An increased level and use of PPE during a COVID-19 outbreak is required to protect staff, visitors and residents from both known and unknown sources of infection.
The level of PPE required by staff and visitors in RACFs is dependent on the area/zone worked within the facility and the activity being undertaken.
Undertake all PPE donning and doffing of PPE with a PPE buddy wherever possible to ensure PPE is worn correctly and a fit check of the P2/N95 has been performed.
Display the approved signs outlining the appropriate PPE for various roles and circumstances at PPE donning and doffing stations.
Display posters for the correct sequence of donning and doffing PPE at PPE donning and doffing stations.
PPE used in RACFs are:
- Surgical mask – single use
- P2/N95 mask – single use
- Protective eyewear – single use or reusable
- Face shield – single use or reusable
- Gown – single use
- Gloves – single use
The PPE required is task specific and are outlined in Table 1.
The sequence for putting on and taking off PPE is outlined in Table 2.
Replace masks if they become damp, visibly soiled, accidently dislodged or have been in place for four hours. Do not touch the outside of the mask or leave the mask under the chin.
Staff who wear P2/N95 masks should ideally complete an initial fit test and must perform a fit check each and every time they don a P2/N95 mask. Where fit testing has not been performed and a P2/N95 mask is recommended for use, a fit-checked P2/N95 mask is preferred to a surgical mask.
To watch a fit check see Personal Protective Equipment demonstration videos | Tasmanian Department of Health.
The level of PPE required for visitors to wear is dependent on the COVID-19 status of the resident and whether the visit is indoors or outdoors (Table 1).
Visitors must be made aware of the risks of visiting during a declared outbreak and must be instructed and observed on the use of PPE and how to perform hand hygiene.
Residents should wear a surgical mask when possible, during face to face visiting.
Definitions
Direct care – where the resident is being physically touched by the carer. Most often occurs during assistance with activities of daily living.
- Examples – assisting with bathing, dressing, toileting, ambulation; performing a procedure such as a wound dressing or catheterisation;
Indirect care – where care is provided but there is no physical touching of the resident by the carer
- Examples – dispensing medication, putting a meal tray down in the resident’s room, giving the resident an electronic device such as an iPad.
Direct contact with the physical environment
- Example – cleaning a resident’s room, cleaning high touch areas in common areas, cleaning bathrooms, waste removal
No direct or indirect care or contact with the physical environment
- Example – preparing food in the kitchen, office work, administrative work.
Visiting/Visitors
- Example – people not employed by the RACF such as friends or relatives or pastoral care
Table 1 - PPE requirements for different activities
|
COVID positive resident and close contacts PPE required |
COVID negative resident PPE required |
|
|
|
P2/N95 mask Eye protection or face shield Gown Gloves |
P2/N95 mask Eye protection or face shield Wear extra PPE as required as per Standard Precautions |
|
Indirect care |
P2/N95 mask Eye protection or face shield Gown |
P2/N95 mask Eye protection or face shield
|
|
Direct contact with the physical environment
|
P2/N95 mask Eye protection or face shield Gown Gloves |
P2/N95 mask Eye protection or face shield Gown and gloves if required for OH&S when cleaning
|
|
No direct or indirect care |
Surgical mask |
Surgical mask |
|
Visiting – face to face visits indoors (e.g. end of life) |
Resident - Surgical mask if able to be worn Visitor – N95/P2 mask, eyewear, gown. Gloves not required but HH must be performed |
Resident – no PPE required Visitor – surgical mask. |
|
Visiting - face to face outside |
Resident – surgical mask if able to be worn Visitor – P2/N95 mask and protective eyewear |
Resident – no PPE required Visitor – no PPE required |
|
Visitors – window visiting with window closed |
No PPE required |
No PPE required |
Table 2 - Sequence for putting on and taking off PPE
|
PPE |
Putting on (donning) sequence |
Taking off (doffing) sequence |
|
Mask + protective eyewear/faceshield |
Hand hygiene using ABHR Put on mask Hand hygiene using ABHR Put on protective eyewear/faceshield Hand hygiene using ABHR
|
Hand hygiene using ABHR Take off protective eyewear Dispose of disposable eyewear/faceshield OR Clean reusable eyewear Hand hygiene using ABHR Take off mask Hand hygiene using ABHR |
|
Mask + protective eyewear/faceshield + gown |
Hand hygiene using ABHR Put on mask Hand hygiene using ABHR Put on protective eyewear/faceshield Hand hygiene using ABHR Put on gown |
Hand hygiene using ABHR Take off gown Hand hygiene using ABHR Take off protective eyewear/faceshield Dispose of disposable eyewear/faceshield OR Clean reusable eyewear Hand hygiene using ABHR Take off mask Hand hygiene using ABHR |
|
Mask + protective eyewear + gloves + gown/apron |
Hand hygiene using ABHR Put on mask Hand hygiene using ABHR Put on protective eyewear/faceshield Hand hygiene using ABHR Put on gown Hand hygiene using ABHR Put on gloves
|
Take off gloves Hand hygiene using ABHR Take off gown Hand hygiene using ABHR Take off protective eyewear/faceshield Dispose of disposable eyewear/faceshield OR Clean reusable eyewear Hand hygiene using ABHR Take off mask Hand hygiene using ABHR |
Resources
Communicable Diseases Network Australia (CDNA)
Infection Control Expert Group (ICEG) – endorsed infection prevention and control guidance
- Revised guidance on the use of personal protective equipment (PPE) for health care workers in the context of COVID-19
- Statement on revised guidance
- Minimising the risk of infectious respiratory disease transmission in the context of COVID-19: the hierarchy of controls
- Guidelines on cleaning and disinfection of protective eyewear in health and residential care facilities
- Guidelines for infection prevention and control in residential care facilities
- Environmental cleaning and disinfection principles for health and residential care facilities