PPE is designed to protect you from harmful substances such as chemicals or infectious agents. In a pandemic situation, it can also help prevent the transmission of infection between staff and patients.
The type of PPE you need will depend on the environment you work in and the procedures you carry out.
Remember: PPE is just one way of protecting staff at work. Handwashing, workplace cleaning practices and risk assessments also play an important role in infection prevention and control.
UK wide guidance on infection prevention and control, including the selection and use of PPE sits on gov.uk as a UK wide resource. This guidance was developed and agreed between the respective four counties of the UK, led by the Department of Health and Social Care (England). Public Health England, is the publisher of the UK wide guidance and manages the content on gov.uk. Health Protection Scotland were commissioned to conduct an evidence based review which forms the basis of much of the Infection Prevention and Control (IPC) guidance.
The published guidance is the responsibility of the four devolved UK nations.The RCN is not responsible in any way for guidance produced by these agencies.
A number of guidance documents have been produced since the pandemic began. The RCN was only invited to comment on the guidance below:
The RCN argued extensively for a review of guidance relating to the use of PPE, including greater alignment with the World Health Organisation (WHO) standards and clarity on the use of PPE for those health care workers providing direct contact within 2m of patients/residents in all care settings given the increase in spread within the community of COVID-19. The RCN's comments were acknowledged and included in the revised tables.
Guidance was issued by PHE on the reuse of single use PPE in extreme shortages (10 April 2020). The development of this guidance and the subsequent CAS alert (England) was undertaken without consultation with the RCN. The RCN does not support the re-use of single use PPE at this time and is currently considering the implications of this guidance.
In the context of the COVID-19 pandemic, we know that our knowledge about the disease and its trajectory as a novel virus is guided by emerging evidence and consensus in relation to its prevention and containment. The RCN commits to sustained and significant learning and communication about the pandemic and will continue to speak up and raise our members' concerns to ensure that any guidance produced is fit for purpose to protect them and the patients/populations they serve.
The RCN remains committed to monitoring all relevant guidance and representing the concerns of our members at this challenging time.
KN95 face masks must not be used as PPE for work as their effectiveness can not be assured. Read the Health and Safety Executive’s health and safety bulletin (June 2020) for more detail.
If you have worn KN95 face masks at work at any point during the pandemic, we recommend you keep a record of this using your workplace’s incident reporting procedure (i.e. datix or equivalent). If your workplace is continuing to use KN95 masks despite this safety alert, please follow our PPE – are you safe? guidance. If you need further support, call us on 0345 7726100.
During the COVID-19 pandemic, some people will become critically ill and their clinical progress, or lack thereof, will prompt frequent review of their likelihood of benefitting from CPR. These conversations, reviews and decision-making processes should be individual, documented and decisions should be easily accessible to all staff (such as Advanced Directions, ReSPECT documents or equivalent).The RCN, NMC and GMC are unanimous in the use of advance care plans being made with people and patients, and are explicit that decisions must be made on an individual basis. All health care establishments have policies in place around CPR and guidelines on attempting CPR.
Current Resuscitation Council UK (RCUK) guidance maintains early CPR and defibrillation give people the best chance of survival in any setting. The RCN aligns to the RCUK professional consensus that chest compressions given in CPR to known or suspected COVID-19 patients could result in increased risk to health care workers as a result of aerosol and droplet excretion from the individual being resuscitated. In response, Public Health England (PHE) maintain that CPR is a non-Aerosol Generating Procedure (AGP) and therefore full PPE (FFP3 respirators, gowns, eye protection and gloves) is not required. PHE have acknowledged that Health care Trusts may opt for AGP levels of PPE if they consider this appropriate to best ensure health care workers’ safety when performing chest compressions and advanced resuscitation in the acute hospital setting.
The RCN will be working at country and regional level to highlight this PHE guidance amendment for the acute hospital setting to encourage Trusts to adopt the RCUK consensus position that chest compressions, CPR, and advanced airway procedures in known or suspected COVID-19 patients require AGP level of PPE. This will ensure local policies reflect a review of this guidance and enable the highest level of PPE protection for all health care workers engaged in advanced resuscitation in acute hospital settings during COVID-19. Call us if you need further advice or support on 0345 772 6100.
In other settings outside of the acute hospital, defibrillators and access to a complete set of non AGP PPE may be less readily available, but first responder CPR interventions are more likely to benefit the individual in cardiac arrest. The RCN, with RCUK and others, have written to PHE to request the urgent development of clear risk-based community first-responder guidance in other health care settings.
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. The NMC has re-iterated in the joint statement on decisions relating to CPR, that all registrants are to use their professional judgement to decide what action should be taken in the best interests of the person in their care. Standards in the NMC Code must continue to be upheld as they are useful to support decision making.
If a decision to commence CPR is made, the RCN recommends that you should follow the Resuscitation Council UK guidelines for COVID-19 CPR and resuscitation in first aid and community setting. Additionally, you should:
Registered nurses or medical professionals lead clinical care during the resuscitation attempt and are therefore accountable for the appropriate delegation and supervision of care provided by unregistered staff e.g. health care support workers. In resuscitation attempts there might be limited time to make enquiries about the competence of other team members. A non-registered team member to whom a task is being delegated during the resuscitation attempt is accountable for accepting the task or not, depending upon their own assessment about their skill level.
Additional guidance is available in the collaborative document Ethical dimensions of COVID-19 for frontline staff.
Many health care professionals have impairments that could mean standard issue PPE is not effective. These include but are not limited to:
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 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.
The Health and Safety Executive also provides guidance for employers and employees on reasonable adjustments.
Double gloving is not required for care of patients with COVID-19 in any care setting. The UK infection, prevention and control (IPC) guidance is clear and advises ‘do not use double gloves for care of suspected or confirmed COVID-19 patients’.
Double gloving represents a waste of resources and may have implications for the skin of HCWs who wear these for long periods of time. Please see our guidance on skin health below and our Tools of the Trade publication on the prevention of work-related dermatitis.
If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.
The current shortage of long sleeved non-surgical gowns to protect HCWs working in high risk areas or performing aerosol generating procedures (AGP) has led the Health and Safety Executive to approve the use of disposable coveralls as an alternative to gowns for high risk activities or for staff working in such areas. The use of coveralls has been added to the UK guidance on PPE selection 1.
The safe donning and doffing (putting on and taking off) of coveralls is required and HCWs required to use coveralls should receive training from their employer on how to do this safely.
Coveralls provided for use in health care to deliver care for COVID-19 related activities must meet the required procurement specifications.
Please see our other sections:
RCN members have been raising concerns that some PPE products they have been provided with have out-of-date ‘use by/expiration’ dates, or have relabelled ‘use by/expiration’ dates.
The NHS has a stockpile of PPE in case of a pandemic or other emergency. This is distributed through the relevant channels. Stock is currently being rotated from emergency supplies to ensure items which have been there the longest are issued first.
In England, Wales and Scotland, the NHS has formally reassured the RCN that all stockpiled products being issued have passed stringent tests.
These tests have been carried out at independent test facilities and by the Health and Safety Executive (HSE) to demonstrate they are safe. The NHS has assured us that the ‘certified’ PPE provided has a much longer shelf-life than the date marked, and that any PPE which has not passed renewed testing is destroyed.
RCN Northern Ireland have contacted HSE NI who have also assured us that the stock in Northern Ireland, as part of a UK consignment, is covered by the same assurance as has been provided in England.
If the PPE provided to you is not fit for purpose (for example elastic on face masks has perished), you should:
Donated PPE will carry no controls over expiry dates. Homemade PPE is not CE marked and carries no quality control assurance at all. Please see further information below under ‘home-made PPE’.
If a risk assessment and public health guidelines identify that you may be required to wear an FFP3 face mask as a form of personal protective equipment, it is important to be clean shaven in order to get a good protective seal of the mask to the face.
Under the Health and Safety at Work Act, you are required to co-operate with the employer to ensure they meet their legal requirements to protect your health and safety and those of other staff.
In circumstances where beards are worn for religious reasons, or where someone has a skin condition that makes it impractical to shave every day, alternative personal protective equipment in the form of respiratory hoods should be offered for those working in areas where FFP3 is deemed necessary.
FFP3 face masks are a form of respiratory protective equipment that provide a higher level of respiratory protection than surgical face masks. Their safety is dependent on wearers undergoing a ‘fit’ test, to ensure that there is an adequate personal fit and seal to protect the wearer from fine aerosols containing virus particles.
There are two fit test methods, qualitative and quantitative.
Qualitative fit testing is a pass/fail test based on the wearer’s subjective assessment of any leakage through the face seal region by detecting the introduction of bitter- or sweet-tasting aerosol as a test agent.
Quantitative fit testing, which involves ambient particle counting or controlled negative pressure measurements, should be used as an alternative to test the adequacy of the respirator.
A fit test must be carried out prior to first wearing a new model of FFP3 masks, whenever there is a change to the type or model 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).
In addition to a fit test, a fit check must be carried out by the user every time a FFP3 mask is put on. The HSE has guidance on this including an instructional video.
The user must be trained on how to carry out a fit check. A fit check is not a substitute for a fit test. On 24 April the Chief Nursing Officer (CNO) and the National Medical Director for England wrote to all Trusts stressing that fit checks are not a substitute for fit testing.
Some members are reporting that equipment to undertake fit testing is not available and, with multiple brands of masks supplied, this is placing additional pressures on an already overstretched workforce. Some employers are reportedly relying on fit checks rather than fit tests.
There are also issues with the suitability of different models of masks, with many nursing staff failing fit tests.
There have been some concerns about the efficacy of the fit testing process.
The RCN views the lack of fit testing as unacceptable and has sought urgent intervention from the HSE in Great Britain and the HSE for Northern Ireland, as we consider staff at risk from exposure to COVID-19 in the workplace as a result of poorly fitting masks avoidable and indefensible. The RCN believes that employers must ensure that those carrying out fit testing, be it in-house or externally are competent to do such testing. Using an externally accredited fit tester, who can also provide training for additional fit testers within an organisation, provides assurances on competency. 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 an FFP3 should be trained in how to carry out a fit check in addition to donning and doffing training.
In the context of the pandemic and to future proof FFP3 provision, the RCN calls on manufacturers to review the design of masks to ensure that there is a good selection of FFP3 masks suitable in fit for a predominantly female nursing workforce.
Where risk assessments require staff to wear FFP3 masks and where a subsequent fit test is failed for all models available, staff should either be redeployed to areas where FFP3 masks are not required or be provided with a powered or constant flow airline breathing apparatus respirator protection with loose fitting hoods or helmets which do not require fit testing.
Consideration needs to be given to the needs of staff who are observing Ramadan and cannot participate in a qualitative test.
PPE is essential for ensuring the health and safety of staff and protecting them from contracting COVID-19. However, it is recognised that wearing PPE for long periods can also create additional health and safety risks for nursing staff. PPE is extremely uncomfortable and can lead to heat stress, fatigue and heat related illness, which places a risk to both nursing staff and the patients that they are looking after.
The health and safety of health and care staff is of paramount importance and the RCN expect 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 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’ below.
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.
If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.
PPE for use in health and care settings must meet specified health and safety standards included within the product specifications for examination gloves, gowns, surgical face masks, respirator masks and eye protection. This is to ensure reliable and effective protection against infection, and ensure PPE is fit for purpose. Any personal protective equipment made by hand, for example cotton face masks, will not provide the level of protection required against COVID-19.
The RCN is clear that health care workers must not accept any home-made PPE donations. Your employer is responsible for providing you with PPE that meets health and safety standards.
Anyone wishing to donate equipment to the health service as part of the COVID-19 response should visit the government website.
If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.
The provision of reusable face respirators is one option for respiratory protective equipment (RPE).
Reusable respirators provide advantages over disposable single use face masks (FFP2/3) that are required for ‘high risk’ procedures and environments associated with the current COVID-19 pandemic. Reusable face respirators can support the reduction in use of single use respirators where supply is problematic and reduce the need for repeat fit testing where multiple brands are supplied, or individuals have difficulty in finding a mask that fits correctly.
All FFP3/2 respirators require fit testing and fit checking.
Where reusable respirators are provided some RCN members report these are pooled following cleaning for reuse by different staff rather than being allocated to individual members for their personal use. This is unacceptable and we expect employers to introduce:
Reusable RPE must also be subject to thorough maintenance, examination and tests. These should be carried out at least once a month by trained personnel following manufacturer’s instructions and records of examinations kept for five years.
Single use equipment including PPE is defined by manufacturers as ‘any medical equipment, instrument or apparatus designed to only be used once and then disposed of’. They are identified through this symbol present on packaging or equipment instructions.
Single use masks and gowns should not be washed/laundered and then reused, as this process may render their protective elements ineffective and damage them, placing the health care worker at risk.
As a result, the RCN does not support the re-use of single use PPE at this time and is currently considering the implications of this guidance. Some types of PPE can be reused in sessional health care settings, please refer to the section on Sessional use PPE.
If you have been asked to reuse PPE, you should raise the following questions with your employer in writing:
Ask for the answers to these questions in writing and use your local reporting procedures to record each time you are placed in this position. If you have one, speak to your local RCN workplace representative for support in asking/escalating these issues. You could also work with colleagues to raise these concerns together, so you are not a lone voice.
If you need further support, please call RCN Direct on 0345 7726100.
For the purpose of this pandemic, some PPE can be retained and reused between patients - such as gowns, eye protection and masks (fluid resistant face masks and filtering face piece respirators such as FFP3/2). If you are asked to reuse other types of PPE, please see Reusing PPE above.
Under the UK infection prevention and control guidance, a session refers to a period of time where a health care worker is undertaking clinical activity in a specific place e.g. providing ongoing care for residents/inpatients in a bay or ward, a medicine round, drink and meal rounds etc.
A session ends when the health care worker leaves the ‘place’ e.g. care setting, such as a patient’s home, ward or allocated care area in a nursing home or takes a break (for example, taking a natural or meal/drink break, leaving the care environment).
PPE should be disposed of after each session where activities have been carried out, or earlier if damaged, soiled, or uncomfortable. The duration of a single session will vary depending on the clinical activity being undertaken.
In practice, sessional use of PPE relates to activities not time. Gloves and aprons must be changed between patients as per existing standard infection prevention and control precautions and/or patient care activities on the same patient (for example, when undertaking catheter care then moving to undertake mouth care) and hand hygiene must be performed.
We continue to receive reports of a lack of suitable and sufficient PPE available to all nursing staff including hospitals, GP surgeries, care homes, hospices, and community nurses visiting people in their homes. In particular, our members cannot obtain equipment such as face masks, eye protection and hand sanitisers. We are concerned that some NHS and social care employers are failing to follow statutory obligations in relation to the provision of PPE. Our members are reporting a number of organisations which are in fundamental breach of:
Regulation 4 of the Personal Protective Equipment at Work Regulations 1992 states:
Every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health or safety while at work except where and to the extent that such risk has been adequately controlled by other means which are equally or more effective. The accompanying guidance states: Employers should, therefore, provide appropriate personal protective equipment (PPE) and training in its usage to their employees wherever there is a risk to health and safety that cannot be adequately controlled by other means. In order to provide PPE for their employees, employers must do more than simply have the equipment on the premises. The employees must have the equipment readily available, or at the very least have clear instructions on where they can obtain it.
By virtue of Section 9 of the Health and Safety at Work etc Act 1974, no charge can be made to the worker for the provision of PPE which is used only at work. Section 9 of the Health and Safety at Work etc. Act 1974 states: "No employer shall levy or permit to be levied on any employee of his any charge in respect of anything done or provided in pursuance of any specific requirement of the relevant statutory provisions". Section 9 applies to these Regulations because they impose a 'specific requirement' - i.e. to provide PPE.
Nursing staff across the country are rising to the challenge of this unprecedented situation. RCN members are coming out of retirement, students are interrupting their studies, and nursing staff are deploying from non-clinical settings, all to support the frontline in the battle against COVID-19 and yet they lack access to basic health and safety equipment in order to do so. We have written to the Health & Safety Executive to make clear our expectation that they will issue instructions to all providers of care where patients are being treated for, or are suspected of, COVID -19 infection.
PPE supply and distribution processes are different across the four UK countries:
The process of distribution is managed through the NHS supply chain. There is a dedicated supply service which includes separate information for NHS trusts and community including care homes and hospice partners. The information is updated regularly. You can also call the dedicated telephone number 0800 876 6802.
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).
The distribution of PPE is being led centrally by National Procurement. There is a dedicated point of contact for PPE in each Health Board. Staff can also raise concerns about a lack of PPE directly with the Scottish Government by emailing covid-19-health-PPE@gov.scot, which is monitored continuously.
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 firstname.lastname@example.org or calling 0300 303 3020.
We are currently awaiting more information.
PPE for use in health and care settings must meet specified health and safety standards included within the procurement specifications for examination gloves, gowns, surgical face masks, respirator masks and eye protection. This is to ensure reliable and effective protection against infection, and ensure PPE is fit for purpose.
Any personal protective equipment made by hand or supplied/bought outside of normal healthcare procurement systems may not meet the required standards under health and safety law or provide the level of protection required against COVID-19.
Employers are responsible for providing their employees with adequate personal protective equipment. The RCN is clear that health care workers must not take their own PPE or, no matter how well meaning they are, accept any PPE hand-made donations.
The RCN guidance on DNACPR and verification of death includes the need to wear PPE as an element of standard infection control precautions. Find out more at COVID-19 guidance on DNACPR and verification of death.
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:
and speak to your line manager.
If you have followed these steps and the issue is still not resolved, please call RCN Direct on 0345 772 6100.
Page last updated - 30/06/2020