Appropriate Use of PPE Guidelines

Note: As of April 17, 2020, the Saskatchewan Health Authority (SHA) implemented Continuous Use Masking Principles and Guidelines. The SHA now requires surgical/procedure masks to be worn by all staff and physicians who may come into direct or indirect contact with patients/residents/clients in clinical care areas. Masks are not required in common areas of SHA healthcare facilities (i.e. hallways or waiting areas unless individuals are symptomatic).

As with other sectors, the healthcare system uses engineered controls, administrative controls and PPE to address the many hazards faced by health care workers. There are extensive PPE requirements for employees in the health care system.

The appropriate use of PPE to protect against the COVID-19 virus is based on established infection prevention and control measures implemented by health authorities. PPE requirements based on droplet and contact precautions include:

• Gloves, a long-sleeved gown, procedure/surgical mask, and facial/eye protection when entering a patient room and in close contact with a COVID-19 patient. These items must be removed after leaving the room.
• Gloves, long-sleeved gown, an N95 respirator, and facial/eye protection when in direct contact with a COVID-19 patient and an aerosol generating medical procedure is performed that could result in fluid from the patient's respiratory system becoming airborne (e.g. intubation, CPR).
• Proper hand hygiene, including washing with soap and water or alcohol-based hand rubs when hands are not visibly soiled.
• Masks and other disposable PPE can be discarded into a plastic-lined garbage container.

Most workers in non-healthcare settings will not require PPE for protection against the COVID-19 virus unless they are in situations similar to health care workers. Non-PPE controls should be put into place by employers as often as possible.

Orders from the provincial Chief Medical Health Officer and support from the Ministry of Labour Relations and Workplace Safety represent the minimum standard that employers must meet. To address COVID-19 health and safety concerns in the workplace, ask yourself the following questions:

1. How are you telling your workers about COVID-19 (i.e. exposure to COVID-19 in your workplace)?

2. Do you have a system in place where workers (including occupational health committee (OHC) or an occupational health and safety representative) can inform you of concerns relating to being exposed to COVID-19 in the workplace?

Find out if there are any specific tasks that concern them (e.g. tasks that involve interacting with others).

Identifying exposure hazards and developing measures to control exposure

3. What are you doing to prevent your workers from being exposed to COVID-19?

• Have you done a walk-through of your workplace to identify specific conditions or tasks that may increase the risk of exposure of your workers to COVID-19?
• Have you asked your workers (including your occupational health and safety committee or an occupational health and safety representative) where potential exposures may occur and how they think exposures can be controlled?
• Are tasks that require PPE necessary at this time or can they wait?

4. Have you developed controls that will eliminate or minimize the risk of exposure?

• What are those controls?
• Have you put them in place?
• How are they working (are they effective)?
• How do you know how they are working?

Controlling the number of people on site

5. How are you controlling the number of workers and other people at your workplace?

• Do all your workers need to come to work? Can some work from home?
• Can you stagger shifts to reduce the numbers present at one time?
• Are you ensuring there is adequate cleaning between shifts?
• Can you prioritize the work that needs to be done at the workplace to help your business operate as close to normal under the circumstances? This will require a determination of core work and where it can safely and productively be performed.

6. If you have workers who need to come to the workplace, how are you ensuring the following steps are being taken to reduce their risk of COVID-19 exposure? Different workplaces will have different needs, but the following steps are a good start:

• Workplaces may have physical barriers in place (e.g. drive-thru windows for customer service).
• Position workers to allow for physical distancing. Keep two metres between workers, as well as your customers.
• Provide soap and water or hand sanitizers, and encourage workers to wash their hands frequently.
• Enhance cleaning and disinfecting of the workplace, particularly high-contact items such as door handles, faucets, keyboards and shared equipment (e.g. photocopiers).

7. How are you checking and tracking whether the above steps are being taken?

A surgical/procedure mask is not a respirator. It is an approved (e.g. ASTM standard F2100), loose-fitting, disposable device that creates an effective physical barrier. It is intended to prevent droplets from an infected source from contaminating the skin and mucous membranes of the nose and mouth of the wearer. These masks can be worn by people infected with the COVID-19 virus to trap droplets expelled when coughing or sneezing. Healthcare workers routinely use surgical masks as part of their PPE requirements.

N95 is a National Institute for Occupational Safety and Health (NIOSH) approved, air-purifying, particulate-filtering, disposable, half-face piece respirator. These devices are designed to protect users from inhaling hazardous airborne particles and aerosols, including dusts and infection agents such as the COVID-19 virus. An N95 respirator is a common protective device in health care settings.

N95 respirators require initial and ongoing training, as well as an approved method for fit-testing to ensure a tight facial seal. Without this training and fit-testing, N95s may not be effective against the COVID-19 virus.

Left: Surgical/procedure mask. Right: N95 respirator

To expand the availability of N95 respirators and surgical masks during the pandemic, some alternate standards designated as equivalent by the Government of Canada/Health Canada will be accepted. This includes respirators such as KN95, FFP2, P2, Korea 1st Class, DS and surgical masks such as Type IIR that are approved or certified under standards used in other countries similar to NIOSH and ASTM.

Public Works and Government Services Canada has information on specifications for COVID-19 products.

Cloth masks are non-medical masks or face coverings which are NOT considered PPE for use in a workplace setting. They are not regulated like surgical/procedure masks and respirators. Cloth masks are considered an additional or supplementary hygiene measure to further prevent transmission of COVID-19. Instead of protecting workers, they protect others from possible transmission.

If an employer determines that PPE is required to protect the health and safety of workers based on a hazard assessment, then the employer must supply approved PPE to workers. Cloth masks do not replace proven measures such as handwashing and physical distancing. Please refer to the Cloth Mask Guidelines for more information.

Many tasks performed by workers in non-healthcare settings will not require PPE.

Occupations that require workers to come into close contact (less than two metres) with people known or suspected of having the COVID-19 need to take extra precautions, including wearing PPE. This includes:

• First responders (e.g. police and fire officials);
• Corrections officials;
• Group home and personal care home workers responsible for resident care;
• Funeral home staff;
• Public health officials; and
• Personal care services.

There is limited evidence on the effectiveness of homemade cloth masks. Employers may use their discretion to allow staff who are otherwise healthy to wear homemade masks. Specific guidelines for cloth masks are available.

For further information on COVID19 please visit:

• Government of Saskatchewan: https://www.saskatchewan.ca/coronavirus
• WorkSafe Saskatchewan: http://www.worksafesask.ca/covid-19
• Workers Compensation Board (SK): http://www.wcbsask.com/employers/covid-19-and-the-workplace