PPE in Clinical Settings

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

Before participating in or observing a clinical procedure, ask yourself or your preceptor:

• Is there a risk of splashing?
• Is there a risk of droplets spraying into my face?
• Will my clothes get soiled?
• Is there a risk of contact with blood or bodily fluids?

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!

PPE may also be required in care locations when mandated by the Ministry of Health. Over the last few years during respiratory season, additional controls like universal masking in care areas has been implemented to prevent the spread of illness.

To increase protections in health-care facilities in B.C., effective January 7th, 2025, medical mask wearing is required by all health-care workers, volunteers, contractors and visitors (including UBC faculty, staff and learners) in patient care areas where active patient care is being provided.²

This policy will remain in effect until VRI season is officially declared over in the spring.

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.¹ Clinical judgement/PCRA takes precedence over any other guidance or recommendations pertaining to PPE usage.

General PPE Guidance for Patient Care

HCPs must follow provincial policy for infection prevention and control measures in health care settings, as applicable, for example, during viral respiratory illness (VRI) season.

When in contact with patients deemed at risk for having a VRI, implement droplet and contact precautions, which includes wearing³:

During aerosol generating medical procedures (AGMPs) on patients suspected or confirmed to have infections that can potentially spread through aerosolization (e.g., COVID-19, circulating novel respiratory viruses), HCPs wear the following PPE³:

AGMPs may generate aerosols in high concentrations, which could contain infectious particles. This presents a risk for possible inhalation of the virus by individuals in the room where the AGMP is performed.⁴

In British Columbia, the classification of a medical procedure as an AGMP is determined by the Provincial AGMP Expert Working Group. Its purpose is to:

1. Review medical procedures requested by clinicians that are performed on patients with suspected (i.e., with COVID-19 risks) or confirmed COVID-19 in health-care settings to determine if the procedures are AGMPs; and,
2. Maintain and update the provincial list of AGMPs as needed⁴

Any additional PPE required other than the items listed above will be determined by the PCRA.