Personal Protective Equipment

- Recommendations

Serial

Recommendations

1

Ensure proper selection and use of PPE based on the nature of the patient interaction and potential for exposure to blood, body fluids and/or infectious material: a. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur. (Strong recommendation, Moderate grade evidence) b. Wear a gown that is appropriate to the task to protect skin and prevent soiling of clothing during procedures and activities that could cause contact with blood, body fluids, secretions, or excretions (Strong recommendation, Moderate grade evidence) c. Use protective eyewear and a mask, or a face shield, to protect the mucous membranes of the eyes, nose and mouth during procedures and activities that could generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed (Strong recommendation, Moderate grade evidence) d. Remove and discard PPE, other than respirators, upon completing a task before leaving the patient’s room or care area. If a respirator is used, it should be removed and discarded (or reprocessed if reusable) after leaving the patient room or care area and closing the door (Strong recommendation, Moderate grade evidence) e. Do not use the same gown or pair of gloves for care of more than one patient. Remove and discard disposable gloves upon completion of a task or when soiled during the process of care (Strong recommendation, Moderate grade evidence) f. Do not wash gloves for the purpose of reuse (Strong recommendation, Moderate grade evidence)

1.1.1    Remarks

➡️ Health workers should

· Wear a gown to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions.
Note: if the gown is not fluid-resistant, and if splashing or spraying is anticipated, a waterproof apron should be worn over the gown
· Remove the soiled gown as soon as possible and perform hand hygiene.
· Wear a medical mask (also known as a surgical or procedure mask) to protect mucous membranes of the nose and mouth against splashes or sprays of body fluids, respiratory secretions and chemicals.
· Wear a medical mask to protect the patient during aseptic procedures (e.g. During surgery or lumbar punctures).
· Wear either eye protection (eye visor, goggles) or a face shield to protect mucous membranes of the eyes during activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.
· Ensure that goggles fit over and around the eyes or personal prescription lenses.
·Ensure that a face shield covers the forehead, extends below the chin, and wraps around the side of the face – note that face shields are more comfortable to wear with eyeglasses.
· Wear a respirator (e.g. N95, ffp2, etc.) For protection from inhalation of airborne particles (tiny particles that float in the air) and/or when performing aerosol-generating procedures.
· Replace the mask or respirator if it is damaged, soiled or wet, or if breathing becomes difficult.
·The wearer should properly be trained in its safe use. Do a fit test before using a respirator for the first time, and perform a seal check every time a respirator is used.
➡️Fit Testing
1. Fit testing is done to identify the style of respirator suitable for each individual, and to ensure that it is worn correctly.
2.   If fit testing of all staff is not possible, fit testing should be prioritized for those at greatest risk infection. These include the following:
· HCW’s most likely to be involved in performing AGPs, in particular endotracheal intubation.
·HCW’s most likely to have the most frequent and or prolonged exposure to airborne infection.
3. When to considered fit testing
- At the commencement of employment for employees with significant risk of exposure to infectious microorganisms transmitted via the airborne route, for example risk is higher in an intensive care unit, during physiotherapy and performing a procedure to induce sputum in potentially infectious patients.
-  When a significant change in the Healthcare workers (HCWs) facial characteristics lead to altering the facial seal of the respirator, as in case of significant change in body weight or facial surgery.
➡️Fit Checking
To ensure that the N95 or FFP2 respirator is properly applied i.e. properly sealed over the bridge of the nose and mouth and that there are no gaps between the respirator and face, health care workers must perform fit checks every time they put on the respirator.
➡️Steps for fit checking includes:
1. Placement of the respirator on the face and place the headbands over the head and at the base of the neck.
2.Compress the respirator to ensure proper sealing on the face, cheeks and the bridge of the nose.
3.Check the positive pressure seal of the respirator by gently exhaling. If air escapes, the respirator needs to be adjusted.
4.Checking the negative pressure seal of the respirator by gently inhaling. If the respirator is not drawn in towards the face, HCW should readjust the respirator and repeat process or check for defects in the respirator.
➡️Special Considerations when using an FFP2 respirator include
· If healthcare workers have facial hair, including a one to two-day beard growth, or a long moustache adequate proper sealing cannot be guaranteed. An alternative respirator such as a powered air purifying respirator should be used.
·Do not touch respirator masks while being worn.
·Change the respirator masks when they become moist.
· Do not reuse respirator masks after they have been removed.
·Do not dangle respirator masks around the neck.
· Perform hand hygiene upon touching or disposing of a used respirator mask.
➡️Removal of N95 or FFP2 Respirator
Considerations when removing an FFP2 respirator to minimize the risk of contamination to the user include:
1.  It should be removed outside the patient care area.
2. lean head forward, remove the respirator masks by the straps from the back of the head forwards.
3. Disposed of in a closed receptacle.
4.Perform hand hygiene after removing the respirator.

1.1.1.1       Gloves

➡️Health workers should

- Wear gloves, according to Standard and Contact Precautions (as examples in the pyramid below), when contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin, or contaminated equipment could occur.

Wearing gloves doesn’t not a replace for hand hygiene.

·If your task requires gloves, perform hand hygiene prior to donning gloves, before touching the patient or the patient environment.

·Perform hand hygiene immediately after removing gloves.

Change gloves and perform hand hygiene during patient care, if

·gloves become damaged,

· gloves become visibly soiled with blood or body fluids following a task,

· moving from work on a soiled body site to a clean body site on the same patient or if another clinical indication for hand hygiene occurs.

Never wear the same pair of gloves in the care of more than one patient.

Carefully remove gloves to prevent hand contamination. (Annex.1)

Discard gloves after each task and clean your hands.

➡️The Glove Pyramid

Used to aid decision making on when to wear (and not wear) gloves. Gloves must be worn according to standard and contact precautions. The pyramid details some clinical examples in which gloves are not indicated, and others in which clean or sterile gloves are indicated. Hand hygiene should be performed when appropriate regardless of indications for glove use (Annex. 2)

1.1.1.2  Gown

1.1.1.3 Medical Masks

Health workers should

1.1.1.4 Eye protection

Health workers should

1.1.1.5 N95 or FFP2 Respirators

Health workers should

Serial	Recommendations
2	Ensure that healthcare personnel have immediate access to and are trained and able to select, put on, remove, and dispose of PPE in a manner that protects themselves, the patient, and others (Strong recommendation, Moderate grade evidence)

1.1.1 Remarks (Annex 3 Sequence for Putting and removing on PPE from CDC)
1.2  Indicators for Monitoring
To ensure the effectiveness of PPE utilization practices in hospitals and reduce the risk of HAIs, specific indicators should be monitored regularly. These indicators provide measurable data to assess compliance, identify areas for improvement, and guide interventions. Here are some Key Performance Indicators (KPIs) that can be tailored to suit different healthcare settings and contexts, ensuring thorough monitoring and evaluation of PPE usage and adherence to infection prevention and control protocols.
 
1.2.1 PPE Compliance Rate
· KPI Definition: The percentage of healthcare workers correctly donning and doffing PPE according to infection prevention and control guidelines.
·Target: Each organization should set its target according to the strength of recommendation and gap analysis.
· Calculation:

Compliance Rate =	Number of Staff Using PPE Correctly	X100
	Total number of staff observed

· Data Source: Observation audits, PPE compliance checklists (which may assess - Proper donning and doffing of PPE, Appropriate PPE used for specific tasks (e.g., gloves, masks, gowns, face shields), PPE is replaced after each use or exposure, Hands are sanitized before and after PPE use, No reuse of single-use PPE items).
· Frequency: Weekly.
 
1.2.2 PPE Availability Rate
· KPI Definition: The percentage of time that PPE is available and accessible in required areas (e.g., patient care, high-risk zones).
· Target: Each organization should set its target according to the strength of recommendation and gap analysis.
· Calculation:

PPE Availability Rate =	Number of days PPE was available in all areas	X100
	Total number of days monitored

· Data Source: PPE inventory logs, supply audits.
· Frequency: Monthly.

1.2.3  PPE Stock-out Incidence Rate
· KPI Definition: The number of PPE stock-out incidents over a given period.
· Target: Each organization should set its target according to the strength of recommendation and gap analysis.
· Calculation:

Stock out Incidence Rate =	Number of Stock out Incidence	X100
	Total number of days in the monitoring period

· Data Source: PPE inventory records, procurement reports.
· Frequency: Quarterly.
1.2.4 PPE Training Completion Rate
· KPI Definition: The percentage of healthcare workers who have completed PPE training within a specified period.
· Target: Each organization should set its target according to the strength of recommendation and gap analysis.
· Calculation:

Training Completion Rate =	Number of staff completing training	X100
	Total number of staff required to train

· Data Source: Training attendance records, staff evaluations.
· Frequency: Annually.
1.2.5  PPE Incident Reporting Rate
· KPI Definition: The number of incidents of PPE misuse or failure reported per 1,000 patient days.
· Target: Each organization should set its target according to the strength of recommendation and gap analysis.
· Calculation:

PPE Incident Reporting Rate =	Number of PPE incidents reported	X100
	Total number of patient days

· Data Source: Incident reporting systems, safety logs.
· Frequency: Monthly.
These KPIs are designed to provide measurable and actionable insights into the effective management and use of PPE in infection prevention and control settings. Regular monitoring of these KPIs will help ensure adherence to protocols, sufficient PPE availability, and overall safety for healthcare workers and patients.
The tools mentioned for monitoring and evaluating the use of PPE in infection prevention and control are developed based on general best practices from established guidelines and frameworks.
 
1.3   Plan to Update this National Clinical Guideline
This guideline will be updated whenever there is new evidence.