Emergency Medicine - RIE
Should be worn for all patient care where you might be at risk of exposure to blood, bodily fluids or possibly infective skin or mucus membranes.
- Gloves
- Apron
PPE and Infection Control
Warning
The reference for infection control PPE is the National Infection Prevention and Control Manual (NIPCM) linked HERE.
To be valuable PPE needs to be correctly removed and hands cleaned with hand rub or soap and water.
Levels of Additional PPE - 'Transmission based precautions' (TBPs)
There are times where we should use extra PPE which currently is defined by the way infections are transmitted
- Direct contact, Droplet, Airborne and Aerosol Generating procedures (AGPs).
See below for a summary and also PPE resources for specific circumstances:
For all patient care, even if no exposure to bodily fluids.
- Gloves
- Apron
Advice for donning and doffing PPE HERE
For all patient care, even if no exposure to bodily fluids.
- Gloves
- Apron
- Eye protection (visor)
- Surgical facemask
Advice for donning and doffing PPE HERE
For all patient care, even if no exposure to bodily fluids.
- Gloves
- Apron
- Eye protection (visor)
- FFP3 facemask
Advice for donning and doffing PPE HERE
AGPs are procedures that cause droplets to turn into aerosols and therefore require airborne PPE.
List of AGPs and 'fallow time' here
- Gloves
- Apron
- Eye protection (visor)
- FFP3 facemask
Advice for donning and doffing PPE HERE
NIPCM advises using clinical judgement.
We've got two ways to decide: pathogen based or clinical features based.
Pathogen based decision
If there's a known or suspected pathogen you can look it up in Appendix 11 of the NICPM under A-Z of Pathogens and the downloadable table. The table outlines required PPE (contact/droplet/airborne) and also ideal patient placement guidance. There are also some reminders for common illnesses in this RDS page (See Measles, CPE, TB).
Clinical features based decision
Most patients coming through the ED don't have a known organism yet and we have to make a decision based on what they've got wrong with them. There isn't necessarily a right answer and you have to use clinical judgement based on:
- Patients symptoms - type and severity
- Care setting and Procedures undertaken
- severity potential illness caused
Respiratory symptoms? - Droplet precautions (as many resp illnesses transmitted by droplets)
Diarrhoea, most vomiting illnesses or rash - Contact precautions
Suspected meningitis - droplet precautions (unless AGP)
If someone is very actively vomiting you might want to add droplet precautions.
Measles in the Emergency Department
"Patients attending without prior notification should ideally be screened and triaged at the reception or entrance.
Patients with suspected measles should not wait in communal areas or reception areas and should be placed in a segregated area (ideally a single room away from others) as soon as possible.
If patients with suspected measles arrive in A&E by ambulance, the ambulance service should pre-alert the receiving department to ensure they are admitted directly to a side room or segregated area."
Measles is spread by the airborne route so airborne type PPE should be used (see above).
Further placement advice available from the intranet here.
Link to airway PPE guidance
For all invasive procedures: A lines, Central lines, chest drains, thoracostomy, thoracotomy, resuscitative hysterotomy, lumbar puncture we should wear:
Visor
Surgical facemask
Sterile Gloves/double gloves
Sterile Surgical gown
If the patient has an febrile/transmissable illness, consider whether the procedure is an AGP and whether you need to change to AGP PPE.
PPE for Visitors is referenced at the bottom of THIS PAGE in the NIPCM
See the HCID Triage Assessment page
Click Here for posters, donning and doffing guides, training videos and sampling protocols.
NHS Lothian Health and Safety resources are based on the intranet here.
TBC