and/or a hazmat suit. This article only covers the more common scenarios concerning the use of aprons, gloves, goggles or visors, and face masks.
The choice of equipment must be driven by a thorough and informed risk assessment process and take into account local policies and procedures. Where there is doubt, the nurse
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Procedure
The nurse should don any appropriate personal protective equipment as per local policy. The nurse should always attend to effective hand hygiene, which is critical for infection control and cannot be replaced by the use of personal protective equipment.
When using personal protective equipment and in all clinical situations, the UK Health Security Agency (2020) state that nurses should be bare from the elbow down and not be wearing any watches, bracelets or rings with a stone.
The donning and doffing procedures described below reflects the order in which this should be performed to maximise safety and avoid contamination. Failure to follow the procedure in this order could increase the infection risk to the nurse and the patient (Yuan et al, 2020).
Donning personal protective equipment
The nurse should always perform hand hygiene, either washing or sanitising, immediately before donning personal protective equipment. Where necessary, the nurse should
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Risks and complications
Failing to use personal protective equipment when needed, and failing to don and doff it correctly, can have far reaching consequences for patients, nurses and their colleagues. The use of personal protective equipment is not a reason to negate other infection prevention and control processes, such as aseptic non-touch technique and hand hygiene. Personal protective equipment must be used where there is a policy or procedure for using it (Health and Safety Executive, 2022).
For much personal protective equipment, ensuring a good fit is important, and equipment should be used within their use by dates.
Not disposing of personal protective equipment correctly and safely increases the risk of infection to others, including the people tasked with the removal and disposal of waste. As a rule, all used personal protective equipment should be disposed of in clinical, or infected clinical, waste bins. Exceptions to this may be goggles or visors,
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Next steps
While it is the responsibility of all health and social care staff to observe effective hand hygiene practices and standard infection control precautions, individual nurses who undertake procedures requiring the application of personal protective equipment should ensure they stay up to date with the training, knowledge and skills required to both select the correct equipment as well as how to don, doff and dispose of it safely (Yeon and Shin, 2020).
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 2: Procedures for the planning, provision and management of person-centred nursing care
9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
9.3 use effective aseptic, non-touch techniques
9.4 use appropriate personal protection equipment
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Resources
Brown L, Munro J, Rogers S. Use of personal protective equipment in nursing practice. Nursing Standard. 2019;34(5):59-66
Cattini P, Kiernan M. Infection prevention and control. In: Lister S, Hofland J, Grafton H and Wilson C (eds). The Royal Marsden Manual of clinical nursing procedures. 10th edn. Chichester: Wiley Blackwell; 2021:69-129
Gordon C, Thompson A. Use of personal protective equipment during the COVID-19 pandemic. B J Nurs. 2020;29(13):748-752. https://doi.org/10.12968/bjon.2020.29.13.748
Health and Safety Executive. Personal protective equipment at work. 2022. https://www.hse.gov.uk/toolbox/ppe.htm (accessed 5 February 2024)
National Institute for Health and Care Excellence. Scenario: prevention and control of healthcare associated infections. 2023. https://cks.nice.org.uk/topics/healthcare-associated-infections/management/management/ (accessed 5 February 2024)
Nursing and Midwifery Council. Future Nurse: standards of proficiency for registered nurses. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 5 February 2024)
UK Health Security Agency. Guide to donning and doffing standard personal protective equipment. 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044504/COVID-19_Non_AGP_Donning_and_doffing_PPE_droplet_precautions.pdf (accessed 5 February 2024)
Yeon HY, Shin YS. Effects of education on the use of personal protective equipment for reduction of contamination: a randomized trial. SAGE Open Nursing. 2020;6:1–10.
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