Personal protective equipment (PPE) and COVID-19

Here you'll find essential advice and information to help ensure you have the right personal protective equipment (PPE) in your work setting. SARS-CoV-2 can be spread via airborne, droplet or contaminated  surfaces including hands and gloves.

Under health and safety legislation, employers have a legal duty to ensure suitable and sufficient risk assessments are carried out and adequate control measures are put in place to reduce the risk of harm to staff and patients, so far as is reasonably practicable. This includes identifying when PPE is required, and the type of PPE which should be used. PPE is designed to protect you from harmful substances such as chemicals or infectious agents. In some situations such as during the pandemic, it can also help prevent the transmission of infection between staff and patients. The type of PPE you need will depend on the risk assessment, which should include the environment you work in and the procedures you carry out. Respiratory protective equipment (RPE) such as FFP3 masks are a form of PPE and, where a risk assessment or national guidance indicates that they should be used, they must be fit tested by a person competent to do so. 

Remember, PPE is just one way of protecting staff at work. Handwashing, social distancing measures, training, workplace cleaning practices, ventilation, vaccination and risk assessments for staff health also play an important role in infection prevention and control and managing the safety of staff and patients.

For more information on this please see the RCN's risk assessment toolkit.

Please see Medicines and Healthcare products Regulatory Agency (MHRA) for detailed information on regulation relating to PPE.

Current Resuscitation Council UK (RCUK) Resuscitation Guidelines (2021) maintains early CPR and defibrillation give people the best chance of survival in any setting. RCUK have also published guidance on COVID-19.  The advice states that for those working in health care settings, the use of FFP3 masks or respirators as well as eye protection, is still recommended when performing chest compressions for patients with suspected or confirmed COVID-19. Aerosol generating procedures PPE, in particular FFP3 mask/respirator and eye protection, should be donned as swiftly as possible to avoid any delays in treatment.

Staff should also refer to their local policy.

The RCN advice is that members outside of the acute hospital setting, should conduct a risk assessment and use their professional judgement to decide whether or not to provide Basic Life Support CPR; taking into consideration the individual needing CPR, the current situation, the environment and their own safety, local policy, and any knowledge of the individual. Standards in the NMC Code must continue to be upheld, as they are useful to support decision making.

The NMC statement on personal protective equipment during the COVID-19 pandemic (April 2020) supports the RCN guidance and reflects the realities of clinical decision-making in the context of this pandemic.

Additional guidance is available in the collaborative document Ethical dimensions of COVID-19 for frontline staff.

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.

We have no access to FFP3 masks. What should we do?

Your employer should, carry out a suitable and sufficient risk assessment which will identify if PPE is required for where you work, for example patients’ own homes. In some instances, for example when carrying out close contact care with a COVID-19 positive patient, you should be provided with a face fit tested FFP3 mask and be given advice and training on face checking and donning and doffing procedures.

Read our position statement on PPE here.

Your organisation should provide accessible information on this and on what the household can do to reduce risks, in advance of and during any visits. You can also see our COVID-19 workplace risk assessment toolkit. Guidance for adult social care is also available

Some of the patients I visit refuse to have the window open where I am working to increase ventilation. What should I do?

Your manager or organisation should send out a communication to all patients and their families explaining why this is important and encourage them to look at government advice.  

We understand that patients or their families may not want to have the window open in advance, particularly when the weather is cold. Worry about heating bills may also be a consideration.  However, for your safety and also to protect them, it is really important to encourage this and the following of Government guidance for ventilation homes.

If families refuse to support these actions, discuss with your manager what additional steps could be taken to encourage the family/carers to be more proactive. 

Can I refuse to go into a persons’ home if I feel that it is unsafe?

Members may feel unsafe whilst delivering care in patient’s own homes for several reasons.

If you have concerns about other safety issues including access to PPE and or ventilation, then you should follow the guidelines in our refusal to treat when making the decision. Contact us for further advice.  

Additionally, if you have been verbally abused or threatened and you feel you will be at serious risk of assault if you enter the home, do not put yourself at risk. Call your manager and follow the RCN guidance on personal safety when working alone. Remember to report the incident using your organisation's incident reporting procedures as soon as possible.

Who developed the guidance?

Each country of the UK has its own infection prevention control (IPC) guidance, that reflects the current COVID-19 situation as ‘business as usual’.

The RCN remains committed to monitoring and contributing to all proposed relevant IPC guidance when asked to do so, representing the interests of our members and stakeholders where relevant.

Many health care professionals have impairments that could mean standard issue PPE is not effective. These include but are not limited to:

• sensory impairments 
• use of prosthesis 
• the use of mobility aids.

For some, PPE is a disabling barrier, for example, employees who communicate well through the ability to lip read will have this communication route disrupted if colleagues are wearing face masks. 

Where there is a change in PPE requirements such as in response to a pandemic, new issues can arise for health care professionals who have not previously been disabled at work. It is essential that processes allow the opportunity for employees to discuss their specific needs regarding PPE and that they are supported by managers in this process.

The Equality Act 2010 (and in Northern Ireland the Disability Discrimination Act 1995) states that employers have a duty to make reasonable adjustments for employees who meet the definition of disabled. This applies to PPE equipment and the processes around administering PPE. The RCN believes that reasonable adjustments should be granted whether this definition is met or not, on the grounds that reasonable adjustments help us to work to the best of our abilities. The RCN’s advice guide on disability discrimination provides lots of helpful information on disability and your employer’s responsibilities. 

The RCN expects that all employers support their staff to make known their needs in respect of PPE.

Your employer should work with you to ensure that any risk of PPE affecting your impairment and ability to continue in your role is recognised and processes put in place to mitigate the risk. This may mean adjusting processes around donning and doffing of PPE, exploring options for adapted PPE and/or opportunities to fit PPE, and be confident that it is fit for purpose prior to use in a clinical setting.

The RCN expects that line managers undertake a workplace risk assessment and refer to Occupational Health for further advice if appropriate. Where adjustments cannot be made, temporary redeployment to work that does not require PPE should be considered. You can also see our COVID-19 workplace risk assessment toolkit.

Our publication Removing disabling barriers at work and our online guide on health ability passports cover the benefits of a diverse workforce including those with impairments and the reasonable adjustments process. 

The Health and Safety Executive also provides guidance for employers and employees on reasonable adjustments. 

Raising concerns

If you feel you are not being supported or that your concerns are not heard, please see our section on  raising concerns about PPE. Support is also available from the RCN Peer Support Service

If the PPE provided to you is not fit for purpose (for example is dirty/contaminated or the elastic ties on the face masks has perished), you should:

• not use the equipment
• refer to your local policies on the use of PPE and report any quality issues immediately to managers, alongside completing a local incident form
• be provided with alternative PPE by your employer that is fit for use.

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.

FFP3 face masks provide a higher level of respiratory protection than surgical face masks. Their effectiveness is dependent on the wearer undergoing a ‘fit’ test, to ensure a protective seal can be achieved. 

There are two fit test methods, qualitative and quantitative. HSE’s guidance requires a fit test report/certificate to be made available to the employee to include the date, method and make and model of mask they have been fit tested for.
  
Fit tests must also be carried out whenever there is a change to the type or model of FFP3 mask or whenever there is a change in circumstances of the wearer that could alter the fit of the mask e.g. weight loss or gain or substantial dental work.

Fit testing must be carried out by a competent person as described by the Health and Safety Executive (HSE). 

What if I have concerns about fit testing?

The RCN views any lack of competent fit testing as unacceptable. Employers should follow the HSE’s guidance on the knowledge requirements of a fit tester and the validation of equipment to be used.

Staff who are required to wear FFP3 masks should be trained in how to carry out a fit check in addition to donning and doffing training. A fit check must be carried out by the user every time an FFP3 mask is put on. The HSE has guidance on this including an instructional video.

To future proof FFP3 provision, the RCN supports innovative design of respiratory protection to ensure that there is a good selection of masks suitable for all, including black minority ethnic groups and female workers within the nursing workforce.

Where risk assessments require staff to wear FFP3 masks, all staff must have passed a face fit test for the mask being worn.  

Further information

A list of external accredited fit testers can provide training for additional fit testers within your organisation.

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.

Gloves should only be worn when indicated. RCN guidance Tools of the Trade, provides specific guidance on glove use and skin care. It is recognised that wearing PPE for long periods can also create additional health and safety risks for nursing staff. PPE can be uncomfortable and potentially lead to heat stress, fatigue and heat related illness. Indications for glove use include contact with mucous membranes, blood and body fluids, chemicals or harmful drugs such as hormone creams or cytotoxic drugs. Gloves are not required for routine vaccinations including COVID-19 and influenza vaccines see the RCN Immunisation services delivery guidance.

When considering gloves members should also review if a plastic apron is required. Aprons should not be worn routinely and only if required.

Unnecessary glove and apron use and double gloving, represents a waste of resources and may have implications for the skin/comfort of health care workers who wear these for long periods of time.

Double gloving

Double gloving is not required for care of patients with COVID-19 in any care setting. Please see your respective country national IPC guidance.  

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.

Training in the safe donning and doffing (putting on and taking off) of gowns/coveralls is required.

It is recognised that wearing PPE for long periods can also create additional health and safety risks for nursing staff. PPE can be uncomfortable and potentially lead to heat stress, fatigue and heat related illness.

The RCN expects employers to meet their legal duties by taking all appropriate steps to both assess and mitigate the risk of nursing staff developing heat stress and related illnesses. These steps include:

• the workplace temperature: while there is no upper legal limit on workplace temperatures, the regulations state that workplace temperatures should be reasonable; the Chartered Institute of Building Engineers recommend that hospital environments should be 18 degrees centigrade.
• regular rest breaks during the shift:  manufacturers’ recommendations on maximum time for wearing FFP3 face masks should always be followed (see RCN workplace risk assessment toolkit)
• allow staff to take power naps especially during night shifts
• access to comfortable rest facilities 
• hydration/meal breaks 
• access to toilet facilities 
• raise awareness amongst staff of the signs of dehydration and heat stress and measures that can be taken to reduce the risk
• clear limits to not work beyond shift time and avoidance of continuous back-to-back long shifts. See our working time and breaks guidance.

The RCN also recognise that certain health conditions will make it more difficult to tolerate wearing PPE. Employers should assess any risks to these individuals and make necessary adjustments under both health and safety and equality law. See ‘PPE for staff with disabilities or impairments’ above. You can also see our Health ability passport guidance.

Further information

For information on how to reduce the risk of heat stress and related illness, please see Rest, Rehydrate and Refuel. 

HSE have also produced a heat stress risk assessment toolkit for employers. 

Our guidance on skin health is here along with our publication on maintaining skin health when using PPE.

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.

PPE in use across the UK may contain natural rubber latex (NRL), including gloves and face masks. 

Proteins found in NRL are known sensitizers which can cause allergic reactions in some individuals and may lead to serious health effects and should be avoided if possible.

Managing exposure and using safe alternatives  

Whilst the use of PPE containing NRL has not been banned, the Health and Safety Executive expect organisations to have systems in place to manage the risk of exposure to staff and patients with NRL allergies. Many health care organisations have taken steps to eliminate or severely restrict the use of products containing NRL from their sites. 

The RCN expects all health and social care organisations to have and to follow their policies on the management of latex allergy in staff and patients.

Safer alternatives or latex free products should be used and staff and patients with known latex allergy should never be exposed to NRL containing products. Powdered NRL gloves should never be used.   

Where no safer alternatives are available and the risk of exposure to a biohazard exists, then a COSHH risk assessment will inform whether the use of PPE containing NRL is acceptable for use by staff without NRL allergy.

Incident reporting

Any allergic type reactions to PPE, including skin rashes, should be reported using the organisations incident reporting form and through the yellow card reporting system to the MHRA. 

Organisations that have no alternative supplies to NRL PPE should document this as a Serious Untoward/Adverse Incident.

Wearing PPE can be uncomfortable and can lead to heat stress, fatigue and heat related illness. It is recognised that wearing PPE for long periods can also create additional health and safety risks for staff.

For those experiencing symptoms due to menopause, this can sometimes add to the burden of working in intensive areas of practice.

It is always important to recognise that for many reasons the impact of the menopause may differ greatly for individuals.

Symptoms can be compounded when having to wear PPE, especially for long periods of time, and it is important that staff are supported to enable them to cope in these challenging times.

It is important, to remain hydrated and to use a good hydrating moisturiser which can be applied under masks and to keep some cool wet wipes handy. You can find further guidance in our Reproductive health and menopause at work advice guide. 

Please also see our section on Heat Stress above.

Further information

The RCN has lots of helpful information in our clinical page, Women's Health: Menopause
 
Menopause. RCN guidance for nurses, midwives and health visitors 

For information on how to reduce the risk of heat stress and related illness, please see Rest, Rehydrate and Refuel. HSE have also produced a heat stress risk assessment toolkit for employers

Menopause at work: managing hot flushes and PPE - Nursing Standard article which may require signing in to access in full

RCN guidance on skin health, also RCN publication on Maintaining skin health when using PPE.

Raising concerns

If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE below.

Please see our guidance on skin health and our publication maintaining skin health when using PPE.

NHS and social care employers must follow statutory obligations in relation to the provision of PPE.

Accessing supplies

PPE supply and distribution processes are different across the four UK countries:

England

The process of distribution is managed through the NHS supply chain. For Community Healthcare Partners, supply of PPE should be through the usual ordering and supply channels.

If there is an urgent requirement that cannot be currently met, please call the National Supply Disruption Response (NSDR) team on 0800 915 9964.

See also NHS England and NHS Improvement: Accessing supplies of Personal Protective Equipment (PPE).

Scotland

The distribution of PPE is being led centrally by National Procurement.

Social care providers who have confirmed/suspected cases of COVID-19 should contact local NHS trusts and boards to establish possible local supply routes.

If there remains an urgent need for PPE, contact the triage centre at NHS National Services for Scotland (NHS NSS) by emailing support@socialcare-nhs.info or calling 0300 303 3020.

Northern Ireland

HSC Business Services Organisation Procurement and Logistics Service manage procurement to all public health and social care organisations in Northern Ireland.

Wales

The process of purchase and distribution is managed by NHS Wales Shared Services. They can be contacted by emailing ProcurementServicesenquiries@wales.nhs.uk.

Raising concerns about PPE

Organisations must have effective procedures in place to allow nursing staff and their representatives to raise any concerns in relation to equipment, policies and processes for managing COVID-19 at the earliest opportunity.

Nursing staff should feel able to raise concerns without detriment and should receive timely feedback on their concerns. If your concerns remain unresolved, refer to:

• our raising concerns guidance
• PPE - are you safe?
• our refusal to treat guidance,

and speak to your line manager.

If you have followed these steps and the issue is still not resolved, please contact us.