PPE: When and What to Use

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Below is a summary from the Ministry of Health Guidance for Primary Care (Version 7, November 9, 2020) and the Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID‑19 (Updated: December 15, 2021) and the update to Directive 5 (Dec 21 2021).

To obtain PPE supply please see Obtaining PPE in Western Ontario.

Personal Protective Equipment (PPE)

Summary of required HCW precautions are displayed in the table below. Please note current guidance is changing rapidly and we will clarify this table as information becomes available.

Activity	HCW Precautions
Before every patient interaction	HCW must conduct a point-of-care risk assessment to determine the level of precautions required
All interactions with and within 2 metres of patients who screen positive (i.e., patients with suspected or confirmed COVID-19)	Droplet and Contact precautions: Fit tested N95 mask. A fit-tested, seal-checked N95 respirator or equivalent is now recommended when caring for patients with suspected or confirmed COVID-19. Eye protection (goggles or face shield) Isolation gown Gloves Perform hand hygiene before and after contact with the patient and the patient environment and after the removal of PPE *Note: N95 masks that are not properly fitted are not as effective as those that have been fit-tested. Non-fit tested consumer N95/KN95 that fit well are preferable to surgical / procedure mask
Other patient care	Fit-tested, seal-checked N95 respirator (or equivalent, or greater protection), non fit tested N95 respirator, consumer KN95 mask, surgical mask. As noted above: N95 masks that are not properly fitted are not as effective as those that have been fit-tested. Eye protection Gown and gloves as appropriate to patient care requirements Use a point-of-care risk assessment for each direct patient encounter to guide your choice of PPE.

HCW precautions should take into consideration both COVID-19 and other potential communicable diseases as part of the point-of-care risk assessment. For patients who screen negative and are coming to the office/clinic for vaccine administration, gloves should be considered (e.g. skin integrity and some vaccines) as per the Canadian Immunization Guide. In most cases gloves do not need to be worn except when: the skin on the vaccine provider’s hands is not intact; administering intranasal or oral vaccines due to the increased likelihood of coming into contact with a patient’s mucous membranes and body fluids; and/or administering Bacille Calmette-Guérin (BCG) vaccine.

General In-Office Masking and Eye Protection

Given community spread of COVID-19 within Ontario and evidence that transmission may occur from those who have few or no symptoms, masking for the full duration of shifts for HCWs working in direct patient care areas is recommended. Donning and doffing masks is a high-risk time, so the frequency of this should be minimized i.e., once an N95 or surgical mask has been put on it should be left on. Read more about pre-symptomatic and asymptomatic transmission from the CEP here.

Masking is also recommended for HCWs working outside of direct patient care areas when interacting with other HCWs and physical distancing cannot be maintained. The rationale for full-shift masking is to reduce the risk of transmitting COVID-19 infection from HCW to patients or other office/clinic HCWs, at a time when no signs or symptoms of illness are recognized, but the virus can be transmitted. This is a form of source control.

The use of eye protection (e.g., goggles or a face shield) is recommended in order to protect HCWs when there is COVID-19 infection occurring in the community. Primary care providers should be knowledgeable on the proper sequence of donning and doffing PPE.