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

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.²

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.

As of May 2, 2024, universal medical mask wearing is not an overarching requirement in health care facilities in B.C..³

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 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,⁴ there are still practices in place to reduce the risk of transmission when caring for patients.

Patients you will care for with suspected and/or confirmed COVID-19 disease require Contact and Droplet precautions to be used⁵:

Note: Use a medical mask along with eye protection (face shield, safety glasses or goggles), gloves and gown when taking nasopharyngeal and throat swabs.⁵

Aerosol-generating medical procedures (AGMPs) performed on patients with confirmed or suspected COVID-19 may generate aerosols in high concentrations, which could contain infectious SARS CoV-2 particles. This presents a risk for possible inhalation of the virus by individuals in the room where the AGMP is performed.⁷

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 needed

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