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Oxford University Hospitals NHS Foundation Trust

AlertCoronavirus / COVID-19

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Please find information on our services and visiting restrictions in our COVID-19 section.

Patients and visitors must wear a face covering in our hospitals.

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COVID-19 Staff FAQs: Personal Protective Equipment

Information alert boxLast updated: 10 July 2020

This is a fast moving situation and we will try to keep this page as up-to-date as possible.
Please continue to check national guidance on the COVID-19 pandemic.

If your question is not answered below, and you are a member of staff, please speak to your line manager or email covidquestions@ouh.nhs.uk

If your question is about an OUH HR matter that isn't addressed here, please discuss this initially with your line manager who can then raise it with the HR consultant for your Division.

Some links are to documents on the OUH internal staff intranet: if you are a staff member and cannot access the intranet, please email covidquestions@ouh.nhs.uk and we will send you the document you need.

Please remember guidance is likely to change rapidly, so check back to see if you have the most up-to-date version of a document.

Please see Face masks for further guidance on face masks for staff and face coverings for patients.

What is PPE?

What is PPE?

PPE stands for Personal Protective Equipment, and comes in several levels.

What is level 1 PPE?
  • Single pair of gloves
  • Disposable plastic apron
  • Fluid repellent surgical mask
  • Eye protection if you feel there is a risk of patient coughing, or splash or droplet exposure.
What is level 2 PPE?
  • Double pair of gloves to allow for changing top pair of gloves between patients or procedures. Bottom gloves should overlap the gown sleeves.
  • Long sleeved fluid repellent gown
  • FFP3 respirator
  • Eye protection (visor which can be disposable or reusable)
What is the PPE Safety Team?
The PPE Safety Team is available to support the safe and correct use of PPE. It has been developed by our Infection Prevention and Control (IPC) colleagues with the support of the Divisions, and will be available across all Trust sites to give advice and help on PPE where needed. Keep an eye out for them - they'll be in pink hi-vis jackets.

The role is supported by the IPC team, but also has volunteers. If you are interested in being part of the PPE Safety Team and learning new skills while supporting your colleagues, please contact the IPC team or email gabriella.damato@ouh.nhs.uk

When to wear PPE and what to wear

When do we wear level 1 and level 2 PPE?

We are now advising level 1 PPE for all face to face patient contacts (within 2 metres) throughout our hospitals.

In COVID-19 cohort wards, a fluid repellent surgical mask should be worn as soon as you walk onto the ward, with the addition of gloves, apron, and eye protection if required when within 2 metres of a patient.

Level 2 PPE should be worn for all aerosol generating procedures irrespective of whether the patient is suspected to have COVID-19 or not. In particular settings like our Adult Intensive Care Unit or respiratory ward level 2 PPE should be worn at all times.

Safe disposal of PPE
Some PPE – including disposable masks and gloves – has been disposed of inappropriately in general waste and recycling bins in our hospitals. This is an infection prevention and control risk – please make sure that you dispose of PPE correctly by putting disposable equipment in clinical waste bins only before leaving a clinical area. Thank you for your co-operation.
What is an aerosol generating procedure?

Aerosols generated by medical procedures are one route for the transmission of the COVID-19 virus. The following procedures are considered to be potentially infectious AGPs:

  • Intubation, extubation and related procedures e.g. manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)
  • Tracheotomy/tracheostomy procedures (insertion/open suctioning/removal)
  • Bronchoscopy and upper ENT airway procedures that involve suctioning
  • Upper Gastro-intestinal Endoscopy where there is open suctioning of the upper respiratory tract
  • Surgery and post mortem procedures involving high-speed devices
  • Some dental procedures (e.g. high-speed drilling)
  • Non-invasive ventilation (NIV) e.g. Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)
  • High Frequency Oscillatory Ventilation (HFOV)
  • Induction of sputum
  • High flow nasal oxygen (HFNO)
  • Cardiopulmonary Resuscitation

    People have asked if a nasogastric tube insertion is an aerosol generating procedure (AGP). It is not included in the list of procedures by Public Health England, and it is recommended that level 1 PPE is worn for this procedure - including appropriate eye protection.
Donations of PPE and other supplies

Our Procurement team has been successful in keeping a steady supply of PPE into the Trust to keep staff safe. The Trust has also received some substantial donations of PPE.

  • If you are contacted by someone wanting to make a substantial donation of PPE, please contact donations.ppe@ouh.nhs.uk
  • If you are contacted by someone wanting to make a non-PPE donation (offers of food, toiletries etc), please contact Oxford Hospitals Charity ouh.charitysupport@ouh.nhs.uk

Please note, the Trust cannot accept all offers of PPE as some do not meet appropriate standards. The Trust is working closely with system partners to ensure that, if there is a surplus of any PPE and another part of the healthcare system has a need, PPE and equipment is shared appropriately.

What do we wear to transfer patients who are intubated from theatre to ICU?

If the patient requires transfer to ICU, it will be the theatre anaesthetist performing this, who should remain in their level 2 PPE. Gloves must be changed before leaving theatre. An Operating Department Practitioner (ODP) with clean level 1 PPE should travel with them to open all doors etc.

Should Level 2 PPE now be used for all patients undergoing aerosol producing procedures in theatres?

Staff should wear protective clothing but only those within 2 metres of an aerosol generating procedure, such as performing intubation, need to wear FFP3 respirators.

What level of PPE should radiographers carrying out X-rays on suspected/confirmed cases be wearing?

Level 1 PPE, the same as all staff who have patient contact, as a chest x-ray is not an AGP.

In non-ventilated patients (including children) who are in a cubicle and are requiring suctioning, should we be wearing Level 2 PPE whenever entering the cubicle?

You should wear Level 2 PPE during the procedure and for up to 1 hour in the area after an AGP has been performed depending on the level of ventilation.

Do nebulisers create aerosols?

They are not included in the list of AGPs because the mist/aerosolisation that you can see is the nebulised medication, and not aerosolisation of upper airway secretions.

Is there is a risk to staff performing AGPs with patients who don't have suspected COVID-19?

We are recommending level 2 PPE for performance of all AGPs, whether the patient has suspected COVID-19 or not.

Viruses can be transferred through diathermy smoke. Why isn't level 2 PPE recommended for all diathermy procedures?

There is no evidence for transmission of respiratory viruses through diathermy smoke.

Face masks

When should I wear a fluid repellent surgical mask?

Fluid repellent surgical masks should be worn for all patient contact (within 2 metre) whether the patient is thought to have COVID-19 or not. On wards where there are COVID-19 patients cohorted, a fluid repellent mask should be worn as soon as you walk onto the ward, with the addition of gloves, apron, and eye protection if required when within 2m of a patient.

You can keep your surgical mask on in between patients and when moving between clinical areas. Masks should be changed appropriately, and please remember not to touch the exterior of the mask.

Masks should never be worn around the neck.

More information is available under Personal Protective Equipment – Mask fitting and removal.

How can I be fit tested for a mask?
If you are a member of staff required to wear level 2 PPE, which includes a Force 8/10 Typhoon reusable mask and/or a disposable FFP3 mask, you must book in to have a fit test before you are next required to use a FFP3 mask.

Fit tests are provided on all four hospital sites.

To book an appointment, please click on the appropriate link in the announcement on the staff intranet, below, and enter your name into an available time slot.

Fit testing - book an appointment

Venue details are included within each of these links.

Who do I contact for training in the use of Force 8 or 10 FFP3 masks?

If you need training for Force 8 or 10 reusable FFP3 masks, please book yourself in by emailing: Force810.masktraining@ouh.nhs.uk

When should I wear a FFP3 respirator mask?

Filtering face piece (FFP3) respirators should be worn during aerosol generating procedures (AGPs) and at all times in our adult intensive care unit (ICU), and respiratory ward where high flow nasal oxygen and other forms of non-invasive ventilation are in regular use.

In theatres, level 2 PPE should be worn by all individuals within 2 metre of aerosol generating procedures.

How long can I wear a FFP3 respirator mask for?

You can wear the mask continuously for as long as is comfortable and between patients. Manufacturer guidelines differs by product, with up to 3 hours being the average.

You should remove the mask if:

  • The mask becomes uncomfortable
  • Breathing becomes difficult
  • The respirator is damaged or distorted
  • The respirator becomes obviously contaminated by respiratory secretions or other bodily fluids
  • A proper face fit cannot be contained

Please dispose of the mask safely, without touching the front of it. See Personal Protective Equipment – mask fitting and removal.

Once separated from the face FFP3s must be discarded. Please wash your hands afterwards.

Can you ever wash disposable FFP3 masks?

No, they are currently single use. They must be disposed of appropriately in clinical waste bins after use.

Do surgeons and anaesthetists in theatre participating in aerosol generating procedures need to change FFP3 every hour?

No, you only need to change your mask at the end of the procedure. However, if the procedure requires sterility and sterility is compromised, you will be required to doff, rescrub and redon.

Additionally, if breathing becomes difficult, if the respirator is damaged or distorted, if the respirator becomes obviously contaminated by respiratory secretions or other body fluids, or if a proper face fit cannot be maintained, you should immediately undertake doffing and redonning procedures.

I have a facial condition that makes it difficult for me to wear an FFP3 respirator mask, what should I do?

Please speak to your line manager who may be able to organise a hood for you to use or discuss alternatives.

I have facial skin damage from wearing PPE
A new at-a-glance guide is now available to provide staff with consistent advice for the care of skin whilst wearing facial PPE. Occupational Health has a direct access Dermatology Clinic for any staff member with skin issues and the self-referral form is available on the Occupational Health intranet
Can we ever use FFP2 masks as part of PPE?

FFP2 masks are not currently recommended by Public Health England to be used as part of AGPs. We note that World Health Organisation guidance does support the use of FFP2 masks for aerosol generating procedures, and we will keep this option in reserve.

I have only been fit tested on FSM 16 and 18 masks which are no longer being stocked. Can I use a different FFP3 mask?

You need to get a satisfactory FIT check before you proceed to a patient's room. A Fit test is a slightly different test which we are not currently using.

If you cannot get a good seal and you feel air leaking from the side of the mask no matter how much you adjust it, you should not enter the patient's room for an AGP. There is guidance on the OxStar and the Infection Prevention and Control websites on how to do a Fit check - please see Personal Protective Equipment – Mask fitting and removal. If you have any problems, please speak to your line manager about alternatives.

Does a surgical mask offer the correct protection when dealing with COVID-19 positive patients given the knowledge that there will be aerosols when coughing, laughing and talking and the staff will be close to the patient?
The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces. The most common modes of transmission are assumed to be droplet and contact.

Fluid-resistant (Type IIR) surgical masks (FRSM) provide barrier protection against respiratory droplets reaching the mucosa of the mouth and nose. The protective effect of masks against severe acute respiratory syndrome (SARS) and other respiratory viral infections has been well established.

There is no evidence that respirators add value over FRSMs for droplet protection when both are used with recommended wider PPE measures in clinical care, except in the context of Aerosol Generating Procedures (AGPs).

PPE coverage

My neck is not covered during procedures and I have seen other countries wear hoods, why can we not do this?

Current PHE advice does not include neck coverage. We do however advise pulling your apron up high around your neck. If you are concerned about your neck, you can wash the exposed area of your neck after potential exposure.

Why are we only using eye protection for some patients in Level 1 PPE, when in WHO guidance it is recommended for all patients?

We are recommending clinical staff risk assess the need for eye protection. If you believe the patient is coughing and you are going to be close enough for that to be a spray concern, then you should wear eye protection.

Eye protection is recommended for any procedure with risk of splash or spray including taking nose and throat swabs. The Trust now has a good supply of reusable safety glasses for individual use, and these can be worn at all times if comfortable.

We have been asked locally to keep our eye protection for reuse by wiping them down with Clinell wipes, is this okay?

Safety glasses supplied for individual use are not single use, and should be cleaned with a Clinell wipe and safely stored for re-use by each individual. The Trust also has a supply of sturdy reusable visors.

Should I be changing scrubs or showering after removing PPE?

You are free to shower after procedures if you feel that is necessary. We do advise changing out of your uniform or scrubs prior to leaving the hospital site and travelling home.

I wear glasses, what should I do about keeping them clean?

Please remember that regular corrective glasses are not considered adequate eye protection, and you should always wear a visor or other disposable eye protection when involved with an aerosol-generating procedure. The Trust has a supply of safety glasses designed to be worn over glasses.

If you wish, you can clean your glasses with Clinell when changing PPE. These can be taken off via the spectacle side arms, passed to your buddy (if you are in theatre or ICU) who will then clean them with Clinell wipes, or put down and then cleaned if you don't have a buddy.

What happens if my gloves tear or my skin is exposed at some point?

Don't panic! It's completely okay if this happens - just make sure you wash your hands or the exposed area thoroughly with soap and water.

What happens if I get a mucosal splash when not wearing appropriate protection from a suspected or COVID patient?

You should follow standard splash incident guidelines and wash out the area with water.

Should I clean my shoes?

You should wear wipeable shoes and clean them with Clinell wipes only if they become grossly contaminated, and after finishing your shift. Shoes should ideally be left at work or kept separately from other clothes. Please do not wear bin bags or shoe covers over your shoes as this presents a slip hazard.

Are we meant to be wearing scrubs underneath Level 1 and Level 2 PPE?

You do not need to wear scrubs under PPE.

Do not come into work, or leave work, wearing your uniform or scrubs.

Uniforms should be transported home in a disposable plastic bag or an alginate bag.

Uniforms should be laundered:

  • separately from other household linen;
  • in a load not more than half the machine capacity;
  • at the maximum temperature the fabric can tolerate, then ironed or tumbled-dried.
Previous guidance regarding gloves before aprons has been changed. Why is this?

Feedback from our staff regarding the PHE guidance of removing gloves before apron suggested that intuitively this seemed like an inherently riskier order.

We have taken this into account and therefore changed the guidance to reflect staff input. We now recommend taking off the contaminated apron first with your gloves on, and then removing the gloves using a pinch and pull technique.

Remember - hand hygiene is the most important part of all PPE.

Do I need to wear a third pair of gloves when performing a sterile procedure?

No, you don't. Guidance says that the second pair of gloves should be adequate to the task, so if you were going to do a sterile procedure, your second pair of gloves would need to be sterile.

We do not have Level 2 PPE in our clinical area. In an arrest situation, what should we do?

If you were wearing Level 1 PPE, and a patient has a cardiopulmonary arrest, the priority is to dial 2222 and request the appropriate emergency team as per the yellow posters in your area.

If in level 1 PPE, the defibrillator can be attached to the patient and the patient shocked if appropriate.

Following this, preparation should be made for intubation as per the instructions provided in the advanced airway drawer of the resuscitation trolley. A member of the ward or department team should be sent to get the nearest resuscitation grab bag which again is signposted at the resuscitation trolley. As soon as someone is in level 2 PPE chest compressions can be started.

No airway management should be attempted before the arrival of the anaesthetist on the resuscitation team. We do not recommend that you take any risk, though we appreciate this is difficult as it is different to everything we would do normally.

In these exceptional circumstances, we do need to ensure the safety of all of our staff. Please see the resuscitation page for more information and a video guide.

How do we know where to find the right equipment (PPE, grab bags etc) in an emergency?

Each clinical area has a poster visible above their resuscitation trolley directing them to the location of their nearest resuscitation grab bag with PPE.

The majority of the COVID cohort wards have added a set of PPE to the bottom drawer of the resuscitation trolley, and this is work which is progressing. The Resuscitation Department have provided lists to various clinical areas of the PPE required for resuscitation and are coordinating the grab bags across all sites for the purposes of the resuscitation team.

The resuscitation grab bags contain 5 sets of PPE, which is the maximum number of people who should enter a room for one of these patients. The system is that a member of the ward team should access the PPE grab bag once the emergency in the clinical area has been declared. If there is an uncertainty about the location of the nearest resuscitation grab bag of PPE, please contact the Resuscitation Practitioners on your site.

What should I do if I work in the community setting, with regarding to disposing of PPE, and advise on uniforms, if we are using our own cars?

Use the same arrangements as you would usually dispose of clinical waste in the community setting, as PPE is standard clinical waste.

Regarding uniforms ensure level 1 PPE is worn for each patient contact and disposed of as above. This along with good hand hygiene should reduce contamination of uniforms or cars.

Where can I get skin issues advice?
In conjunction with Dermatology colleagues, Occupational Health is offering additional support for any staff member developing skin issues in relation to work. Please submit a Skin clinic self-referral form which is available on the Occupational Health intranet.
Is bare below the elbow the right strategy when dealing with COVID-19 patients?

Consistent with the World Health Organization (WHO) guidelines, full sleeve gowns are recommended for high risk procedures (e.g. during AGPs) or where there is a risk of extensive splashing of blood and/or other body fluids.

In all other settings, the UK has a longstanding bare below the elbow policy as part of our long-term strategy to manage healthcare associated infections. COVID-19 is not airborne, it is droplet carried. You cannot be infected with COVID-19 via the skin.

We know the cross-contamination from gowns for infection can be carried by the gown sleeves and the advice therefore is bare below the elbows and you scrub your hands, your wrists and your forearms after removing your apron, gloves and mask.

In addition to wearing PPE, clinicians should practise usual infection prevention and control measures, including environmental cleaning and hand hygiene, to reduce the risk of onward transmission.

PPE supplies

Who is the contact for central supplies of PPE equipment?

Each clinical directorate should have a named person to contact for PPE supplies. This named person will link with the Procurement team to email for stock.

Does the trust now have good supplies of FFP3 masks? How do we access the centralised PPE?

Procurement have been working really hard to ensure we do have sufficient supply of FFP3 masks. The centralised stock is supervised by the Procurement team. As above, each clinical directorate should have a named person who has a contact in Procurement.

Other equipment

Is paper allowed in theatre when undergoing an AGP with a COVID-19 patient?

There will be anaesthetic charts available in a wipeable format which should be screenshot and printed or uploaded to EPR. The chart should be wiped clean and left in theatre.