Personal protective equipment (PPE) and COVID-19
Read more about the UK variants and what the RCN is doing in our bulletin.
The RCN was one of a number of organisations who wrote to the government calling for urgent action on better ventilation and PPE, as well as increased awareness and research to prevent the further loss of lives. This matter is still ongoing. See our open letter and the government response for further information.
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. PPE is one measure within the hierarchy of controls used in the workplace. The type of PPE you need will depend on a risk assessment which should include the environment you work in and the procedures you carry out. Respiratory protective equipment (RPE) such as FFP3 and FFP2 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.
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.
Under health and safety legislation, employers have a duty to ensure that risk assessments are carried out and control measures put in place to reduce the risk of harm to staff and patients. The hierarchy of controls should be prioritised and used to guide safe practice in the workplace. This hierarchy contains a number of risk controls to assess and manage prior to the use of PPE and (in the case of SARS-Co-V2 management) includes actions such as isolation of patients suspected or known to have COVID-19, safe systems of work, the provision of policies, education/training, and finally the use of PPE.
The HSE/HSE NI and MHRA both issue alerts and notices relating to equipment, PPE or treatment of patients.
The below list is non-exhaustive. Please speak to your employer or local procurement team about any concerns and keep up to date with any local reporting procedures and policies.
KN95 face masks
KN95 face masks must not be used as PPE for work as their effectiveness cannot be assured. Read the Health and Safety Executive’s health and safety bulletin (June 2020) for more detail.
If you are offered KN95 face masks at work as an alternative to FFP2 or 3 masks, we recommend you keep a record of this using your workplace’s incident reporting procedure (i.e. datix or equivalent). If your workplace continues to use KN95 masks despite this safety alert, please follow our PPE – are you safe? guidance. If you need further support please contact us.
Thermal cameras and temperature screening products
Please see Medicines and Healthcare products Regulatory Agency (MHRA): Don't rely on temperature screening products for detection of coronavirus (COVID-19).
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. Whilst Public Health England (PHE) maintain that CPR is a non-Aerosol Generating Procedure (AGP) and therefore does not require full PPE (FFP3 respirators, gowns, eye protection and gloves), they have acknowledged that Health Care Trusts may opt for AGP levels of PPE if they consider this appropriate. This best ensures health care workers’ safety when performing chest compressions and advanced resuscitation in the acute hospital setting. Staff should also refer to their local policy for further information.
The RCN has worked 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. 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. Contact us if you need further support.
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 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:
- not listen or feel for breathing – look only for the absence of signs of life and the absence of normal breathing
- call for an ambulance
- early use of a defibrillator (if available)
- don PPE if immediately available
- commence chest compression CPR only, covering the patient’s mouth and nose with a cloth/item of clothing if there is a perceived risk of infection.
The recent NMC statement on personal protective equipment during the COVID-19 pandemic supports the RCN guidance and reflects the realities of clinical decision-making in the context of this pandemic.
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.
If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.
We are currently using FRSM and have no access to FFP3 masks. What should we do?
Your employer should, as a minimum be following national infection prevention and control guidance on what PPE is required for where you work, for example patients’ own homes. In some instances, for example when carrying out aerosol generating procedures, you must be provided with FFP3 masks and be given advice and training on fit testing, face checking and donning and doffing.
The RCN believes that all staff should have access to the higher degree of respiratory protection (for example FFP3) and are working hard to get this in place. Read our position statement on PPE here. In the meantime, there may be steps that you can take to reduce any risks. These would include asking the patient or their carer to have the window open in the room where the patient will be cared for as long as reasonably possible before your expected arrival and to keep it open when you are delivering care, taking into account other issues, such as the external temperature or outdoor air quality (e.g. diesel fumes or bonfires).
Family members or others in the household should be asked to wear face coverings during your visit and wherever possible keep at least 2 metres away from you, if not supporting the care of the patient. Others in the household, should remove themselves to a different room and shut doors to also help reduce exposure.
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.
Some of the patients I visit refuse to have the window open where I am working to increase ventilation. What should I do?
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.
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.
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.
People who live in the residence are refusing to wear face coverings or social distance. What should I do?
Try explaining to the residents why it is important to wear face masks and socially distance. Your manager or organisation could send out a communication to support this. It would be helpful to have spare copies of the communication to give to relatives or friends who may be visiting the patient at the time of the visit and are unaware of the risks.
If they are still refusing, discuss with your manager what additional steps could be taken to encourage the family including your manager speaking directly to the family or carers and a written agreement on what steps need to be taken to keep everyone safe.
I feel vulnerable when I ask for the windows to be open or for the family to wear masks – I have been abused
Your personal safety is important particularly when you are a working alone. Under health and safety legislation, your employer has a duty to ensure that measures are put in place to reduce the risk of verbal and physical abuse, including de-escalation training and means of raising the alarm. You should also be supported to carry out a dynamic risk assessment, to assess the environment and any immediate risks and how to withdraw to a place of safety should you need to.
You should raise any concerns with your manager and discuss what additional steps could be taken to protect you, including your manager speaking directly to the family or carers and a written agreement on expected behaviours.
For further information please look at the RCN’s guidance on personal safety when working alone.
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. Contact your local RCN safety rep if you have one, or the local security/safety manager for advice.
Your organisation should have a policy on managing violence and aggression and what steps need to be taken if patients or family are abusive or not following agreed steps to keep staff safe during home visits.
For further information visit the RCN’s webpages on refusing to treat.
Who developed the guidance?
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. ARHAI Scotland continue to provide the evidence 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.
Was the RCN consulted in the development of UK guidance on IPC or PPE?
A number of guidance documents have been produced since the pandemic began.
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.
Guidance on the re-use of single use PPE
Guidance was issued by PHE on the reuse of single use PPE in extreme shortages in April 2020. The development of this guidance was undertaken without consultation with the RCN. The RCN does not support the re-use of single use PPE at this time.
Guidance for health care professionals on immunisation and COVID-19
PHE have issued clinical guidance for health care professionals on maintaining immunisation programmes during COVID-19. The RCN was not consulted on this guidance.
Guidance for the remobilisation of services within health and care settings Infection prevention and control recommendations
On 9 July 2020 the RCN was asked to provide broad feedback on an early iteration of the IPC guidance COVID-19: Guidance for the remobilisation of services within health and care settings Infection prevention and control recommendations. The RCN provided broad feedback at this time, in anticipation of confirmed further consultation on content detail. The guidance was issued without further RCN involvement despite an offer to support this work.
This UK IPC guidance document was revised and updated on 1 June 2021. The RCN was not consulted or asked to review any changes prior to its publication.
What happens next?
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.
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 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.
RCN members have raised concerns that some PPE products have had 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.
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.
HSE NI have also assured RCN Northern Ireland, 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 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 alterative PPE by your employer that is fit for use.
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 you have concerns about PPE processes or equipment, please see our section on raising concerns about 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 and FFP2 face masks are types of tight fitting 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.
Where national Infection Prevention and Control Guidance and/or local risk assessments indicate that FFP3 or FFP2 levels of protection are required, a fit test must be carried out prior to first wearing a new model of FFP3 or FFP2 mask. Fit tests must also be carried out 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 an FFP3 or FFP2 mask is put on. The HSE has guidance on this including an instructional video. The HSE’s guidance also 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.
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.
What if I have concerns about fit testing?
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 FFP3 or FFP2 masks 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 and FFP2 provision, the RCN calls on manufacturers to review the design of masks to ensure that there is a good selection of FFP3 and FFP2 masks suitable in fit for a predominantly female nursing workforce.
Where risk assessments require staff to wear FFP3 or FFP2 masks and where a subsequent fit test is failed for all models available, staff should either be redeployed to areas where FFP3 and FFP2 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.
The previous 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:
- expired PPE
- home-made PPE.
Long sleeves and hand hygiene – some members have reported being asked to cut the sleeves short to facilitate hand hygiene. Likewise, some Trusts support rolling up of sleeves to support hand hygiene and unnecessary glove use. Members should follow their local IPC policies/guidance. Please see our section below on raising concerns if required.
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:
- Ensuring the temperature of the working environment is comfortable (looking at air temperature, reducing sources of radiant heat, reviewing air speed and humidity). 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 the maximum time for wearing FFP2/3 face masks should always be followed, but masks would need to be changed if, breathing becomes difficult; the respirator is damaged; the respirator becomes obviously contaminated by respiratory secretions or other bodily fluids, or a proper face fit cannot be maintained (e.g. due to sweat causing slippage).
- Allow staff to take power naps especially during night shifts
- Access to comfortable (temperature as well as seating) rest facilities and water/fluids containing electrolytes
- Access to toilet facilities and ability to take breaks
- Raise awareness amongst staff of the signs of dehydration and heat stress and measures that can be taken to reduce the risk
- Limit to shift length and continuous back to back long shifts (cross refer to shift work position)
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.
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.
PPE in use across the UK may contain natural rubber latex (NRL), including gloves and face masks.
Proteins found in NRL are known to cause allergic reactions in some individuals, including:
- a type I allergy or immediate hypersensitivity reaction which can cause skin urticaria or more serious swelling of the throat or mouth and severe asthma
- a type IV delayed hypersensitivity reaction which occurs when the NRL (the sensitiser) enters the skin and combines with immune cells.
Type IV reactions can cause contact urticaria. In sensitised individuals with a type I allergy to NRL, exposure can be life threatening.
Powdered NRL gloves are particular risk to those with latex allergies as proteins attach themselves to the powder and become airborne increasing the risk of exposure.
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.
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.Read more about raising concerns about PPE.
Wearing PPE is extremely 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. For some, symptoms may include poor concentration, tiredness, poor memory, feeling low or depressed and lowered confidence. Hot flushes at work are a major source of distress for many women. Things that make hot flushes more difficult to cope with are working in hot and poorly ventilated environments, formal meetings and high visibility work such as formal presentations.
These 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 in these circumstances, 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 The menopause and work: guidance for RCN representatives which outlines some of these symptoms and possible adjustments to be considered in the workplace.
Please also see our section on Heat Stress above.
The RCN has lots of helpful information in our clinical page, Women's Health: Menopause
Menopause. RCN guidance for nurses, midwives and health visitors
Menopause and mental health pocket cards
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
If you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE below.
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.
Pooling use of respirators amongst groups of staff is not acceptable
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:
- individually allocated masks
- suitable storage facilities and labelling to manage risks associated with cleaning and replacement of filters, reducing the transmission of infection and
- availability of appropriate sizes.
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:
- Why are we in this position?
- Has the risk assessment been revised and what are the revisions? Please provide me with a copy.
- What are the additional risks to me and my colleagues?
- Confirm the additional risks that are created by reusing PPE
- What other control measures have been considered?
- What considerations have been made before getting to a point of reusing PPE?
- What assessment has been made that the PPE is suitable to reuse?
- What qualification does the person have in order to inspect the PPE in order to say it is suitable to wear again?
- What is the agreed action plan to support implementation of this shortage and does it include a consideration of all measures to manage usage effectively? Please provide me with a copy.
- How long in time am I expected to reuse PPE?
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 contact us.
For the purpose of this pandemic, some PPE can be retained and reused between patients - this only applies to extended use of facemasks (all pathways) or FFP3 respirators (together with eye/ face protection) in the medium and high risk pathway for healthcare workers where AGPs are undertaken for COVID-19 cohorted patients/individuals.
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. Sessional or extended use should be limited to care areas where healthcare workers are providing continuous care for a group of cohort suspected or confirmed COVID-19 patients.
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 have received reports of a lack of suitable and sufficient PPE and alcohol hand sanitiser available to all nursing staff including hospitals, GP surgeries, care homes, hospices, and community nurses visiting people in their homes. NHS and social care employers must follow statutory obligations in relation to the provision of PPE, otherwise they may be in breach of the following:
- Health & Safety at Work Act 1974
- Regulation 4 of the Personal Protective Equipment at Work Regulations 1992
- Control of Substances Hazardous to Health Regulations 2002
- Management of Health and Safety at Work Regulations 1999
- The implied terms to provide a safe place of work and reasonable support in all our members’ contracts of employment.
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 have risen to the challenge of this unprecedented situation. RCN members have come out of retirement, students have interrupted their studies, and nursing staff are deploying from non-clinical settings, all to support the frontline in the battle against COVID-19 and yet many may 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.
Raising concernsIf you have concerns about PPE processes or equipment, please see our section on raising concerns about PPE.
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.
- COVID-19 FAQs
- COVID-19 and vaccination FAQs
- COVID-19 and staffing levels
- COVID-19 and time off
- Employment guidance for NHS staff
- Individual risk assessments
- Nursing students & trainee nursing associates advice
- Personal protective equipment (PPE) advice
- Redeployment guidance
- Managing COVID-19
- COVID-19 vaccination
- Immunisation & large-scale vaccination delivery during COVID-19
- Prescribing safely under COVID-19
- DNACPR & verification of death
- Mental health care delivery
- Our position
- RCN position on mandatory vaccination
- Open letters
- Media statements
- Campaigning during COVID-19
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:
and speak to your line manager.
If you have followed these steps and the issue is still not resolved, please contact us.
Page last updated - 22/09/2021