Where it is not reasonably practicable to prevent exposure to a substance hazardous to health (as may be the case where healthcare workers are caring for patients with suspected or known airborne micro-organisms) the hazard must be adequately controlled by applying protection measures appropriate to the activity and consistent with the assessment of risk. If the hazard is unknown the clinical judgement and expertise of IPC/HPT is crucial and the precautionary principle should apply.
Respiratory Protective Equipment (RPE) i.e. FFP3 and facial protection, must be considered when a patient is admitted with a known/suspected infectious agent/disease spread wholly or partly by the airborne or droplet route and when carrying out aerosol generating procedures (AGPs) on patients with a known/suspected infectious agent spread wholly or partly by the airborne or droplet route.
The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment that includes e.g task being undertaken, the infectious state of the patient, the presenting symptoms, risk of acquisition and the availability of treatment.
For a list of organisms spread wholly or partly by the airborne (aerosol) or droplet routes see Appendix 11.
The following risk categorisation is the minimum requirement for staff groups that require FFP3 fit testing. NHS Boards can add to this for example where high risk units are present. This categorisation is inclusive of out of hours services.
National Minimum Risk Categorisation for fit testing with FFP3
Level 1 – Preparedness for business as usual
Staff in clinical areas most likely to provide care to patients who present at healthcare facilities with an infectious pathogen spread by the airborne route; and/or undertake aerosol generating procedures i.e. A&E, ICU, paediatrics, respiratory, infectious diseases, anaesthesia, theatres, Chest physiotherapists, Special Operations Response Team (Ambulance), A&E Ambulance Staff, Bronchoscopy Staff, Resuscitation teams, Mortuary staff.
Level 2 – Preparedness in the event of emerging threat
Staff in clinical setting likely to provide care to patients admitted to hospital in the event of an emerging threat e.g. Medical receiving, Surgical, Midwifery and Speciality wards, all other ambulance transport staff. In the event of an ‘Epidemic/Pandemic’ Local Board Assessment as per their preparedness plans will apply.
All tight fitting RPE i.e FFP3 respirators must be:
Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website. Powered respirator hoods are an alternative to tight-fitting FFP3 respirators for example when fit testing cannot be achieved.
FFP3 respirator or powered respirator hood:
Powered hoods must be:
Further information can be found in the Respiratory Protective Equipment (RPE) literature review and the Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence (IDHC) literature review.
Frameworks to support the assessing and recording of staff competency in PPE for IDHC are available in the resources section of the NIPCM.