Personal protective equipment use in health and disability care settings

Guidance on the use of personal protective equipment (PPE) in health and disability care settings during the COVID-19 pandemic.

Last updated: 20 September 2021

On this page:


Health workers can download the Āwhina app to stay up-to-date on the latest information relevant to COVID-19 and the health and disability sector.

The information and documents on this page are updated frequently. If you have any questions, please email [email protected].


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

  • stay home if you’re unwell and get tested
  • perform hand hygiene regularly
  • practice respiratory hygiene and cough etiquette
  • avoid touching your face
  • regularly clean high-touch surfaces
  • maintain physical distancing where possible and practical
  • get vaccinated
  • optimise ventilation in indoor spaces. 

Masks or face coverings provide a further level of protection against the spread of COVID-19. Detailed information on face covering requirements at each Alert Level can be found on the Unite Against COVID-19 website.


When to use PPE

The use of Personal Protective Equipment (PPE) needs to be considered as part of a range of activities that reduce the risk of transmission of infection, when used correctly, and in the appropriate context. The use of PPE may not be required in some interactions.

Before providing care, you should carry out a risk assessment which considers the clinical situation, the risk of exposure, the type of interaction, task, the environment, ventilation, and any health risks of the patient or client. This is an important part of Standard Precautions.

In addition to Standard Precautions, you should use Transmission-Based Precautions with patients who are probable or confirmed cases of COVID-19 or meet the Clinical and Higher Index of Suspicion (HIS) criteria, as well as patients with acute respiratory and influenza-like illnesses. Transmission-Based Precautions may include additional PPE requirements such as the use of a medical mask or P2/N95 particulate respirator, eye protection, gown and gloves.

Read more about Standard and Transmission-Based Precautions.


Covid-19 risk assessment

Risk assessment posters provide guidance for carers providing health care to people, taking into account whether you know the person you are interacting with has probable or confirmed COVID-19 (or they meet the Clinical and Higher Index of Suspicion criteria), or if the person's COVID-19 status is unknown.

No matter what someone’s COVID-19 status is, you should always follow routine infection prevention and control precautions for all care. See Standard and Transmission-Based Precautions for detailed information.

Care of a Covid-19 Case

COVID-19 status unknown

When a person’s COVID-19 status is unknown, there are some risk assessment questions you need to ask ahead of the interaction (e.g., by phoning the client before the visit or with signage at your health facility), or if not possible, while maintaining the required distance dependent on the current Alert Level for your region. Please see below:


PPE requirements for specific health and disability care settings

Hospital

Refer to the infection prevention and control procedures for DHB acute care in hospitals:

Maternity

Home

The Ministry recommends that clients and their family/whānau are encouraged, if able, to wear their own face coverings (e.g., a mask) while health, disability and support workers are in their home.

Community care providers providing care in people’s place of residence:

Disability Support and Home care workers working in clients' homes:

Physiotherapy

Taking  Covid-19 swabs


PPE information:  masks, respirators, gloves, aprons and eye protection

Medical masks and respirators

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 at Alert Level 2 and above. 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 determine the face covering requirements for any clinical or shared work environments in conjunction with the local decision makers.

Health organisations that decide workers are not required to wear masks in non-client-facing settings should ensure the following mitigations are in place:

  • Maintain single person or small bubble groups
  • Understand and optimise ventilation
  • Encourage vaccination
  • Ensure workers to stay home if symptomatic or sick
  • Practice good hand hygiene and physical distancing
  • Use the NZ COVID Tracer app.

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.

A medical mask or particulate respirator should be replaced if it becomes damp or damaged, at the end of a session, or if it has been worn continuously for an extended period (up to 4 hours). 

Medical masks and respirators should not be touched or adjusted while they’re being used and should be removed and discarded into the waste prior to eating and drinking. Always perform hand hygiene before and after you remove your mask or respirator.

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

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.

Fit testing of P2/N95 particulate respirators is required unless the Ministry of Health deems an exemption can be applied due to exceptional circumstances.

Fit check P2/N95 Particulate Respirator

When a P2/N95 particulate respirator is required to be worn you need to don 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.  

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 guide provides 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 or plastic safety glasses that have side visors and fit closely to your forehead and face or a long 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 and disposal of PPE

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

It is important to note that you must always perform hand hygiene before putting on any PPE, and again both before and after you remove the 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.

Standard and Transmission-Based Precautions

Standard Precautions

Standard Precautions are a set of routine infection prevention and control practices used to prevent transmission of diseases associated with healthcare. Standard Precautions should be used for all patient/client care activities, regardless of their diagnosis or suspected infectious status. This helps to protect health care workers from infection and prevents the spread of infection from patient to patient.

Before any patient interaction, all health care workers should also assess the infectious risks posed to themselves, their colleagues, other patients and visitors.  

The key elements of Standard Precautions are as follows:

  • Hand hygiene - perform hand hygiene before and after touching a patient/client, before and after cleaning or aseptic procedures, and after touching patient surroundings, as well as before and after putting on and taking off PPE. 
  • PPE - Select PPE before any health care activity based on an assessment of the likely risk of exposure to body substances or contaminated surfaces. For example, wear gloves if your hands may be in contact with body fluids, wear an apron or gown to prevent soiling of clothing, and wear a face shield/mask/goggle if droplets or splashes are likely to be generated near your face (e.g., when taking a nasopharyngeal swab).
  • Respiratory hygiene and cough etiquette - sneezing or coughing into the crook of your elbow or covering coughs and sneezes with a tissue, then putting the tissue in a bin and cleaning your hands.
  • Safe use and disposal of needles and other sharps 
  • Aseptic ‘non-touch’ technique - for all invasive procedures, including appropriate use of skin antisepsis. 
  • Patient care equipment – clean, disinfect and reprocess reusable equipment between patients. 
  • Appropriate cleaning and disinfection - of environmental and other frequently touched surfaces.
  • Safe waste management 
  • Safe handling of linen 
     

Refer to the World Health Organization (WHO) poster for further information.

Hand hygiene

Hand hygiene means washing your hands with soap and water for at least 20 seconds and drying them for 20 seconds. You can also use hand sanitiser (containing at least 60 percent alcohol) if soap, water and paper hand towels are not available, and if your hands are not visibly dirty. If you use hand sanitiser, cover all the surfaces of your hands and rub them together until they feel dry.

Perform hand hygiene before and after touching a patient/client, before and after clean or aseptic procedures, after touching patient surroundings, as well as before and after putting on and taking off PPE.

Remember to wash your hands before preparing and eating food, after using the toilet, and after sneezing and coughing.

Review the ‘5 moments for hand hygiene’.
See also the hand hygiene video and posters.

Respiratory hygiene and cough etiquette

People with respiratory symptoms should be facilitated and encouraged to sneeze or cough into the crook of their elbow or cover their coughs and sneezes with a tissue, then put the tissue in a bin and clean their hands.

Health care facilities should:

  • Put signage at the entrance to health care facilities instructing people with acute respiratory symptoms to practice respiratory hygiene and cough etiquette, and alert staff to their symptoms.
  • Make hand hygiene information, hand sanitiser, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.
  • Place people with acute respiratory symptoms at least 1 metre away from others in common waiting areas or in a single room (if available). Ask the person to wear a mask until they can be moved to a single room.

Transmission-Based Precautions

Transmission-Based Precautions are a secondary set of infection prevention and control practices. They are used in addition to Standard Precautions for patients who may be infected or colonised with infectious pathogens, specifically to prevent transmission of infections.

Transmission-Based Precautions are – contact, droplet and airborne. 

The Transmission-Based Precautions required to prevent each mode of transmission are set out in the following sections of this page.

Contact Precautions

Contact Precautions are required when interacting with people known or suspected to have infections or diseases that can be transmitted through either direct or indirect contact with people, objects or environmental surfaces that have infectious matter on them.

The following Contact Precautions apply for all interactions that involve contact with the patient or potentially contaminated objects and surfaces in the patient’s environment:

  • Wear single-use, non-sterile gloves
  • Wear a disposable plastic apron or fluid-resistant long sleeve gown

The patient should be placed in a single room, preferably with its own bathroom.  Appropriate signage of PPE requirements should be displayed outside the room.

Droplet Precautions

Droplet Precautions are required when interacting with people known or suspected to have infections or diseases that can be spread by droplets.

The following Droplet Precautions apply for all interactions:

  • Wear a medical mask upon room entry or when interactions mean that physical distancing of 1 metre cannot be maintained
  • Wear eye protection (goggles or face shield) to reduce exposure to respiratory droplets by touching your eyes or patient coughing or sneezing
  • Where possible, the patient should wear a medical mask whilst awaiting assessment, or for any movement outside of the single room, along with strict adherence to respiratory hygiene and cough etiquette.

The patient should be placed in a single room, preferably with its own bathroom. Appropriate signage of PPE requirements should be displayed outside the room.

Airborne Precautions

Airborne Precautions are required when interacting with people known or suspected to have diseases spread by very small particles that can suspend in the air and can be inhaled into the lungs. 

The following Airborne Precautions apply for all interactions:

  • Wear a P2/N95 particulate respirator that you have fit checked before room entry. See PPE information on masks, respirators, gloves, aprons and eye protection for guidance on donning and fit checking.
  • Where possible, the patient should wear a mask whilst awaiting assessment, or for any movement outside of a single room, along with strict adherence to respiratory hygiene and cough etiquette.
     

Patients in a hospital setting should be placed within an airborne infection isolation room (negative pressure room). In other settings, the patient should be placed in a single room, preferably with its own bathroom. Appropriate signage of PPE requirements should be displayed outside the room.

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.


Visits to COVID-19 cases in isolation

Visiting should be restricted to essential visitors only and align with the COVID-19 Alert Levels range of measures and the health care facility’s visitor policy.

If visitors are allowed, they need protection from infectious respiratory droplets while they are in the room and should be provided with a medical mask. Show visitors:

  • how to put on a mask properly
  • how to dispose of the mask safely
  • how to perform hand hygiene before and after handling the mask, and when they enter and leave the room. 

Visitors should be asked to leave the room if the patient needs an aerosol producing procedure.


Updates to this page

On 17 September 2021 this page was updated to incorporate information previously included in a separate ‘PPE frequently asked questions’ page.

On 15 September 2021 this page was updated to clarify that health, disability and support workers providing care in health and disability settings are recommended to wear medical masks at Alert Level 2 and above.

The following documents were updated on 8 September 2021 to reflect new Delta Alert Level 2 advice:

  • Alert Level 2: Risk assessment questions if COVID-19 status is unknown 
  • Alert Level 2: Personal Protective Equipment (PPE) in maternity settings
  • Alert Level 2: Personal Protective Equipment (PPE) for community care providers who are providing care in people’s place of residence
  • Alert Level 2: Personal Protective Equipment (PPE) for disability support workers who work in clients’ homes
  • Alert Levels 3 and 4: Personal protective equipment (PPE) for disability support workers who work in clients' homes.

Key document changes include:

  • clarifying that with the very low risk of COVID-19 in the community at Alert Level 2, a P2/N95 particulate respirator is only required if the person meets the Clinical and Risk Factor Criteria
  • updated guidance that women receiving care in maternity settings under Alert Level 2 should wear a mask during in-person care and during labour and birth, if tolerated
  • updating guidance for disability support workers to also include guidance for home care workers
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