PPE Selection by Risk in UK Healthcare

PPE selection in UK healthcare is risk-based. Match the equipment to the specific task and the route of transmission. Over-PPE wastes resources and causes patient distress; under-PPE creates safety risk.

This chapter is the practical framework. For specific tasks and trust-mandated PPE, follow the local IPC policy.

The PPE categories

Gloves

When to wear:

• Contact with body fluids (blood, urine, stool, vomit, wound exudate, secretions).
• Contact with mucous membranes (catheter insertion, NG tube, oral care for some patients).
• Contact with non-intact skin (wound care).
• Cleaning contaminated surfaces or equipment.
• Handling specimens.

When not needed:

• Routine patient contact with intact skin (taking a pulse, helping with mobility).
• Most non-clinical contact (taking observations on a clean patient, simple communication tasks).

Glove change moments: between tasks on the same patient (dirty to clean); between patients; when integrity is compromised.

Aprons

When to wear:

• Body fluid contact with splash risk.
• Wound care.
• Personal care including washing.
• IV access procedures.

Single-use: disposed of after the task or patient. Don’t move from one patient to another in the same apron.

Surgical mask

When to wear:

• Patient with droplet-spread infection (influenza, COVID-19 in many protocols, meningococcal).
• Procedures with splash risk to the face (catheter insertion sometimes; certain wound care).
• Patient who is themselves coughing significantly.

Doesn’t protect against airborne particles. Those need respirators (FFP2/3).

Eye protection

When to wear:

• Splash risk to the face (suction, IV access with bleeding risk, certain wound care).
• High-fluid procedures.
• Patient with active vomiting in close care.

Types: safety glasses, goggles, full face shield. Match to the splash risk.

Respirator (FFP2 or FFP3)

When to wear:

• Aerosol-generating procedures on patients with airborne disease (suctioning a TB patient, intubation).
• Caring for patients with known airborne disease in close range.
• Specific trust requirements during outbreaks.

Fit-testing required: respirators are face-shape-specific. A poorly-fitted respirator gives false reassurance.

Standard precautions

For every patient encounter, regardless of known infectious status:

• Hand hygiene per the 5 moments.
• Gloves and apron for body fluid contact.
• Mask and eye protection for splash risk.
• Safe sharps handling.
• Clean equipment.

Standard precautions apply universally because not all infections are identified at the point of care.

Transmission-based precautions

When a specific infection is known or suspected:

Contact precautions (e.g., MRSA, C. difficile):

• Gloves and apron for all patient contact.
• Single-room or cohorting.
• Dedicated equipment where possible.

Droplet precautions (e.g., influenza, meningococcal):

• Surgical mask within 1-2 metres of the patient.
• Gloves and apron for body fluid contact.
• Single-room ideal.

Airborne precautions (e.g., TB, chickenpox, measles):

• Respirator (FFP3 typically).
• Negative-pressure isolation room ideal.
• Restricted entry to non-immune staff.

The PPE decision

For each task, ask:

1. What’s the route of transmission risk? Contact, droplet, airborne, splash.
2. What’s the level of exposure? Brief, prolonged, high-fluid.
3. What does the trust policy require? May be more specific than the general framework.
4. What’s the minimum effective protection? Don’t over-PPE.

Donning and doffing

Putting on PPE (donning):

1. Hand hygiene.
2. Apron.
3. Mask (if needed).
4. Eye protection (if needed).
5. Gloves last.

Taking off PPE (doffing):

1. Gloves first.
2. Hand hygiene.
3. Apron.
4. Eye protection.
5. Mask last.
6. Hand hygiene.

The order matters for self-contamination prevention. Gloves are the dirtiest item and come off first. The mask, which covers your respiratory route, comes off last.

Common PPE errors

Wearing gloves for everything. Hand hygiene replaces gloves for routine touches. Constant glove wear actually reduces hand hygiene compliance.

Walking out of a room in PPE. PPE doesn’t travel between rooms. Doff at the point of leaving.

Reusing single-use items. Aprons, gloves, masks are single-use unless explicitly extended-use under specific protocols.

Inadequate doffing. Glove removal techniques that contaminate the hand are common. Standard technique: pinch the wrist of the first glove, peel inside-out, hold the removed glove in the still-gloved hand, slide the bare fingers under the wrist of the second glove and peel inside-out over the first.

PPE in the OSCE

The OSCE Implementation station tests PPE selection and use. Examiners watch:

• Appropriate PPE for the task.
• Donning before patient contact.
• Doffing in the right order.
• Disposal in the right waste stream (clinical waste for soft PPE; sharps in sharps bin).
• Hand hygiene at appropriate moments.

Over-PPE in the OSCE (wearing a mask and eye protection when the task doesn’t warrant it) is sometimes marked as well as under-PPE. The examiner is looking for appropriate clinical judgement.

The next chapter covers ANTT (aseptic non-touch technique), the procedure-agnostic IPC method.