COVID-19: Infection prevention and control recommendations for health and disability care workers

Guidance on infection prevention and control (IPC) practices and personal protective equipment (PPE) in health and disability care settings for COVID-19.

Last updated: 23 March 2022

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General advice 

To reduce your risk of getting COVID-19 and transmitting it to others you should: 

  • Be up-to-date with their COVID-19 vaccinations.
  • Stay home if you’re unwell and have a COVID-19 test 
  • Perform hand hygiene regularly 
  • Practice respiratory hygiene and cough etiquette 
  • Maintain physical distancing where possible and practical 
  • Clean and disinfect surfaces as appropriate 
  • Optimise ventilation in indoor spaces.  
  • Wear appropriate PPE

For community guidance, visit COVID-19: Use of face masks in the community and the Unite Against COVID-19 website

COVID-19 IPC risk assessment 

This advice is for all health care workers in the following settings:

  • Aged residential care
  • Maternity
  • Home based care
  • Primary care

This updated guidance assists healthcare workers in selecting the appropriate PPE following a risk assessment for COVID-19. The guidance is consistent with international evidence and practice.

PPE are part of Standard Precautions which are a set of IPC measures required for all healthcare interactions. Read more about Standard and Transmission-Based Precautions.

A risk assessment is required before each interaction by the health and disability care worker (HCW) to determine what PPE is required. The risk assessment considers the patient/client/resident, the environment the task to be undertaken in and the risk of exposure to blood or body fluids. It determines the PPE is required and if additional respiratory protective PPE may be needed.

Risk assessment for COVID-19 

Before every interaction, consider the following risk factors: 

What increases the likelihood that the person may be infected with COVID-19

  • Does the person or any other household member have confirmed COVID-19 infection?
  • Does the person have any COVID-19 symptoms?
  • Is the person a household contact of a COVID-19 case or still under an isolation order?
  • Has the person been notified by Public Health and asked to self-isolate?
  • Has the person travelled internationally in the last 10 days?
  • Is an adequate contact history able to be obtained from the person? If not, a more precautionary approach is needed

What circumstances increase the risk

  • Prolonged face-to-face contact < 2metres from person
  • Will the interaction occur in a well-ventilated space?
  • Is the person and any others with them in the room able to wear a medical mask?
  • Is there widespread community transmission in your region/area?
  • Does the person require an aerosol generating procedure*?

Aerosol generating procedures – Ministry of Health

Infectious period

A person who tests positive to COVID-19 is required to isolate for a full 7 days, with Day 0 being from symptom onset, or day test taken, whichever came first. They will not be considered a household close contact for 90 days.

General COVID-19 IPC measures to reduce the risk of exposure in community healthcare settings 

To reduce the risk of exposure to COVID-19, the health and disability care worker should: 

  • Be up-to-date with their COVID-19 vaccinations.
  • Triage a person prior to any face-to-face encounter:  
    • if possible defer the visit if a person has new onset of clinical symptoms or they are COVID-19 positive.  
    • determine if a virtual appointment is possible, or delay care until no longer infectious. 
  • Practice physical distancing where possible – when close contact is required, minimise the length of the interaction. 
  • Perform regular hand hygiene. 
  • Encourage the person and any other who needs to be in the room to wear a mask where possible*.  
  • Consider the environment in which the interaction will take place: 
    • if home visiting, where possible, open the windows to improve ventilation during visit. 
    • if in a community healthcare facility, open the windows to improve ventilation if possible. Ensure any mechanical ventilation system is appropriate for use.  
    • use of other IPC measures – reduce number of people in room or premises, use of physical barriers, floor markings to maintain physical distancing.
  • use and dispose of PPE correctly

* Aged residential care residents are not required to wear a face covering  

Select personal protective equipment by referring to the COVID-19 Interim guide for PPE selection to protect primary and community health and disability care workers – Omicron update below. 

COVID-19 Interim guide for PPE selection to protect primary and community health and disability care workers – Omicron update

Complete a risk assessment before every interaction with the patient/client/resident to select appropriate PPE.

Full copy of the guidance: 

PPE guidance for COVID-19 testing 

Care of a COVID-19 case

IPC procedures for DHB acute care hospitals 

If you have any questions or queries you can email the IPC team at the Ministry [email protected] or contact your DHB IPC team.

IPC guidance for the supervision of rapid antigen testing for COVID-19 in pharmacies

COVID-19: Personal protective equipment 

The use of personal protective equipment should be considered as one of a range of infection prevention and control measures that can reduce the risk of infection from COVID-19 when used correctly, and in the appropriate context.  

PPE includes a range of items to protect the healthcare worker from exposure to harmful pathogens. Details on each of these are outlined below. 

It is important that healthcare workers check all items of PPE before donning to ensure items are not damaged, have not expired and the healthcare worker has received the appropriate education and training for putting on, taking off and safely disposing of used PPE. Consideration needs to be given to climate and temperature control, comfort breaks and hydration breaks.  

Use of medical masks and P2/N95 particulate respirators in health and disability care settings 

The following document provides information on the use of medical masks and P2/N95 respirators in health and disability care settings, including guidance on fit testing and fit checking. 

Medical masks 

A well-fitting medical mask provides protection from droplets produced by the wearer because they are contained within the mask. It also protects the wearer from infectious respiratory droplets produced when a person within 1 metre of them coughs or sneezes. 
The Ministry recommends that health, disability and support workers providing care in health and disability settings wear medical masks in all COVID-19 Protection Framework ‘traffic light’ settings. This includes school nurses and workers providing care to people in their own homes or in Disability and Aged Residential Care Facilities.

For non-client facing activities, the Ministry encourages health organisations to recommend that their workforces wear face coverings (eg, a mask) in clinical or shared work environments.

The following guide provides information on the types of masks available and the purpose of the mask ie, what it protects you from

P2/N95 Particulate Respirators 

P2/N95 particulate respirators are worn to protect against exposure to airborne pathogens smaller than droplets (< 0.5 microns). They work by filtering particles out of the air as you breathe. To be effective, a tight facial seal covering the nose, mouth and chin is required. 

Fit testing and fit checking

When a P2/N95 particulate respirator is required to be worn:

  • fit testing of P2/N95 particulate respirators is required unless the Ministry of Health deems an exemption can be applied due to exceptional circumstances.
  • every time it is used it must be put on correctly according to the manufacturer’s requirements and a fit check (also called a ‘user’s seal check’) must be performed.

We are aware that access to fit testing services remains constrained. In situations where fit testing has not yet been carried out, and a P2/N95 respirator is recommended for use, a fit-checked/user seal checked P2/N95 respirator should be worn. View the fit checking guidance.

Types of P2/N95 particulate respirators

There are different types of P2/N95 particulate respirators. Below are some useful links to manufacturer’s information to help don and fit check a P2/N95 particulate respirator correctly. Always refer to the manufacturer’s guidelines.   

Note not all brands, make or model below may be available.  

This is not an endorsement of any brand, make or model, but provides guidance on how to don and fit check the different styles of respirators.   

Manufacturers guidance on donning and fit checking 

Gloves

Gloves protect your hands when exposure to blood or other body fluids is anticipated. They should be changed between each patient or if they become punctured or torn. Hand hygiene should be performed every time you put on or take off a pair of gloves. 

Use gloves of appropriate size and type for the nature of care to be provided. For example, single use non-sterile gloves for general patient care or single use sterile gloves for aseptic non-touch technique procedures. 

The following guides provide information on the types of gloves available 

Aprons and gowns 

A fluid-resistant, long-sleeve gown should be worn to protect skin and prevent soiling of clothing during activities that are likely to generate excessive splashing of blood or other body fluids, for example when a patient is vomiting. There are different types and grades of fluid resistant gowns. 

You can wear a plastic apron whenever contamination of your clothing is anticipated during patient care, where this is unlikely to involve excessive blood or body fluid exposure. 

Eye protection 

Eye protection is worn to prevent exposure of the mucous membranes of the eye (conjunctiva) when there is likely exposure to blood body fluid splashes, respiratory droplets or from touching eyes with contaminated fingers.  

Eye protection includes goggles, safety glasses (that have side visors and fit closely to your forehead) or a face shield that covers your eyes, nose and mouth. 

When selecting protective eyewear consider the task and fit. Reusable eye protection should be cleaned safely prior to reuse, following local Infection Prevention and Control protocols or manufacturer’s instructions.  
 
Prescription glasses do not provide adequate eye protection due to gaps around the frames. Eye protection for wearers of prescription glasses include goggles which are designed to be worn over prescription glasses, safety goggles with prescription lenses or a face shield. 

Safe use of PPE 

Correctly putting on, taking off and disposing of PPE is important for your safety to  help you reduce your risk of contaminating yourself, your clothing or the environment you are working in.

Follow your facility’s policies or do a risk assessment to determine the best place to put on, remove and dispose of PPE items. 

The most important step is to ensure that you don’t remove your medical mask or particulate respirator until after leaving the patients room, home or care area. 

It is also important that you perform hand hygiene before putting on any PPE, and after you remove items of PPE. 

In a healthcare setting, used PPE should be discarded into a lined waste bin in accordance with the healthcare settings policies and procedures. 

In a community setting, used PPE should be put into a separate bag, and sealed/tied off before it is placed into general waste. 

These resources show the best practice approach to putting on, taking off and disposing of PPE in different health care settings.

PPE guidance for Home Care workers

As a home care worker, I provide health care for New Zealanders every day.

I love connecting with people and learning about their different cultures.

I enjoy helping them and take pride in my work.

To do my job well,  I need to protect myself and the people I care for by wearing the right PPE.

Before I see a client,  I always complete a risk assessment by asking myself some questions  to determine what the risk of infection could be.

This helps me decide on the right PPE to wear before I provide care.

Protecting us all, that’s what really matters.

I sanitise my hands before I hop out of my car.

My car is like my office.

I store everything I might need for the day in my boot.

In my bag, I have  medical masks, gloves, gowns or aprons, eye protection,  P2 / N95 particulate respirators, hand sanitiser, disinfectant wipes  and a waste bag.

Some of these items I’ll need to change throughout the day,  but others I can wear for a whole session.

I decide according to what happens at each of my visits.

While there is COVID in the community,  I ask everyone in the house to put on a mask before I arrive.

I also ask if windows and doors can be opened  so that I know the house is well ventilated before I enter.

The type of PPE I need to wear depends on the type of care I need to provide.

When a medical mask is the best choice  I hook the elastic bands behind my ears and fit the mask to my face  I make sure it fits well along my nose, cheeks and below my chin.

When a respirator is more appropriate  I position it over my nose and chin,  pulling the top strap over my head to rest above my ears  and the bottom strap to rest around my neck.

I place my fingers at the top of the nose band and slide them down both sides,  molding the band to my face.

Checking the seal of a respirator is really important  I cup both hands over the edges of the respirator  and quickly breathe in and out.

If I can feel any air leaking, then I know there’s not a proper seal.

I readjust until I know everything fits well and there’s no leakage.

Once my mask is on, I don’t touch it again to avoid contamination.

I sanitise my hands and then I’m safe to enter the house.

Most of the time all I need to wear is my mask,  but there are times where I will need more protection.

If I need to put on more PPE, I do this when I am inside the home.

If I need to wear a gown or apron  I fasten it behind my neck and at my waist.

Eye protection can be goggles or a face shield.

I adjust properly to my face and around the back of my head.

When putting on gloves  I pull them up high enough to cover the wrist bands of my gown.

If they ever get damaged or contaminated,  I change them straight away.

Finally, I check everything fits well before I start providing care.

When it’s time to take off my PPE,  I remove my gloves.

I peel them off one at a time  and try not to touch the outside of them with my bare skin.

I then dispose of them in the rubbish.

When removing my gown  I take care not to touch the front of it.

I break the ties at the back,  roll the gown down my arms and fold the gown into itself.

I then dispose of it in the rubbish.

Now is a good time to sanitise my hands.

Next I take off my eye protection  I pull the strap over my head,  taking care not to touch the front of my goggles.

If I know I can reuse them,  I wipe them with a disinfectant wipe,   dispose of the wipe in the rubbish and take the goggles with me.

I sanitise my hands on my way back to my car.

A lot of the time it’s ok for me to wear a respirator or a mask  so I don’t need to remove it between visits.

But when it is the right time to take it off  I grab the straps, pull them over my head  and remove the respirator away from my face without touching the front.

I dispose of it in the waste bag that I have stored in my boot.

I sanitise my hands one last time.

To keep myself safe,  I follow this process every time I visit a client  and before I finish work for the day.

Time for me to go!

PPE guidance for Residential Care workers

As an aged care worker, I provide health care for New Zealanders every day.

I’ve been working here for 14 years now  and I love taking care of the residents and working with a great team.

To do my job well,   I need to protect myself and the people I care for by wearing the right PPE.

Before I see a resident,  I always complete a risk assessment  by asking myself some questions to determine what the risk of infection could be.

This helps me decide on the right PPE to wear before I provide care.

There will be many times where all I need to wear is a mask or respirator,  and other situations where I need to wear more.

Before providing care I prepare myself with the items I might need.

Gowns or aprons, eye protection, medical masks,  P2 / N95 particulate respirators, disinfectant wipes, gloves and hand sanitiser.

Some of the PPE I’ll need to change throughout the day,  but other items I can wear for a whole session.

I decide depending on the type of care I need to provide.

Before putting on my PPE I clean my hands thoroughly.

In situations where I need to wear full PPE,  I put on my gown or apron first.

I fasten it behind my neck and at my waist.

During COVID my process can be a little different.

I may already have my respiratory protection on.

This could be a medical mask or a respirator.

If a medical mask is the best choice  I hook the elastic bands behind my ears and fit the mask to my face.

I make sure it fits well along my nose, cheeks and below my chin.

If a respirator is more appropriate  I position it over my nose and chin,   pulling the top strap over my head to rest above my ears  and the bottom strap to rest around my neck.

I place my fingers at the top of the nose band and slide them down both sides,  molding the band to my face.

Checking the seal of a respirator is really important  I cup both hands over the edges of the respirator and breathe in and out.

If I can feel any air leaking, then I know there’s not a proper seal.

I readjust until I know everything fits well and there’s no leakage.

Once my mask is on, I don’t touch it again to avoid contamination.

 Eye protection could be goggles or a face shield.

I adjust the strap around the back of my head to fit.

When putting on gloves,  I pull them up high enough to cover the wrist bands of my gown.

If they ever get damaged or contaminated, I change them straight away.

Now that I have everything fitting correctly, I can start providing care.

When it’s time to take off my PPE,  I remove my gloves first.

I peel them off one at a time  and try not to touch the outside of them with my bare skin.

I then dispose of them in the rubbish.

I sanitise my hands.

When removing my gown  I take care not to touch the front of it.

I break the ties at the back,  roll the gown down my arms and fold the gown into itself.

I then dispose of it in the rubbish.

I sanitise my hands before removing any other items.

There are many occasions where my eye protection can be worn for a session.

 If it’s time to remove it and I know I can reuse it,  I pull the strap over my head, taking care not to touch the front.

I wipe the front with a disinfectant wipe,  dispose of the wipe in the rubbish,  and store the visor safely for the next time I need it.

If I can’t reuse it, I dispose of it in the rubbish.

A lot of the time it’s ok for me to wear my respiratory protection for a session too.

I can keep it on and sanitise my hands before I see my next resident.

But when it is the right time to take it off,  I grab the straps, pull them over my head  and remove the respirator away from my face without touching the front.

I dispose of it in the rubbish.

I clean my hands a final time.

To keep myself safe,  I follow this process every time I care for a resident  and before I finish work for the day.

Time for me to go!

 

Sessional use of PPE 

Sessional (or continuous) use of PPE is the ability to wear specific PPE items without needing to remove and replace each and every time you have undertaken and completed a task or activity. 

A ‘session’ refers to a period of time where a health care worker is undertaking duties in a specific care setting or exposure environment e.g., on a ward round or providing on-going care for in-patients. The duration of a session will vary depending on the task or activity being undertaken.

A medical mask or particulate respirator must be changed every 4 hours or earlier if,  

  • it is soiled/contaminated or becomes damp 
  • it is uncomfortable 
  • it is damaged 

PPE items that can be worn sessionally:

  • Medical masks 
  • P2/N95 particulate respirators 
  • Eye protection* 
  • Long sleeve fluid-resistant gowns (unless soiled). 

*Eye protection - (does not include prescription glasses), includes face shields and goggles. Re -use of face shields can be considered if a process for decontaminating and storing eye protection has been approved by your infection prevention and control specialist. Goggles that have an elastic strap and face shields that have a foam headband may be difficult to clean. (Single person use is recommended).

If you accidently touch the front of your mask or eye protection, stop and perform hand hygiene.

PPE Items that cannot be worn sessionally are:

  • Gloves. (Staff must not ‘double’ gloves or sanitise gloves)

Change gloves (if task requires use) between activity/task and, wash/dry hands or sanitise using alcohol hand sanitiser between donning new gloves. 

Remember to avoid touching your mouth, nose and eyes.

PPE should be removed and disposed of safely after each session or earlier if damaged, soiled, or uncomfortable.

Aerosol generating procedures

Aerosol generating procedures are interventions that can promote the generation of fine airborne particles (< 5 microns). These fine particles remain suspended in the air for longer periods than larger particles and can be inhaled resulting in a risk of airborne transmission.

Some aerosol generating procedures may increase the risk of airborne transmission of COVID-19. 
 
Aerosol generating procedures include: 

  • intubation, extubation and related procedures, for example manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract) 
  • tracheotomy or tracheostomy procedures (insertion, open suctioning or removal) 
  • bronchoscopy and upper ENT airway procedures that involve suctioning 
  • upper gastrointestinal endoscopy where there is open suctioning of the upper respiratory tract 
  • surgery and post-mortem procedures involving high-speed devices 
  • some dental procedures (for example, use of any rotary handpieces, triplex syringes or ultrasonic scalers) 
  • Non-Invasive Ventilation, Bi-level Positive Airway Pressure Ventilation, Continuous Positive Airway Pressure Ventilation, High Frequency Oscillatory Ventilation, and High Flow Nasal Oxygen 
  • induction of sputum (cough). 

A P2/N95 particulate respirator should be worn by the health care worker during any aerosol generating procedure if the patient is a probable or confirmed COVID-19 case, or meets the clinical and Higher Index of Suspicion (HIS) criteria (as per current COVID-19 case definition).
 
For more information, including how to fit check, refer to PPE guidance: masks, respirators, gloves, aprons and eye protection.

Physical distancing 

Recommendation of physical distancing of at least 1 metre should be maintained in healthcare settings between healthcare staff, patients/clients/residents and visitors and other risk reducing strategies such as the use of PPE. Whenever feasible, this distance should increase especially in indoor settings and it is recommended that this should remain at 2 metres when caring for patients/clients/residents who have respiratory infections. 

Infection prevention and control guidance overview 

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