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: 10 December 2021

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General advice 

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

  • Be fully vaccinated and have the COVID-19 booster as and when required 
  • 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

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 and replaces previous information under the ‘Alert Level’ system.

Standard Precautions are a set of IPC measures required for all healthcare interactions. 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 and determines the risk of exposure to blood or body fluids and if personal protective equipment (PPE) is required.

Read more about Standard and Transmission-Based Precautions.

Risk assessment for COVID-19 

Before every interaction, consider 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 close 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 (excluding travel by air from a country/area with which NZ has quarantine free travel)?
  • Does the person require an aerosol generating procedure?
  • Is an adequate contact history able to be obtained from the person?

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 fully vaccinated for COVID-19.  
  • Triage a person prior to any face-to-face encounter:  
  • Consider deferring 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. 
  • Perform regular hand hygiene. 
  • Encourage the person and any other who needs to be in the room to wear a mask where possible*.  
  • Practice physical distancing where possible – when close contact is required, minimise the length of the interaction. 
  • Consider the environment in which the interaction will take place: 
  • If home visiting, where possible, open the windows to improve ventilation before and during visit. 
  • If occurring in a community healthcare facility, open the windows to improve ventilation if possible. Ensure any mechanical ventilation system is appropriate for use.  

* 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 below. 

Infectious period

The person with COVID-19 infection is generally infectious for at least 10 days after the onset of symptoms, or a positive test result. If there are whānau/family or others in the household, their period of infectivity also needs to be considered. Seek advice from the public health team. 

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

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

View the risk assessment table here: 

Full copy of the guidance: 

PPE guidance for COVID-19 testing 

Care of a COVID-19 case

IPC procedures for DHB acute care in 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 of P2/N95 particulate respirators is required unless the Ministry of Health deems an exemption can be applied due to exceptional circumstances. When a P2/N95 particulate respirator is required to be worn, you need to put on the respirator correctly according to the manufacturer’s requirements and perform a fit check – sometimes called a ‘user’s seal check’ – every time it is put on. 

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 

This poster sets out how to put on and remove PPE safely: 

It is 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 waste bag in accordance with the healthcare settings procedures. 

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

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. The duration of a session will vary depending on the task or activity being undertaken 

It is still expected that medical or particulate respirators will be removed when staff go for their meal breaks. A new mask or particulate respirator will be needed on return to duties.  

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 

All staff can wear items of PPE sessionally. These include: 

  • Medical masks 
  • P2/N95 particulate respirators 
  • Eye protection 
  • Long sleeve fluid-resistant gowns. 

Items that cannot be worn sessionally are:

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

A session refers to a period of time where a worker is undertaking duties in specific zones/areas.  

A session ends when staff leaves the zone or area. 

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

Key principles 

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 

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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