Personal Protective Equipment (PPE)

Fraser Health’s Infection Prevention and Control practitioners work to educate staff and clinicians on the proper infection prevention and control practices, including the proper use of personal protective equipment.

If you see any breaches of infection prevention and control practices, please inform your supervisor. If needed, the site directors and medical directors will follow up to address the situation.

No, you should not be double masking. 

Double masking refers to wearing a cloth mask over/under a medical procedure mask/filtering facepiece respirator (e.g. N95), or a medical mask over another medical mask/filtering facepiece respirator (e.g. N95) with an aim of improving the mask fit by making the mask tighter to the face or to prevent contamination of the underlying mask.  

The risks associated with double masking include:

• Potential to affect the fit by limiting the ability of the medical mask to adequately cover your mouth and nose.
• Placing a mask over top of a filtering facepiece respirator (e.g. N95) can compromise the seal of the respirator and increase exposure to the wearer.
• Wearing extra PPE complicates the doffing process and increases the risk of self-contamination.
• Increases the layers of material through which you need to breathe.  This makes it harder to breathe and less comfortable to wear for your shift

The personal protective equipment (PPE) being used within B.C. Health Authorities (including procedure and surgical masks) have been assessed to ensure that they meet Health and Safety as well as Infection Prevention and Control standards for particulate filtration efficiency, bacterial filtration efficiency, fluid resistance and provide a good fit around the mouth and nose.  Fraser Health continues to ensure that the personal protective equipment (PPE) being supplied in our workplaces meets the required Health and Safety standards to protect your health. 

References
BCCDC. (2020). Appropriate Personal Protective Equipment (PPE) for COVID-19 in Healthcare Settings. Retrieved from Coronavirus COVID-19 BC Centre for Disease Control: http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID19_AdditionalPPEPoster.pdf

The practice of extended use of PPE during the current pandemic has been reviewed by the BC Centre for Disease Control and the Ministry of Health.

As long as proper hand hygiene is followed, and the protocols related to the extended use of masks and eye protection are followed, this practice is safe and ensures everyone has access to the protective equipment they require.

Your mask should be changed prior to leaving the unit or patient care area for breaks (a new one obtained when you return to work) or if it becomes soiled, wet, damp or difficult to breathe through. Extended use of isolation gowns (disposable and reusable) apply when providing care to patients on Droplet Precautions and the area you are working in requires frequent changes of gowns. Staff who care for patients on Droplet Precautions in a cohorted area and are moving from one patient to the next in a short period can wear the same gown from one patient to the next. The gown should be changed before the next patient if: it is visibly soiled or moistened during care, the patient is on any additional precautions (i.e., airborne, contact, contact plus or enhanced contact precautions), there is major, obvious contact with the patient and after performing AGPs.

Gloves must be changes and hand hygiene performed before moving from one patient to the next.

Health workers should be using PPE based on the applicable precautions for the client.This includes wearing eye protection and a procedure mask for all client encounters during this COVID-19 pandemic.

When caring for patients with respiratory symptoms or those who have known/suspected COVID-19, use additional droplet/contact precautions, which includes performing hand hygiene, donning a gown, a procedure mask, a face shield and gloves. Observe airborne precautions for any aerosol generating procedures by wearing an N95 respirator. A Point-of Care-Risk Assessment (PCRA) should be completed prior to every patient/client/resident interaction and may identify whether additional PPE is required.

There is a COVID-19 Donning and Doffing PPE Guidance for Community Programs Providing Community Client Home Services available on Pulse. (e.g., Home Health, Home Support, Mental Health and Substance Use Services) 

COVID-19 like many other pathogens is killed by use of soap and water. Laundering used uniform/scrubs/other work clothing at home in the regular wash hot water cycle and tumble-dry is acceptable and will kill COVID-19 and will not contaminate your washing machine. 

In addition to the areas that normally receive scrubs, they are being issued to those areas that are caring for positive and suspect COVID-19 patients on the cohort units.

By following current Infection Prevention and Control best practices, you will be safe. Regular handwashing, coughing or sneezing into your elbow, and disposing of tissues appropriately are important ways to prevent the spread of respiratory illness.

• Staff must always do a point of care risk assessment when assessing a patient

• Ask patients with respiratory symptoms to put on a mask and perform hand hygiene (ABHR)

• Isolate patients with symptoms of respiratory illness: fever, new or worsening cough, sore throat, nasal congestion, headache, muscle pain or malaise

• Use Droplet/Contact precautions, including performing hand hygiene, donning a gown, a procedure mask, a face shield and gloves, if within 2 meters of a patient with respiratory symptoms

• Observe airborne precautions for any aerosol generating procedures (refer to Aerosol Generating Procedures (AGP) in Acute Care SOP - internal link; must be signed in to the Fraser Health network to access). 

• Be current with N95 fit testing (tested within the last 12 months).

For more information contact your site Infection Prevention and Control Practitioner. You can also access the IPC section of the Pulse website (internal link; must be signed in to Fraser Health network to access)

Procedure masks come with ear loops that are quick to don and doff for every day use in patient care areas. Surgical masks are meant to be used where surgical procedures are performed (ex. OR, ADC, cath labs). Surgical masks come with ties to be tied overtop surgical or bouffant caps and adjusted for a close fit. 

Procedure mask	Surgical mask

Masks used in Fraser Health generally follow the ASTM F2100 standards. All rated procedure/surgical masks provide sufficient protection for droplet precautions (including COVID-19 patients).

The current ASTM standard specifies performance requirements for the material used in masks with five basic criteria: 

An alternative standard considered acceptable by the government of Canada for COVID-19 response is the EN 14683 standard. This is an European standard with multiple “types” of masks (instead of multiple “levels”). There are three Types: Type I, Type II, and Type IIR. Only Type IIR is acceptable as it is the only one with splash resistance tested.

Selection of the most appropriate mask must be based on the risk of blood and body fluid exposure anticipated for the patient care needed. The biggest difference between the three ASTM levels is the splash resistance. There is increased fluid resistance with Level 2 and Level 3 masks and these should be used for tasks where higher amounts of fluid exposure and risk of splash are present.

The chart below can assist you in making this decision:

		Level 1 (80 mmHg)	Level 2 (120 mmHg)	Level 3 (160 mmHg)
Pressure correlation		Venous pressure	Arterial pressure	High pressures that may occur during trauma, surgeries, etc.
Risk of splash		Low	Medium	High
Uses		Can resist splash or spray at venous pressure. Suitable for short procedures and exams that don’t involve (or minimal) spray or fluids.	Can resist splash or spray at arterial pressure. Suitable for low-to-moderate levels of sprays and fluids.	Have the highest fluid resistance. Suitable for heavy levels of sprays and fluids.
Tasks*	Procedure	- General bedside procedures - Examination - Simple wound care - Respiratory etiquette	- General dental procedures - Procedures with moderate risks of splash (ex. inserting arterial line, inserting central venous line, starting hemodialysis, upper GI endoscopy, uncomplicated vaginal delivery)	- High risk procedures (ex. complicated vaginal delivery, procedures in emergency department to control bleeding) - High risk dental procedures (ex. use of air polisher, ultrasonic scaler)
	Surgical	- General bedside procedures in PAR - Transporting patients  - Tasks not directly involved with surgery or other procedures with risk of splash (ex. routine tasks by holding bay nurse, circulating nurse) - Surgical procedures with low risk of splash (ex. intraocular injection, robotic surgical procedures, minor surface suturing)	- Procedures with moderate risks of splash (ex. inserting arterial line, epidural) - Surgical procedures with moderate risk of splash (ex. minor local procedures such as biopsy and abscess drainage, insertion of contraceptive devices, locally anesthetized ophthalmologic surgery, laparoscopic procedures)	- High risk procedures  - Surgical procedures with high risk of splash (ex. open heart surgery, AAA, orthopaedic surgery, C-section, transplant, craniotomy) - General oral surgery

The mask should be disposed of and replaced as soon as it gets visibly soiled, wet, difficult to breathe through, or damaged, and once it has been doffed (e.g. for breaks).   

Use a faceshield in addition to your procedure mask, to prevent it from getting wet while showering/bathing patients. Anti-fog sprays or wipes can be used to prevent the faceshield from fogging up. Other ways to reduce the steam produced are to reduce the temperature of the water or consider an alternate method of bathing i.e. sponge bath.

Anti-fog wipes (Soap Castile Towlette 100 Bx Soap Towlette) can be ordered using FHA Order# 468748.  

No, using a level 3 mask would not mean the mask capability will last longer. 

The moisture/steam generated during a shower/bath, would go into the mask through the path of least resistance, meaning the sides of the mask. This can easily saturate the two inner layers of the mask causing decreased filtration capability. This saturation would be the same regardless of the level of mask used.  

Don a respirator (e.g. FFR (N95) or equivalent, or EHFR) to which you have a current fit-test (in last 12 months) if providing care to a patient on airborne precautions. In addition, use a respirator if Point of Care Risk Assessment indicates a higher risk of transmission of COVID-19:

• Patient undergoing AGPs
• In a room or unit with multiple patients who are suspected or confirmed to have COVID-19 (e.g., cohort unit or COVID-19 test collection and assessment centres)
• If there is prolonged close proximity (e.g., more than 15 minutes of face-to-face contact) to the patient
• If the patient has excessive and sustained coughing without wearing a medical mask for source control
• If it is anticipated that the patient will be doing an activity with heavy expiratory exertion (e.g., shouting and singing)
• In a room that is crowded or confined

Commercial- and medical-grade filtering facepiece respirators (FFRs) (e.g. N95s) are of similar structure and design, the main difference between them is that commercial FFRs aren’t tested for fluid resistance. All FFRs (N95 or equivalent) are equally effective at filtering particles and providing protection against airborne infectious disease such as during an aerosol generating procedure.Fluid resistance is necessary for procedures that may generate high-pressure streams of liquid.

The commercial grade FFRs are approved for use in health care settings by Health Canada. If you have been fit-tested to a commercial grade FFR model such as 3M 8210 and are working in an operative or procedural setting conducting tasks that pose a risk of high pressure fluid splashes or sprays use the FFR in combination with a faceshield. In the event your FFR does become contaminated with blood or body fluid follow standard practice of stepping out of the patient room, doff and replace your FFR.

Masks are required in health care settings, such as in hospitals, long-term care and assisted living facilities, community clinics and in home health/home support. If you are interacting with an individual who has flu-like symptoms, please ask them to put on a mask and use hand sanitizer. If masks are not available in your immediate area, please ask a clinical staff member, or a triage nurse (in the emergency department), to provide a mask.

All Fraser Health staff, physicians, and contracted staff working in patient care areas are required to wear eye protection. As well, extended use and cleaning processes have been implemented. Eye protection helps prevent staff from touching their eyes and prevents droplet from entering their eyes. 

Eye protection refers to PPE that protects the eyes, which includes safety glasses, goggles, and face shields. In general, eye protection are used when there is a potential for exposure to hazards involving the eyes (e.g. particulates, laser, BBF splash). Specific eye protection standards may vary depending on the hazard. Face protection refers to PPE that protects the face (including the eyes), such as face shields. These are used if both eyes and face protection are required (e.g. AGP). 

All staff and medical staff who work in patient care areas are to wear a surgical/procedure mask (or N95 or equivalent respirator based on PCRA) and eye protection (ie., face shield, goggles, or safety glasses) during your shift. 

The mask can be donned at the beginning of the shift and does not have to be changed between patients. The mask must be changed when it becomes soiled, wet/damp or hard to breathe through, and once doffed (i.e. for breaks etc.).

Please note: Prescription glasses are not equivalent to safety glasses.

All safety glasses/goggles used within Fraser Health for droplet and other BBF protection must meet one of the following standards:  1) CSA Standard CAN/CSA-Z94.3-07 or Z94.3-15, Eye and Face Protectors, or 2) ANSI Standard ANSI/ISEA Z87.1-2015, Occupational and Educational Personal Eye and Face Protection Devices. In addition to the CSA/ANSI requirement, please ensure you choose safety glasses or goggles which fit you. Please refer to the BCCDC Eye Protection Fit Tool for more information: Eye_Protection_Fit.pdf (bccdc.ca). If your safety glasses/goggles satisfy all the conditions above and are in good conditions, they are up to Fraser Health standards.

Do not proceed and notify your supervisor/manager.

Refer to the Fraser Health Self Look-up Report to determine your current status. (Internal link - opens in new window when signed in to Fraser Health network)

You have two options:
(internal links; you will need to be signed in to Fraser Health's internal network to access)

1. Have your department-trained fit-tester (if applicable) complete a fit-test for you.
2. Use the online booking tool to schedule your fit-test during a Health and Safety fit-test session (You will need to be use Google Chrome or Microsoft Edge browsers)