In order to curb the spread of Covid-19 infections in Nigeria, the Federal Government has made the use of Personal Protective Equipment, like face masks, mandatory in public settings.
What PPE should I expect to have for different clinical settings?
Infection prevention and control guidance issued on 21 August separates the management of patients into three COVID-19 pathways: ‘high’, ‘medium’, and ‘low’ risk, with different PPE requirements for each.
This is the minimum level of PPE you should expect to be provided with, and the NMA has called for wider use of respiratory protective equipment due to concerns about possible aerosol transmission outside of those procedures designated as aerosol-generating.
High risk clinical settings
Defined as where:
- Untriaged individuals present for assessment or treatment (symptoms unknown) or;
- Confirmed COVID positive individuals are cared for or;
- Symptomatic or suspected COVID individuals including those with a history of contact with a COVID case, who have been triaged/clinically assessed and are awaiting test results present or;
- Symptomatic individuals who decline testing present.
Recommended high risk PPE
- Single use gloves.
- Single use apron (or gown if risk of spraying/splashing).
- FRSM type IIR mask for direct patient care.
- Eye/face protection.
Medium risk clinical settings
Defined as where:
- triaged/clinically assessed individuals are asymptomatic and are waiting a COVID test result with no known recent contact with a COVID case or;
- testing is not required or feasible on asymptomatic individuals and infectious status is unknown or;
- asymptomatic individuals decline testing.
Recommended medium risk PPE
- Single use gloves.
- Single use apron (or gown if risk of spraying/splashing).
- FRSM type IIR mask for direct patient care.
- Eye/face protection.
When carrying out aerosol generating procedures, or in areas where AGPs are being conducted you should expect to have a:
- single use gown
- FFP3 respirator or hood.
Low risk clinical settings
Defined as where:
- clinically assessed individuals with no symptoms or known recent COVID contact who have isolated/shielded AND have a negative COVID test within 72 hours of treatment and, for planned admissions, have self-isolated from the test date or;
- individuals who have recovered from COVID and have had at least three consecutive days without fever or respiratory symptoms and a negative COVID test or;
- patients or individuals are regularly tested and remain negative.
Recommended low risk PPE
- Single-use gloves.
- Single-use apron (or gown if the risk of spraying/splashing).
- Surgical mask type II for extended use and FRSM type IIR for direct patient care.
- Eye/face protection if required for care procedure/task where anticipated blood/body fluids spraying/splashes.
Using your own PPE
Your employer must provide you with a safe working environment and with appropriate PPE for the area in which you are working.
For the level of PPE you need in different clinical settings, please see the response above.
You should not have to purchase your own PPE. However, if there is no alternative, you may decide to buy and wear the correct level of PPE for the area you are working in. You should not face criticism or more serious action if you do this.
The NMA is continuing to press the government to ensure that you can work safely and can protect yourself, your colleagues, your patients and your family.
Please contact us for further clarification and support.
Note: If you are a doctor in a supervisory or managerial role you may be in breach of FG’s guidance if you take steps to prevent or discourage the use of appropriate and necessary PPE.
Steps for maintaining good hand hygiene
The WHO advises healthcare workers to perform hand hygiene at five key moments.
This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings.
This approach recommends health-care workers to clean their hands:
- before touching a patient
- before clean/aseptic procedures
- after body fluid exposure/risk
- after touching a patient
- after touching the patient’s surroundings.
