Topic 2.3 Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE) forms an important component of infection prevention and control by providing a physical barrier between healthcare workers, clients, assistance animals and infectious hazards. While PPE does not replace standard precautions such as hand hygiene or environmental cleaning, it provides additional protection when there is a risk of exposure to infectious microorganisms, blood, body fluids or other potentially hazardous substances. When selected and used appropriately, PPE helps protect both the wearer and those around them, reducing opportunities for disease transmission and supporting safe service delivery.

Occupational Therapists (OTs) work across a diverse range of clinical and community environments where infection risks vary considerably. Unlike some healthcare professionals, OTs rarely undertake invasive procedures; however, they frequently work in close physical proximity to clients, assist with mobility and transfers, support activities of daily living, conduct home visits and interact with shared equipment and environments. Practitioners working alongside assistance animals must also consider situations where contact with animal bodily fluids, contaminated equipment or environmental hazards may require additional protective measures. PPE should therefore be selected following an individual risk assessment rather than applied routinely in every situation.

The COVID-19 pandemic significantly increased public awareness of PPE and highlighted both its importance and its limitations. During the pandemic, masks, eye protection, gowns and gloves became familiar components of healthcare practice. However, the pandemic also demonstrated that PPE is only one element of a comprehensive infection prevention strategy. PPE is most effective when combined with hand hygiene, respiratory hygiene, environmental cleaning, vaccination, ventilation and evidence-based organisational policies.

This topic examines the principles underpinning PPE, the different types of protective equipment used within occupational therapy practice, appropriate selection based on risk assessment, correct donning and doffing procedures, and practical considerations for maintaining therapeutic relationships while wearing PPE.

What is Personal Protective Equipment?

Personal Protective Equipment refers to specialised clothing or equipment designed to reduce exposure to biological, chemical or physical hazards.

Within infection prevention and control, PPE provides a barrier that helps prevent infectious microorganisms from:

• contacting the skin
• entering the eyes
• entering the nose
• entering the mouth
• contaminating clothing
• spreading to other people, animals or environmental surfaces.

PPE should always be viewed as one component of the broader hierarchy of controls. It is considered a lower-order control because it relies on correct human behaviour and does not eliminate the hazard itself. Consequently, PPE should be used alongside higher-order infection prevention measures wherever possible.

The Hierarchy of Controls

The hierarchy of controls is a widely recognised risk management framework that prioritises strategies according to their effectiveness in controlling hazards.

In relation to infection prevention, the hierarchy includes:

1. Elimination of the hazard where possible.
2. Substitution where appropriate.
3. Engineering controls (e.g., ventilation, physical barriers).
4. Administrative controls (e.g., policies, scheduling, education).
5. Personal Protective Equipment (PPE).

Occupational Therapists should implement higher-order controls whenever reasonably practicable before relying solely on PPE.

For example, improving ventilation, postponing non-urgent appointments during infectious illness or providing telehealth services may reduce infection risks more effectively than relying on masks alone.

Risk Assessment Before Selecting PPE

PPE should never be selected simply because it is available or routinely used.

Instead, Occupational Therapists should undertake a risk assessment considering:

• the client’s health status
• suspected or confirmed infectious diseases
• mode of disease transmission
• likelihood of contact with body fluids
• type of intervention
• duration of exposure
• environmental conditions
• involvement of an assistance animal
• current public health advice
• organisational policies.

Selecting PPE according to actual risk supports both effective infection prevention and person-centred care.

Types of Personal Protective Equipment

The type of PPE required depends upon the anticipated exposure and mode of disease transmission.

Common PPE used in occupational therapy includes:

• gloves
• surgical masks
• P2/N95 respirators
• eye protection
• face shields
• gowns
• aprons.

Each item provides protection against different types of exposure.

Gloves

Disposable gloves protect the hands from contact with:

• blood
• body fluids
• non-intact skin
• contaminated equipment
• contaminated waste.

Gloves should be worn only when indicated.

Examples include:

• wound management
• cleaning bodily fluids
• handling contaminated waste
• assisting with continence care
• cleaning up animal urine or faeces.

Gloves do not replace hand hygiene.

Hand hygiene must be performed before putting gloves on and immediately after removing them.

Gloves should:

• be single use
• never be washed for reuse
• be changed between clients
• be changed between contaminated and clean tasks on the same client when appropriate.

Masks

Masks reduce the transmission of respiratory pathogens.

Two main types are commonly encountered.

Surgical Masks

Surgical masks primarily protect against respiratory droplets.

They are appropriate when:

• providing care to clients with suspected respiratory illness
• respiratory hygiene is required
• droplet precautions are indicated.

They also reduce the wearer’s respiratory emissions.

P2/N95 Respirators

P2 or N95 respirators provide a higher level of respiratory protection against airborne particles.

They may be required when:

• airborne precautions are implemented
• caring for clients with airborne infectious diseases
• organisational policies require enhanced respiratory protection.

Fit testing and fit checking are essential to ensure effective protection.

Eye Protection

The eyes provide a potential route for microorganisms to enter the body.

Eye protection includes:

• safety glasses
• goggles
• face shields.

These may be indicated when there is a risk of splashes or respiratory droplets reaching the eyes.

Gowns and Aprons

Protective gowns and aprons reduce contamination of clothing and exposed skin.

They may be required when:

• body fluid exposure is anticipated
• extensive client contact is expected
• cleaning contaminated environments
• transmission-based precautions require additional protection.

Disposable gowns should generally be discarded after single use.

Donning and Doffing PPE

Correct application and removal of PPE are essential.

Improper removal is a common cause of contamination.

Although procedures vary slightly depending on the equipment used, the general sequence is:

Donning

1. Perform hand hygiene.
2. Put on gown or apron if required.
3. Apply mask or respirator.
4. Apply eye protection.
5. Put on gloves.

Doffing

1. Remove gloves.
2. Perform hand hygiene if indicated.
3. Remove gown.
4. Remove eye protection.
5. Remove mask or respirator.
6. Perform hand hygiene immediately after all PPE has been removed.

Practitioners should avoid touching the contaminated outer surfaces of PPE during removal.

PPE in Assistance Animal Practice

Most occupational therapy sessions involving assistance animals do not require specialised PPE beyond standard precautions.

However, PPE may be appropriate when:

• cleaning up animal bodily fluids
• handling contaminated bedding
• responding to known infectious disease risks
• undertaking environmental cleaning following contamination.

Importantly, PPE should never be used as a substitute for excluding an unwell assistance animal from work or obtaining appropriate veterinary assessment.

Communicating While Wearing PPE

PPE may create barriers to communication, particularly for:

• autistic people
• children
• people with hearing impairment
• people who lip-read
• individuals with cognitive impairment
• people experiencing anxiety or trauma.

Occupational Therapists should minimise these barriers by:

• explaining why PPE is being worn
• speaking clearly
• using visual supports where appropriate
• maintaining eye contact
• checking understanding
• allowing additional processing time
• considering transparent masks where clinically appropriate and available.

Maintaining therapeutic rapport remains essential, even when PPE is required.

Common Errors in PPE Use

Common mistakes include:

• failing to perform hand hygiene
• wearing gloves unnecessarily
• touching the face while wearing PPE
• wearing damaged PPE
• reusing disposable PPE
• removing PPE incorrectly
• failing to change PPE between contaminated tasks.

Education, regular practice and organisational support improve compliance and reduce contamination risks.

The Occupational Therapist’s Role

Occupational Therapists should:

• undertake individual infection risk assessments
• select PPE appropriate to the identified hazards
• correctly don and doff PPE
• educate clients and carers regarding PPE use
• model evidence-based infection prevention practices
• minimise communication barriers created by PPE
• collaborate with multidisciplinary teams
• remain informed about current public health guidance.

PPE decisions should always balance infection prevention with person-centred, neuroaffirming and trauma-informed care.

Key Practice Principle

Personal Protective Equipment should be selected following an individual risk assessment and used as part of a broader infection prevention strategy that includes hand hygiene, environmental cleaning, ventilation and evidence-based organisational policies. Occupational Therapists should use PPE appropriately to protect themselves, their clients and assistance animals while maintaining effective communication, therapeutic relationships and inclusive, person-centred practice.