PPE in Clinical Settings
PPE may be used/required in both community-based clinics and hospital settings. A decision on using PPE must be made whenever an HCP or learner has direct contact with a patient.1
Starting October 3, 2023, medical mask wearing is required in health care facilities in BC by all health-care workers, volunteers, contractors and visitors in patient care areas (including UBC faculty, staff and learners who operate in the mentioned areas)2. Health care facilities include:
- All health authority hospitals and clinical settings
- Long-term care facilities
- Seniors assisted living settings
- Private hospitals
- Provincial mental health facilities
A patient care area is any area within a health care facility (including a contracted facility), hallway or lobby, which is accessible to patients, residents in long-term care facilities or clients who are there to access care or services. This includes any other location where care is provided (such as at home and community care locations), but does not include administrative areas or private staff offices that are not generally accessed by patients, residents or clients.
For all UBC Faculty of Medicine learners, please contact your respective program if you have any questions. For more information visit the UBC’s Safety & Risk Services website. Additional questions can be directed to fom.safety@ubc.ca.
How do we determine whether PPE is necessary?
To determine whether PPE is necessary, a point-of-care risk assessment (PCRA) is performed. In a PCRA, the infectious risks that a patient, situation, or procedure poses to individuals, other HCPs, other patients, and visitors are assessed. A PCRA is based on a health care team’s professional judgment about the clinical situation, as well as up-to-date information on how the specific healthcare facility has designed and implemented physical (engineering) and administrative controls, and the use and availability of PPE.
Performing a PCRA is important for avoiding PPE over-reliance, misuse, or waste.1
Some examples of common settings where additional PPE (e.g. face shields, eye protection) could be considered are: assisting childbirth, irrigating wounds, administering anaesthetics, and observing and participating in surgeries. This is not an exhaustive list! Ask yourself or your preceptor if you could be splashed, breathe in, or come into contact with infectious agents before participating in a procedure.3
As a student on clinical placement, you may or may not be involved in point-of-care risk assessments.
How do we determine which PPE is necessary?
After a PCRA deems PPE necessary for a clinical encounter, federal, provincial, and local guidelines should be considered next to determine which PPE must be used. PPE guidelines do not replace clinical judgement. Attending staff or clinical supervisors should always evaluate whether the PPE proposed by federal, provincial, and local guidelines is appropriate for the task they will be performing.4 Clinical judgement/PCRA takes precedence over any other guidance or recommendations pertaining to PPE usage.
General PPE Guidance for Patient Care regarding COVID-19
Some communicable diseases, like COVID-19, require additional PPE to be worn. While COVID-19 is no longer considered a global health emergency,6 there are still practices in place to reduce the risk of transmission when caring for patients.
1. Patients you will care for with suspected COVID-19
For direct care of patients with droplet and contact precautions (within 2 metres), the following PPE is required2:
- Gloves
- Medical (surgical/procedure) mask
- Eye protection
- Gowns
When eye protection is recommended, students should wear safety glasses, goggles, or a face shield.
Non-aerosol-generating medical procedures (non-AGMPs)5
Aerosol-generating medical
procedures (AGMPs)5
Recommended PPE:
- Surgical/procedure mask
- Eye protection
- Gloves
- Gown
Recommended PPE:
- N95 respirator
- Eye protection
- Gloves
- Gown
Medical Masks and AGMPs
The World Health Organization and provincial guidance continues to recommend a respirator or a medical mask (based on a risk assessment) in health-care settings for a person who is confirmed or suspected to have COVID-19.
From the Provincial Infection Control Network of BC (PICNet)7: Respiratory viruses, including COVID-19 viruses, can be spread by respiratory droplets from an infected person when they breathe, speak, shout, sing, cough or sneeze. Respiratory drops range in size from:
- Large liquid droplets (>5μm), which tend to quickly fall to the ground with 2 metres
- Small aerosols, which can linger in indoor spaces for a longer period of time and can accumulate in enclosed spaces unless they are diluted with clean air from a ventilation system or the outdoors
Protection from infection is provided by immunization, personal protective equipment (PPE), good ventilation and hand hygiene. Elevated risk has been noted in aerosol transmission with possible longer distance spread during prolonged exposure (typically more than 15 minutes) and without the use of medical grade PPE under the following circumstances:
- Environmental conditions that increase the concentration and buildup of exhaled respiratory droplets in air spaces, such as poor ventilation or air handling in enclosed crowded spaces
- Activities that generate increased and/or forceful exhalation of respiratory droplets such as aerosol generating medical procedures (AGMP), excessive and sustained coughing, and activities with heavy expiratory exertion (e.g., physical exertion from exercising and raising voices during singing or shouting)
Because AGMPs create conditions that increase the risk for potential airborne transmission, N95 respirators are required for AGMPs for patients with an unknown or moderate to high risk, or as determined by organizational risk assessment and guidance. For more information about AGMPs, visit PICNet.
Health-care workers should perform a PCRA before every patient encounter to determine appropriate infection control actions and PPE.
Why do I need an N95 respirator for AGMPs involving COVID-19-suspected or -confirmed patients?
AGMPs generate high concentrations of droplets smaller than 5μm, referred to as small droplet nuclei. Unlike large droplets - which can only travel short distances before falling to the ground, and which transmit infection through contact with the eyes, nose, and mouth (droplet transmission) - small droplet nuclei can remain suspended in the air for significant periods of time and move with air currents, enabling airborne transmission of the infectious particles travelling within; that is, droplet nuclei can infect health care workers if inhaled into the lungs.
While pathogens such as coronaviruses are usually not able to spread by the airborne route (typically spreading by droplets), AGMPs create conditions that increase the risk for potential airborne transmission.5 This is why N95 respirators are required for AGMPs for patients with an unknown or moderate to high risk.
N95 respirators filter the air of aerosolized infectious particles (small droplet nuclei), and for this reason are effective in preventing the potential airborne transmission of COVID-19 in the context of AGMPs.
A Note about N95s:
If you have an existing N95 respirator certification, it is imperative that you only use the model on which you have been successfully tested. If you will be using N95s, please ensure that the model you have been tested is available at your worksite. If you need to be tested to a new model, contact the Faculty of Medicine Health & Safety team at fom.safety@ubc.ca.