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Oxford University Hospitals NHS Foundation Trust

Alert Coronavirus / COVID-19

If you have a new continuous cough, a high temperature, or a loss or change to your sense of taste or smell, do not come to our hospitals. Follow the national advice on coronavirus (COVID-19).

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 box Last updated: 6 May 2021

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.

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. Eye protection to be worn if directly caring for patients with confirmed or suspected COVID-19

Level 2 PPE

  • Single pair of gloves
  • Long sleeved fluid repellent gown
  • FFP3 respirator
  • Eye protection (visor which can be disposable or reusable)

We constantly review all available evidence on levels of PPE, and at present no changes are indicated by national guidance or established evidence.

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 have put together a visual guide for you to see when you should be wearing level 1 and level 2 PPE - you can download it from the intranet: Recommended PPE for OUH (pdf)

Level 1 PPE should be worn when caring for patients who are confirmed or suspected COVID-19 or patients who are on a Amber risk pathway, or when caring for any patient where there is a risk of body fluid exposure risk. As per current PHE guidance, a fluid repellent surgical mask should be worn at all times when in the hospital.

Level 2 PPE should be worn for all aerosol generating procedures (AGPs) where the patient is suspected or confirmed to have COVID-19, and for patients who are on an amber risk pathway.

Do patients have to wear PPE?

As per PHE guidance patients should wear a face mask at all times in hospital unless there are exceptional circumstances.

Safe disposal of PPE

How should I dispose 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.

There are offensive waste bins near the exits for disposal of masks when you leave the hospitals. Clean your hands immediately after removing a mask.

Aerosol generating procedures

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:

  • tracheal intubation and extubation
  • manual ventilation
  • tracheotomy or tracheostomy procedures (insertion or removal)
  • bronchoscopy
  • dental procedures (using high speed devices, for example ultrasonic scalers/high speed drills
  • non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)
  • high flow nasal oxygen (HFNO)
  • high frequency oscillatory ventilation (HFOV)
  • induction of sputum using nebulised saline
  • respiratory tract suctioning
  • upper ENT airway procedures that involve respiratory suctioning
  • upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs
  • high speed cutting in surgery/post-mortem procedures if respiratory tract/paranasal sinuses involved.

Do nebulisers create aerosols?

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

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.

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 two metres of an aerosol generating procedure (such as performing intubation on a patient whom is suspected or confirmed to have COVID-19, or is on an amber or red pathway), need to wear FFP3 respirators.

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

If the patient requires transfer to ICU, the PPE requirement is dependent on the risk pathway the patient is on. Gloves must be changed before leaving theatre.

What level of PPE should radiographers carrying out X-rays on suspected/confirmed COVID-19 patients be wearing?

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

Why isn't level 2 PPE recommended for all diathermy procedures?

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

Donations of PPE and other supplies

What should I do if someone offers to donate PPE?

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

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.

Face masks

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 an FFP3 mask.

Fit tests are provided on all four hospital sites.

Book an appointment for a fit test here.

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

Force 8/10 mask training has moved from the e-LMS system to the simple book system, so it is now in the same place as booking a fit test.

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 differ by product, with up to three 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. Once separated from the face, FFP3s must be discarded.

Please wash your hands afterwards.

Can you ever wash disposable FFP3 masks?

No, they are 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 - what can I do?

An at-a-glance guide is now available to provide staff with consistent advice for the care of skin whilst wearing facial PPE.

Facial skin care guidance under PPE.

Contact Occupational Health for further advice.

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 Organization guidance does support the use of FFP2 masks for aerosol generating procedures, and we will keep this option in reserve.

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.

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

Safety goggles supplied for individual use are not single use, and should be cleaned with a green 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 goggles 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 OK 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 green 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.

How should I wash my uniform?

Wash your uniform:

  • 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 tumble-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.

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

Please ensure that, wherever possible, you know the patient's COVID status. When a patient is on a green pathway (COVID negative), then an entire resuscitation event can be run in level 1 PPE.

Where the patient is on an amber or red pathway (unknown, suspected or confirmed COVID) then the guidance below should be followed.

If you were wearing Level 1 PPE and a patient has a cardiopulmonary arrest or an event which requires emergency help, 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 PPE box or grab bag. Most clinical areas now have ready access to a Resuscitation PPE box which contains five sets of level 2 PPE.

Please ensure staff are aware of the location of this. There are grab bags available in addition to the resuscitation PPE box which 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 OxSTAR resuscitation web 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.

There is a Resuscitation PPE box available in the majority of clinical areas (or within easy reach of your clinical area). Please ensure staff know the location of their resuscitation PPE box.

The resuscitation PPE boxes contain five sets of PPE, which is the maximum number of people who should enter a room in these situations. In addition, there are grab bags available at set locations which are signposted above the resuscitation trolleys in your clinical area.

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

Use the same arrangements as you would usually to 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.

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.

Miscellaneous

With there being increased awareness of aerosol transmission and the new strain being more transmissible, will staff working on COVID wards be offered higher levels of respiratory protection?

As of now, the national guidance is to maintain the same levels of PPE. We will of course amend our policy if this were to change.