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.

Last updated: 7 October 2020

On this page:

See also:

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.


When to use PPE

The first lines of defence to reduce your risk of getting or spreading infections, including COVID-19 are:

  • staying home if you’re unwell
  • hand hygiene
  • respiratory hygiene and cough etiquette
  • not touching your face
  • regularly cleaning high-touch surfaces
  • physical distancing where possible and practical.

PPE is not needed in all interactions. Its use 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. Before putting PPE on, remember to ask the key risk assessment questions about a person’s health status

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. Read more information on Standard and Transmission-Based Precautions.


How to use PPE

It’s important to use PPE correctly and safely for the work you are doing.

This guidance is based on the best available evidence and is in line with World Health Organization guidelines. It will be updated as we move through this pandemic and the New Zealand context of COVID-19 evolves.

General PPE advice in health and disability care settings for COVID-19

This PPE guidance should be read in conjunction with the Frequently Asked Questions.

It’s important to consider if you need PPE or not before putting it on. These posters will help you decide based on 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 whether the person's COVID-19 status is unknown.

If a person’s COVID-19 status is unknown, there are some risk assessment questions you need to ask ideally ahead of the interaction (ie, phoning the client before 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.

No matter what someone’s COVID-19 status is, you should always follow routine infection prevention and control precautions (Standard Precautions as well as any necessary Transmission Based Precautions) for all care.

COVID-19 status unknown

COVID-19 status probable or confirmed

PPE use in specific health and disability care settings

Masks and gloves

Risk assessments should be undertaken to determine whether masks or gloves, and which type, are required. If they are required, the following guidelines have been developed to ensure the appropriate mask or gloves are worn in the healthcare setting.

Masks

Gloves

Posters and guidance specific to different health and disability care settings are also available.

Maternity

Physiotherapy

Home

Working in people’s place of residence:

Working in client’s homes:

Hospital

Taking swabs

Role of face masks and respirators

Read information on the use of N95/P2 respirators in health and disability care settings, and advice for fit testing and fit checking them.

Putting on and taking off PPE

See the poster for putting on (donning) and taking off (doffing) PPE safely. There is also a PPE instruction video produced by Auckland DHB to help you.

Hand hygiene posters and hand washing and PPE videos are also available.


Latest updates to this page

Our advice is under active review and is updated regularly as the COVID-19 context in New Zealand changes. The latest updates are detailed here.

4 September 2020

  • Updated - Respiratory Physiotherapy guidelines for managing patients with COVID-19 infection.  
    This document replaces the previous document and includes updates and expansion on the following areas including;
    • Specific respiratory physiotherapy procedures and interventions associated with aerosol generating procedures. 
      • Guidance for undertaking a risk assessment for procedures that carry a risk of exposure to respiratory secretions. 
      • PPE requirements during respiratory physiotherapy (including the use of aerosol generating procedures) for patients not diagnosed with COVID-19 
      • Information on Standard Precautions and the use Transmission-based Precautions. 

13 August 2020

  • Updated - Alert Level 2 and Alert 3: Frequently asked questions related to Infection Prevention and Control, PPE and COVID-19 (13 August 2020) 
    • This document replaced the most recent equivalent - Alert Level 1 : Frequently asked questions related to PPE and COVID-19 (11 July 2020)
    • The new version  includes the risk assessment question links for Alert Level 2 and Alert Level 3  
       
  • Updated - Alert Level 2 and Alert Level 3: Risk assessment questions if COVID-19 status is unknown (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1: Risk assessment questions if COVID-19 status is unknown (25 June 2020) 
    • The new versions include updates to reflect the change in Alert status for New Zealand’s regions. 
       
  • Updated - Alert Level 2 and Alert Level 3: Personal Protective Equipment (PPE) required when caring for a COVID-19 case (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1: Personal Protective Equipment (PPE) required when caring for a COVID-19 case (25 June 2020). 
    • The new version includes updates to reflect the change in Alert status for New Zealand’s regions. Mask advice for cleaning staff
       
  • Updated - Alert Level 1: Personal protective equipment (PPE) in maternity settings (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) in maternity settings (25 June 2020) 
    • The new version includes updates to reflect the change in Alert status for New Zealand’s regions. 
       
  • Updated - Alert Level 2 and Alert Level 3: Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (25 June 2020) 
    • The new version includes updates to reflect the change in Alert status for New Zealand’s regions. 
      These documents have been added and were in place before alert level 1 where the document was retired
       
  • Updated - Alert Level 2 and Alert Level 3: Personal protective equipment (PPE) for staff caring for COVID-19 patients in hospital (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) for staff caring for COVID-19 patients in hospital (25 June 2020) 
    • The new version includes updates to reflect the change in Alert status for New Zealand’s regions.  
       
  • Updated - Alert Level 2 and Alert Level 3: Personal Protective Equipment (PPE) for taking COVID-19 naso/oropharyngeal swabs (13 August 2020) 
    • This document replaces the most recent equivalent – Alert Level 1:  Personal Protective Equipment (PPE) for taking COVID-19 nasopharyngeal or throat swabs (25 June 2020)
    • Rationale for the use of personal protective equipment (PPE) has been added to strengthen the guidance on the use of PPE to mitigate the risk to healthcare workers when collecting a naso/pharyngeal swab from people who meet either or both the Clinical or Higher Index of Suspicion (HIS) criteria for COVID-19. 
    • Further information has also been added on performing hand hygiene when putting on and taking off PPE.
    • The updated guidance applies across Alert Levels 2 and 3.
       
  • Added - Alert Levels 3 and 4: Personal protective equipment (PPE) for disability support workers who work in client's homes (13 August 2020)

3 July 2020

  • Updated - Alert Level 1: Frequently asked questions related to Infection Prevention and Control , PPE and COVID-19 (3 July 2020)
    • This document replaced the most recent equivalent  - Alert Level 1 : Frequently asked questions related to  PPE and COVID-19 (11 June 2020)
    • The new version has expanded the Transmission - Based Precautions section from the previous document, to include a table. 
    • The section on aerosol generating procedures has been expanded to describe what an AGP is and what the risks are during this type of procedure.

25 June 2020

  • Updated - Alert Level 1: Risk assessment questions if COVID-19 status is unknown (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1: Risk assessment questions if COVID-19 status is unknown (11 June 2020)
    • The new version includes updates to reflect the new COVID-19 case definition published on 24 June 2020, including the clinical and Higher Index of Suspicion (HIS) criteria.
  • Updated - Alert Level 1: Personal Protective Equipment (PPE) required when caring for a COVID-19 case (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1: Personal Protective Equipment (PPE) required when caring for a COVID-19 case (11 June 2020).
    • The new version includes updates to reflect the new COVID-19 case definition published on 24 June 2020, including the clinical and Higher Index of Suspicion (HIS) criteria.
       
  • Updated - Alert Level 1: Personal protective equipment (PPE) in maternity settings (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) in maternity settings (12 June 2020)
    • The new version includes updates to reflect the new COVID-19 case definition published on 24 June 2020.
       
  • Updated - Alert Level 1: Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (12 June 2020)
    • The new version includes updates to reflect the new COVID-19 case definition published on 24 June 2020.
       
  • Updated - Alert Level 1: Personal protective equipment (PPE) for staff caring for COVID-19 patients in hospital (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1: Personal protective equipment (PPE) for staff caring for COVID-19 patients in hospital (12 June 2020)
    • The new version includes updates to reflect the new COVID-19 case definition published on 24 June 2020
       
  • Updated - Alert Level 1: Personal Protective Equipment (PPE) for taking COVID-19 naso/oropharyngeal swabs (25 June 2020)
    • This document replaces the most recent equivalent – Alert Level 1:  Personal Protective Equipment (PPE) for taking COVID-19 nasopharyngeal or throat swabs (17 June 2020)
    • The new version includes: additional rationale for PPE recommendations when taking naso/oropharyngeal swabs; updates to reflect the new COVID-19 case definition published on 24 June 2020, particularly the clinical and Higher Index of Suspicion (HIS) criteria; commentary that when a swab is taken from someone with no clinical or HIS criteria, use of a plastic apron or fluid-resistant long sleeve gown is optional, based on a risk assessment of potential exposure to respiratory secretions.

22 June 2020

  • Updated – The role of face masks and respirators in health and disability care settings (17 June 2020)
    • This document updates and replaces - Transmission of COVID-19 and the role of face masks in health settings (23 April 2020) on the Advice for all health professionals website page.
    • The update includes information on the use of N95/P2 respirators in health and disability care settings and information and advice on ‘fit testing and fit checking' of respirators.

17 June 2020

  • Updated - Alert Level 1:  Personal Protective Equipment (PPE) for taking COVID-19 nasopharyngeal or throat swabs (17 June 2020)
    • This document replaces the most recent equivalent – Personal Protective Equipment (PPE): for staff taking nasopharyngeal/throat swabs from people with suspected COVID-19 infection (01 May 2020).
    • The Alert Level 1 version includes: links to further information on Standard and Transmission Based Precautions, general advice around positioning when taking a swab, advice on PPE that can be worn for the duration of a session (or undertaking the collection of a series of swabs), the specific addition of recommending the use of a plastic apron or fluid-resistant long-sleeve gown when taking swabs.  
    • This advice will continue to be updated as needed based on feedback and the evolving COVID-19 context in New Zealand.

12 June 2020

  • Updated - Alert Level 1: Personal protective equipment (PPE) in maternity settings (12 June 2020)
    • This document replaces the most recent Alert Level 2 equivalent – Alert Level 2: PPE use in maternity settings: requirements to prevent COVID-19 (15 May 2020).
    • The Alert Level 1 version reflects our current low risk COVID-19 environment and aligns with other IPC advice that has been developed for Alert Level 1. 
    • This advice will continue to be updated as needed based on feedback and the evolving COVID-19 context in New Zealand.
  • Updated - Alert Level 1: Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (12 June 2020)
    • This document replaces the Alert level 2 documents - Personal protective equipment (PPE) for community care providers who are providing care in people’s place of residence (03 June 2020) and Guidelines for personal protective equipment (PPE) Disability Support and Care Workers who work in clients homes (03 June 2020). 
    • The Alert Level 1 version reflects our current low risk COVID-19 environment and aligns with other IPC advice that has been developed for Alert Level 1. 
    • This advice will continue to be updated as needed based on feedback and the evolving COVID-19 context in New Zealand.
  • Updated - Alert Level 1: Personal protective equipment (PPE) for staff caring for COVID-19 patients in hospital (12 June 2020)
    • This document replaces the most recent Alert Level 2 equivalent – Alert Level 2: Personal Protective Equipment (PPE) requirement for staff caring for COVID-19 patients in hospital (15 May 2020).
    • The Alert Level 1 version is intended as a reference document for the use of PPE when caring for people in the hospital setting who are probable or confirmed COVID-19 cases, or someone who is under investigation for COVID-19. The document aligns with other IPC advice that has been developed for Alert Level 1.

11 June

  • Updated - Alert Level 1: Risk assessment questions if COVID-19 status is unknown (11 June 2020)
    • This document replaces the most recent Alert Level 2 equivalent – Alert Level 2: Risk assessment questions if COVID-19 status is unknown (29 May 2020)
    • This is a risk assessment for first point of contact with people whose COVID-19 status is unknown. The risk assessment should be undertaken before contact with the person if possible (by phone or signage), otherwise physical distancing of at least 1 m should be maintained while asking the questions, before any PPE is used.
    • The Alert Level 1 version has new risk assessment questions that reflect our current low risk COVID-19 environment. Acknowledging this COVID-19 risk environment and that we are coming into a period of winter illnesses, the assessment also specifies a standard IPC approach for interactions with someone who could have a non-COVID-19 acute respiratory illness (ie, new or worsening respiratory symptoms, however no recent travel history or contact that puts them at risk of COVID-19). 
    • This advice will continue to be updated as needed based on feedback and the evolving COVID-19 context in New Zealand.
       
  • Updated - Alert Level 1: Personal Protective Equipment (PPE) required when caring for a COVID-19 case (11 June 2020)
    • This document replaces the Alert Level 2 equivalent – PPE required when caring for a suspected, probable or confirmed COVID 19 case (including for care provided in place of residence) (15 May 2020)
    • It is intended as a high-level reference document when caring for a probable or confirmed COVID-19 case, or someone who is under investigation for COVID-19. If a person’s COVID-19 status is unknown, a risk assessment should be carried out before using any PPE, as per Alert Level 1: Risk assessment questions if COVID-19 status is unknown.
    • This advice will continue to be updated as needed based on feedback and the evolving COVID-19 context in New Zealand.
       
  • Updated - Frequently asked questions related to PPE and COVID-19 for the health and disability sector (11 June 2020)
    • This document replaces the Frequently Asked Questions (29 May 2020).
    • The Frequently Asked Questions (FAQs) have been updated to align with other Alert Level 1 guidance and provide additional information around Standard Precautions and Transmission Based Precautions (including Contact, Droplet and Airborne).

3 June

  • Updated: PPE use for community care providers: requirements for providing care in people's homes (14 May 2020) and PPE use for disability support and care workers: A guide when working in client’s homes (15 May 2020) 
    • Question 2 in the risk assessment has been updated to be consistent with changes to Alert Level 2: Risk assessment questions if COVID-19 status is unknown (29 May 2020) - see further details below. When providing care in a patient/client's place of residence, in the very unlikely scenario they answer 'yes' to question 2, the person providing care should wear a surgical mask if physical distancing of 1 metre cannot be maintained. Unlike contexts where emergency or urgent care is provided, there is no need to provide the patient/client with a surgical mask to wear if they answer ‘yes’ to question 2, as they are not posing a potential exposure risk to others.
    • This advice will continue to be updated as needed during and between alert levels based on the COVID-19 context in New Zealand.
    • The updated documents are titled and dated as follows: PPE use for community care providers: requirements for providing care in people's homes (3 June 2020) and PPE use for disability support and care workers: A guide when working in client’s homes (3 June 2020).

29 May

  • Updated: Alert Level 2: Risk assessment questions if COVID-19 status is unknown (15 May 2020)
    • Question 2 in the risk assessment flow chart has been updated to: 'In the last 14 days has the person been overseas or in contact with other people who are probable or confirmed to have COVID-19?'  Reference included to recent overseas travel and reference removed to ‘contact with other people who were unwell with respiratory symptoms and fever, or are suspected to have COVID-19.’ If the answer is 'yes' to question 2, we advise that the patient/client is provided a mask to wear if they are in a situation of needing to present for emergency or urgent care (noting this is expected to be a rare occurrence in our current context). This is a precautionary measure for the very low risk that they are a pre-symptomatic or asymptomatic COVID-19 case, to prevent potential transmission to others.
    • This was an anticipated amendment to be made two weeks from the move to alert level 2 if we continued to see reducing numbers of active COVID-19 cases in New Zealand and strengthening evidence that community transmission is low. 
    • This advice will continue to be updated as needed during alert levels based on the COVID-19 context in New Zealand. 
    • The updated document is titled and dated as follows: Alert Level 2: Risk assessment questions if COVID-19 status is unknown (29 May 2020)
       
  • Updated: Frequently asked questions about PPE (15 May 2020)
    • The wording of the key risk assessment questions has been updated to be consistent with the updates to Alert Level 2: Risk assessment questions if COVID-19 status is unknown (29 May 2020)
    • The use of N95/P2 respirators has been clarified as required for aerosol generating procedures (AGPs) only when working with a person whose status is COVID-19 suspected, probable or confirmed. Examples of dental procedures that generate aerosols have been added to the definition of AGPs. 
    • The updated document is titled and dated as follows: Frequently asked questions about PPE (29 May 2020)

15 May

  • Updated: Guidelines for Personal Protective Equipment use in Healthcare settings including care provided in homes (25 April 2020)
    • This has been updated to specifically give advice for PPE when caring for a COVID-19 case (suspected, probable or confirmed) in health and disability care settings, rather than also addressing requirements when caring for someone with unknown COVID-19 status.
    • The document is now called: Alert Level 2: PPE required when caring for a suspected, probable or confirmed COVID-19 case (15 May 2020).
    • It is intended as a high level reference document and is aligned with setting specific guidance developed in previous Alert Levels that is still available on this website.   
  • New: Risk assessment questions if COVID-19 status is unknown (15 May 2020)
    • This flow chart has been created to assist the health and disability sector in completing risk assessments to determine the need for PPE when caring for people of unknown COVID-19 status. 
    • Risk assessment questions were previously listed in the Frequently Asked Questions document and the poster: PPE use for community care providers: requirements for providing care in people's homes.
  • Updated: PPE use for community care providers: requirements for providing care in people's homes (7 May 2020)
    • This has been updated to be consistent with Alert Level 2 guidance reflecting physical distancing of at least 1 metre, as opposed to 2 metres.
    • The new document is titled and dated as follows: PPE use for community care providers: requirements for providing care in people's homes (14 May 2020).
  •  Updated: PPE use in hospitals: A guide for staff caring for COVID-19 positive people in hospital (1 May 2020)
    • This has been updated as follows: to be consistent with Alert Level 2 guidance including referring to the new Alert Level 2: Risk assessment questions if COVID-19 status is unknown (15 May); to include a comment to refer to local DHB guidance; to reflect inclusion of suspected, probable and confirmed COVID-19 cases.
    • The new document is now titled and dated as follows: PPE use in hospitals: A guide for staff caring for COVID-19 patients in hospital (15 May 2020).
  • Updated: PPE use for disability support and care workers: A guide when working in client’s homes (7 May 2020)
    • This has been updated to be consistent with Alert Level 2 guidance, including physical distancing. The importance of completing a risk assessment prior to the use of any PPE has also been emphasised in the table.
    • The new document is now titled and dated as follows: PPE use for disability support and care workers: A guide when working in client’s homes (15 May 2020).
  • Updated: PPE use in maternity settings: requirements to prevent COVID-19 (1 May 2020)
    • This has been updated to be consistent with Alert Level 2 guidance including referring to the new Alert Level 2: Risk assessment questions if COVID-19 status is unknown (15 May)
    • The first table has been rationalised as duplication identified.
    • The new document is titled and dated as follows: PPE use in maternity settings: requirements to prevent COVID-19 (15 May 2020).
  • Updated: Frequently Asked Questions (23 April)
    • This has been updated to be consistent with Alert Level 2 guidance including referring to the new Alert Level 2: Risk assessment questions if COVID-19 status is unknown (15 May)
    • Included link to World Health Organization poster on Standard Precautions.
    • Updated physical distancing content.
    • The new document is titled and dated as follows: Frequently Asked Questions (15 May 2020).
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