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.

As with other sectors, the health care 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 and facial/eye protection when entering a patient room and in close contact with a COVID-19 patient. Please refer to the Public Health Order related to Face Coverings for masking requirements. 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 hand sanitizer approved by Health Canada (DIN or NPN number) when hands are not visibly soiled.
• Masks and other disposable PPE can be discarded into a plastic-lined garbage container.

Most workers in non-health care 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.

If it is determined that respiratory devices are required PPE in the workplace, employers must purchase approved respiratory protective devices. They must also meet regulatory requirements under section 88 of The Occupational Health and Safety Regulations including ensuring that:

• Workers must be fit tested in an approved manner to the make, model and size of the respirator;
• Workers wearing respirators are trained, can perform user seal checks, and know how to don and doff the respirator properly;
• Workers complete visual inspections of the respirator before use to check for defects or damage to the straps, nose clip or filter material; and
• Workers are informed of any limitations of the respirator stated by the manufacturer.

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. Health care workers routinely use surgical masks as part of their PPE requirements.

N95 respirators are an approved (e.g. NIOSH) 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. The protective devices are common protective in health care settings and 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, they may not effectively protect against the COVID-19 virus.

A list of authorized medical devices including surgical/procedure masks and N95 respirators is available from the Government of Canada.

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 approved COVID-19 products.

Certain particulate filter efficiency respirators (PFEs) manufactured in Canada are approved by Health Canada and can be used as PPE. Approved devices will have an IO authorization number, name and model of the device, name of the manufacturer and the product level of protection stamped directly onto the product. IO authorization numbers can be revoked by Health Canada. Employers are responsible for ensuring the IO authorization number is authentic and current.

A list of devices that have been approved by Health Canada can be found on the list of authorized medical devices. Devices with revoked IO authorization numbers can be found on the list of products no longer authorized.

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 and Mask Use in the Workplace for more information.

Many tasks performed by workers in non-health care 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 COVID-19 need to take extra precautions, including wearing PPE, including:

• 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 service facilities.