Section 8 Section 8 PPE PPE Personal Protective Personal Equipment Protective Equipment PERSONAL PROTECTIVE EQUIPMENT (PPE) Ref - Department of Health Guidance 2005 with respect to Influenza PPE OVERVIEW Within social care services, as in normal circumstances, selection of PPE must be based on an assessment of the risk of transmission of micro organisms to the service user (or patient), and the risk of contamination of a care worker’s clothing and skin by the service user’s blood or other body fluids, secretions or excretions. In any circumstance, care in the correct donning and removal of PPE is essential to avoid inadvertent contamination. PPE should be worn to protect staff and thus reduce the transmission of pandemic influenza between service users and staff and from one service user to another. Appropriate PPE for care of service users during a pandemic influenza is summarised below. PPE DURING A PANDEMIC ‘FLU OUTBREAK Advice on the donning and removal of PPE during a ‘flu pandemic from Health Protection Agency, East Midlands South already exists; but as yet it has not been through the formal, DoH consultation and approval procedures. However, the final guidance is not expected to differ in essence from the guidelines set out here. Essentially, during a pandemic, PPE should not differ greatly from existing practice in the case of a severe undiagnosed respiratory disease and Standard Infection Control Procedures and Respiratory Etiquette should be adopted - all contaminated clothing must be removed before leaving a patient care area. Disposable surgical masks being removed last. Within healthcare settings PPE is expected to consist of items such as disposable plastic aprons and gloves and, where appropriate, face masks, eye protection and respirators. Fluid repellent surgical masks can reduce the risk of influenza transmission and eye protection may be deemed necessary when the types of care being given could result in contamination with sputum or mucus from the nose or mouth of a ‘flu sufferer. Current advice is that staff who are caring for ‘flu sufferers should don face masks when undertaking close, personal care tasks and nursing care. Although nursing care rarely takes place within social care units, in the event of ‘flu pandemic care staff may be nursing service users who cannot be hospitalised. During an influenza pandemic it is predicted /anticipated that residential homes for elderly persons are likely to be undertaking some limited nursing care because of an anticipated shortage of hospital beds. A surgical face mask (FFP3 filter standard) to prevent aerosol contamination, should be worn by healthcare workers for close patient contact (e.g. within 3 feet) this will provide a physical barrier and minimise contamination of facial mucosa by large droplet particles, one of the principal ways influenza is transmitted. Consideration should be given to asking service users who are coughing to wear a mask while care is being provided, if they can tolerate one. If not, they should use disposable single-use tissues to cover their mouth when coughing. NB - The CCDC’s current advice is that, unless staff have close contact with a service user who has respiratory symptoms, face masks are not considered an essential or vital PPE. Their main function is primarily to remind staff not to touch their faces and mouth and noses. The ‘flu virus is unlikely to be caught by inhalation of the general atmosphere, but rather by inhalation of the large droplets from a cough or sneeze. Most surgical masks should be (FFP3 filter standard) but will still become saturated and wet within 12 minutes of use. Surgical face masks should:- cover both nose and mouth and not be allowed to dangle around the neck after use not be touched once put on be changed once they become moist be worn only once and discarded in an appropriate receptacle as clinical waste hand hygiene must be performed after disposal is complete It is essential that masks are removed and disposed of between patients. If masks are not to become hazardous in themselves they must be removed and disposed of very carefully - in the same way that dressings and tissues should be. DISPOSABLE APRONS AND GLOVES If glove supplies become limited during a pandemic priorities for glove use may need to be established. In this circumstance gloves should always be worn as a priority for contact e.g. with blood and bloody fluids, invasive procedures and contact with sterile sites. Gowns are not required for routine care of patients with influenza - disposable plastic aprons are sufficient but must only be used a single use items – for one procedure or episode of patient care. RESPIRATORS Respirators are unlikely to be used except in hospital settings. However, if they are deemed necessary by a health care professional then every user should be fit tested and trained in the use of the respirator, as fit is critical. Advice for smaller social care units such as community homes, hospices, hostels and respite units is likely to be based on that given to domestic situations. It is expected that masks will only be required if close personal care or nursing takes place at the unit. Day centres, nurseries, schools and children and family centres are likely to be closed if insufficient staff members are well enough to attend, but in any event staff should not have to nurse service users as anyone with symptoms should be sent home and masks are unlikely to be necessary. Home care staff should use masks when visiting sick service users as they could transfer the illness from the service user to themselves and /or others on their travels – but again the masks must be changed between service users and care must be taken not to touch the wet mask surface. CARE OF SERVICE USERS /RESIDENTS WITH ‘FLU All staff (and relatives) should use personal protective equipment for care of residents with pandemic influenza Entry to ‘flu Close resident Aerosol areas but no contact (< 3 feet) generating resident contact procedures b & c a Hand hygiene Gloves d +e Plastic apron d - Gown - f&g +g Surgical mask - FFP3 respirator - - Eye protection - Risk assessment a. Standard Infection Control Principles apply at all times. b. Examples of aerosol-generating procedures include intubations, nasopharyngeal aspiration, tracheotomy care, chest physiotherapy, bronchoscopy, and nebulizer. c. Wherever possible, aerosol-generating procedures should be performed in single rooms with minimal staff present. d. Gloves and aprons should be worn during certain cleaning procedures, consult housekeeping guidelines in H&S and housekeeping manuals. e. Gloves should be worn in accordance with Standard Infection Control Principles. If glove supplies become limited, this recommendation may need to be relaxed. Glove use should be prioritised always for contact with blood and bodily fluids, invasive procedures and contact with sterile sites. f. Consider in place of apron if extensive soiling of clothing or contact of skin with blood and other bodily fluids is anticipated. g. If non-fluid repellent gowns are used a plastic apron should be worn underneath.