4.1. Recommended PPE
The following guidance identifies the minimum level of PPE recommended for the protection of healthcare workers in the context of COVID-19. Additional PPE may be used, as determined by local risk assessment, organisational policy, or worker preference.
Staff utilisation of PPE in non-patient areas
Organisational guidelines on the use of facial protection should be consistent with current jurisdictional guidance, which may include government directions, Victorian Department of Health or Commonwealth Department of Health and Aged Care guidance.
The following respirators and face masks may be appropriate, based on local policy and other relevant guidance. They are listed in order of higher to lower levels of protection:
- N95 or P2 respirator mask: These are high filtering masks. If they fit correctly, they provide the best protection. Respirator masks with straps that go around the head are likely to fit better and give more protection than respirator masks with ear loops.
- KN95 mask or KF94 mask: These are high filtering masks but are not as well fitted as a respirator. They usually have ear loops, so they do not achieve as good a seal between the mask and the face as an N95 or P2 respirator mask.
- Surgical or medical masks: These provide protection when worn correctly, fitting snugly over the nose, mouth, and chin.
Health services should employ risk assessment in determining mask requirements in public-facing areas (for example, visitor's enquiry desk). Health services may consider not employing mask requirements during periods of low community COVID-19 transmission risk.
In periods of high community COVID-19 transmission risk (informed by local epidemiology, COVID-19 hospitalisation numbers or in areas with high levels of immunocompromised patients), health services should require staff to wear masks with the choice of surgical mask or P2/N95 respirator at the individuals or services discretion and according to their fit test profile.
Individual staff choice to wear a mask should be maintained in non-patient facing areas, for example, corporate support offices. Surgical masks and P2/N95 respirators should be made available to all staff at all times to support choice and risk (for example, cases returning to, or contacts attending, the workplace).
Staff utilisation of PPE for clinical and patient-facing areas
P2/N95 respirators are recommended to be worn by all staff in all patient facing areas (including nurses’ stations or administration areas in wards) when COVID-19 transmission risk is high and an optional choice of surgical mask or P2/N95 respirator when COVID-19 transmission risk is low. At a minimum, surgical masks are recommended in clinical and patient-facing areas with N95/P2 masks to be used:
- for COVID-19 cases returning to work
- for close contacts attending the workplace
- according to the preference of the individual staff member, or
- as directed by the health service.
Health services are supported to recommend P2/N95 respirators for specific groups in high-risk areas as determined by the health service.
Health services should ensure that (subject to availability) P2/N95 respirators are available for staff based on their preference and fit test/fit check profile.
PPE when caring for patients with confirmed or suspected COVID-19 infection
The following transmission-based precautions are recommended for the care of COVID-19 patients. COVID-19 patients include suspected, probable, and confirmed cases, and contacts and patients who are recommended to isolate or quarantine.
Patients should always wear masks when outside of the isolation room (for example, during transfers, procedures, or diagnostics), noting that P2/N95 respirators offer a higher level of source protection and should be worn where it's safe to do so.
Table 2: Transmission-based precautions for COVID-19 – recommended PPE
|Disposable or reusable gown/apron
* P2/N95 respirators should be fit tested.
- Wear gown and gloves when a risk assessment indicates potential exposure to blood or body fluids, including respiratory secretions (for example, in symptomatic patients, or in aerosol generating behaviours or procedures). This applies to all settings, in all circumstances.
- Long-sleeved gowns may offer higher level protection.
- Hand hygiene should not be compromised by PPE use.
PPE that is labelled and marketed as single use should not be reused. The only exception is during periods of critical short supply when health services should implement clear guidance regarding re-use.
PPE that is labelled and marketed as reusable may be reused following cleaning and disinfection between each use. Reusable PPE should be inspected before each use to confirm that it is undamaged and still fit for purpose.
PPE for visitors
Masks are recommended to be worn by visitors to clinical areas at all times. Health services may consider requiring P2/N95 respirators to be worn by visitors to high-risk areas and during periods of increased transmission risk.
4.2. Donning and doffing PPE
PPE should be donned (put on) and doffed (taken off) in a controlled and safe environment to reduce the risk of contamination to self, others, or the surrounding environment. While doffing PPE it is particularly important to prevent contact between contaminated PPE and clean surfaces, skin, or clothing.
Staff should be trained and competent in donning and doffing (including one step or 2 step removal methods) and performing a fit check(see 4.3. Respiratory protection) when a P2/N95 respirator is donned. Staff not familiar with PPE may need the help of a PPE spotter or buddy to monitor and support safe practice. Mirrors may also be used to ensure that PPE has been donned correctly.
Table 3: Standard sequence for donning and doffing PPE
Donning (putting on)
Doffing (taking off)
Prior to entering a room or zone, perform hand hygiene and don:
On leaving the room or zone, doff:
* A fit check must be completed when donning a respirator
** Gloves and gown may be removed together in a one-step method or as two separate steps.
For more information, see the following resources:
Donning and doffing stations
Positioning donning and doffing stations:
- Station should be located in places that are protected from excess foot traffic, contaminated environments, and from potential handling by patients, residents, or others.
- Stations must have sufficient room for staff to comfortably and safely don or doff without risk of contamination to or from themselves and the environment.
- Whenever possible maintain a minimum 1.5 metre distance between donning and doffing stations.
- If the doffing station is inside the patient’s room, where possible maintain a minimum 1.5 metre distance from the patient.
- The doffing station should be located immediately outside or inside the patients’ room or the designated isolation area/zone, as close as possible to the door.
Stocking PPE stations:
- Ensure stations are cleaned and restocked on a regular schedule.
- A sufficient volume and range of recommended PPE must be available for staff.
- Avoid stacking excessive volumes of PPE on tables or floors at donning stations: PPE must be stored clean, dry, and protected from environmental contamination.
- Waste bins (including a clinical waste bin) should be available at doffing stations.
- Display signs to identify the station. Display PPE sequence posters.
- Unused PPE that has been stored inside an isolation room is considered contaminated and must be discarded once the patient is cleared and the stock is no longer required.
The use of a PPE spotter program is optional and may not be required or appropriate in all situations.
The purpose of a PPE spotter is to support safe and effective donning, doffing and use of PPE, particularly by staff who are less familiar with wearing PPE.
PPE spotters should be easily identifiable and assigned to observe the real time PPE donning and doffing process by staff, contractors, and visitors to identify and correct any deficits or breaches in PPE selection and use.
PPE spotters should be trained to explain, promote, and model safe and effective use of PPE.
The PPE spotter’s functions may include:
- Educating others to identify which PPE should be worn, where and when it should be worn, and when it should be changed. This includes donning and doffing sequences.
- Observing and assisting when others are donning or doffing PPE. The spotter should give calm and clear directions by calling out each step of the sequence. They should proceed at a controlled and careful pace, confirming correct completion of each step before moving to the next step.
- Monitoring PPE use and giving on-the-spot feedback to assist and correct any breaches or unsafe practices. This should be done in a positive way that promotes behaviour change and offers collegial support.
- Conducting compliance audits to monitor and report staff practice. The spotter should have a pathway to escalate unresolved concerns, deficits, and ongoing practice breaches.
Additional responsibilities may include assisting with the investigation and follow-up of staff experiencing adverse effects of PPE use (for example skin or pressure injuries).
Facilities should establish workplace protocols to investigate and manage PPE breaches.
If there is a breach in PPE or potential self-contamination, staff should notify the direct supervisor and follow organisational procedures for incident reporting.
4.3. Respiratory protection
Masks and respiratory protection
Individual tolerances, fit test results, and preferences must be considered when choosing the appropriate respiratory protection equipment (RPE).
Cloth face masks are not recommended for staff working in healthcare, residential aged care, or supported accommodation settings. Cloth face masks may only be worn by HCWs when arriving or leaving the facility.
Surgical masks and P2/N95 respirators can be worn continuously for up to 4 hours. A mask should be disposed of after 4 hours, or earlier if it becomes damp or soiled, hard to breathe through, loses its shape and no longer conforms to the face, or before going on a break.
Before P2/N95 respirators are used, each user should undergo fit-testing to verify which brands of respirator will seal to their face. The user should also perform a fit check each time the respirator is donned to confirm that it seals.
Fit testing is the process of verifying which brand, model and size of respirator will seal to the face of an individual. Fit testing is carried out using specialised equipment. Fit testing can be conducted by individual health organisations or independent contractors using either qualitative or quantitative methods. Both methods are valid and appropriate.
All employees who wear a respirator should undergo fit testing to ensure that an effective face seal is achieved and to comply with the Australian and New Zealand Standard AS/NZS 1715:2009.
For staff unable to pass a fit test, an alternative respirator (such as a PAPR) should be made available. There must be alternatives available for staff required to wear P2/N95 respirators unable to pass a fit test.
Students on placement who are required to wear a P2/N95 respirator should be fit-tested, either prior to commencement, as part of their onboarding process.
If fit testing has not yet been carried out, a P2/N95 respirator should still be used in preference to a surgical mask. A respirator, whether fit-tested or not, must always be fit-checked (see below) every time it is donned.
Staff should wear their PPE eye protection and facial dressings (if being used) while fit testing to ensure the protection does not interfere with the respirator fit or facial seal.
Fit checking is the process of evaluating the seal of a P2/N95 respirator at the point of use. Staff must perform a fit check every time they put on a P2/N95 respirator to confirm that a seal is achieved. A fit check is a distinctly different function to a fit test (above).
The procedure for donning and fit checking a respirator:
- Place the respirator on the face so the top rests on your nose and the bottom is secured under your chin.
- Place the top strap or tie over the head. Position it high on the back of the head.
- Pull the bottom strap over your head. Position it around your neck and below your ears.
- Place fingertips from both hands at the top of the nosepiece. Using two hands, mould the nose area to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece
- Ensure the head straps and respirator edges around the facial seal are not twisted, wrinkled, or folded.
- Check that the respirator has a negative pressure seal by covering the respirator with both hands and inhaling sharply. If the respirator is not drawn in towards the face, or if air leaks around the face seal, readjust the respirator.
Always refer to the manufacturer’s instructions for fit checking each brand or type of P2/N95 respirator.
Selection of respirators
Respirators used for HCW protection must be registered with the Therapeutic Goods Administration (TGA) as medical devices for use in health care, surgery, clinical or medical settings. This can be confirmed by checking the TGA Australian Register of Therapeutic Goods (ARTG) listing. TGA registered devices have a 6-digit Australian Register of Therapeutic Goods (ARTG) reference number and a GMDN code which identifies if it is registered for HCW use or use by the public. See 'TGA listed respirators' in under section 8.3.
Respirators with exhalation valves
Exhalation valves allow infectious particles to be exhaled from an infected person into the environment. Respirators with exhalation valves are not appropriate for use in health services as they do not provide source control and so are not fit for purpose where the required protection is bidirectional.
Elastomeric respirators approved by the TGA may be considered an alternative form of respiratory protective equipment. A risk assessment should be performed by the facility. Elastomeric respirator use must be accompanied by training programs for safe use, decontamination, and maintenance. In addition, the wearer should be fit-tested and receive training in safe use, donning and doffing, and infection prevention and control.
Elastomeric respirators with exhalation valves that do not filter exhaled air are not appropriate for use. They do not provide source control and so are not fit for purpose where the required protection is bidirectional.
Powered air-purifying respirators (PAPR)
Powered air purifying respirators (PAPR) use a blower to force air through a filter into the breathing zone of the wearer. A PAPR may have a tight-fitting half or full facepiece or a loose-fitting facepiece, hood, or helmet.
PAPRs meeting the requirements of AS/NZS 1715: Selection, use and maintenance of respiratory protective equipment (or its equivalent, such as an equivalent US or European Standard on respirators) may be considered as an alternative form of respiratory protective equipment in some circumstances, including:
- for increased comfort during prolonged RPE use (such as an entire shift)
- Where staff are routinely performing intubation in COVID-19 intensive care unit (ICU) areas
- when staff are unable to achieve a face seal; for example, due to beards, facial contours, deformity, allergy, or injury; for example, pressure ulcers from P2/N95 masks.
PAPRs provide additional comfort and visibility when healthcare workers must stay in the patient’s room continuously for prolonged periods.
In addition to protecting the wearer from external pathogens, PAPR that have filters for expired air also function as source control if the wearer is infectious.
PAPRs are available in distinct types, weights, and comfort levels. When selecting a PAPR, avoid models that do not filter the exhaled air. Consider face and skin protection. Partial-face PAPRs have advantages for verbal and visual communication but leave the eyes and other skin surfaces exposed to the risk of splash or spray contamination.
External surfaces of the PAPR should be considered contaminated, particularly the filter, which is a concentration point for particles. Care should be taken when doffing to avoid transferring contamination from the PAPR to self or clothing.
Reusable PAPR components must be cleaned and disinfected after use as directed in manufacturer's instructions and stored to prevent contamination. Documented cleaning and disinfection instructions should include cleaning methods, detergent agent, and disinfection agent (using TGA-listed products with claims for effectiveness against COVID-19), frequency and responsibility for cleaning.
Considerations for implementation:
- PAPR may not provide any additional protection compared to a well-sealed P2/N95 respirator.
- Some models of PAPR rely on a facial skin seal. These will require fit testing.
- Employers must ensure that appropriate cleaning, storage and charging facilities are available.
- PAPR should only be used by healthcare workers trained and competent in safe donning and doffing sequences, decontamination / cleaning after each use, when and how to change filters and charging of the battery, etc.
- PAPR should be used according to the manufacturer’s instructions, including recommended use, filter position, reprocessing of re-usable components, and battery use.
- PAPR selected for use during aseptic procedures should not pose a risk to the aseptic field.
- Employers need to allow for additional time for employees to don/doff and undertake tasks such as maintenance and decontamination (compared to the use of disposable respirators).
- Some employees may not be able to wear a hooded PAPR and this should be considered for each employee.
Respiratory protection programs (RPP)
Respiratory protection programs implement strategies designed to protect workers from workplace respiratory hazards, including COVID-19. All Victorian health services where health care workers, including volunteers and students on clinical placement, have the potential to be exposed to respiratory hazards are required to establish and maintain an RPP. See .
Employers are responsible for:
- completing a risk assessment that identifies staff who require P2/N95 respirators
- ensuring users of respirators undergo AS/NZS 1715:2009 approved fit-testing. Either qualitative or quantitative methods are valid and appropriate
- providing education and training on the safe and appropriate use of selected PPE.
Employees are responsible for:
- using PPE as instructed by the employer
- reporting any damage, defects, or malfunctioning PPE
- reporting any physical or medical limitations that may impact their ability to safely wear PPE.
Masks for use by patients
In clinical areas, communal waiting areas, public access areas, and during transportation, it is recommended that patients suspected or confirmed to have COVID-19 wear a face mask, noting that respirators provide higher level protection than surgical masks. Due to this, respirators should be worn when safe to do so.
A face mask is not recommended when a patient’s breathing or clinical care may be compromised.
It is recommended that children two years old and under never wear a face covering or mask due to choking and strangulation risks.
Other patients should be provided with either a surgical mask or P2/N95 respirator according to their preference.
4.4. Protective eyewear
The eyes, mouth, and nose all contain mucosal surfaces that are potential routes of acquisition of COVID-19. Eye protection has been associated with a lower risk of infection and provides a physical barrier to the deposition of virus-containing particles.
Protective eyewear should be used (in addition to other required PPE) by healthcare workers providing direct care or working within the patient zone with individuals with confirmed or suspected COVID-19.
Eye protection options include face shields, goggles, and safety glasses (including single use and reusable models) but does not include regular prescription glasses.
When wearing a P2/N95 respirator, it is important to select compatible eye protection that can be correctly positioned and does not interfere with or breach the respirator fit or facial seal. Staff should have eye protection available at the time of fit testing.
Goggles and safety glasses
Closely fitted wrap-around goggles or safety glasses that meet Australian Standards AS/NZS 1337.1-2010 (personal eye protection) provide reliable eye protection from splashes, sprays, and respiratory droplets that can come from multiple angles. Standard prescription glasses, contact lenses or safety glasses that are not wrap-around do not provide adequate protection and are not recommended as eye protection.
For optimal protection, goggles must fit snugly, particularly from the corners of the eye across the brow. Other types of protective eyewear include safety glasses with side-shield protection.
Single-use or reusable face shields are an alternative to goggles or safety glasses. Face shields are particularly useful for splashes and sprays of blood or body fluids, depending on the type of work performed.
All face shields should provide a clear plastic barrier that covers the face. They should extend below the chin and to the ears, and there should be no exposed gap between the forehead and the shield’s headpiece. Face shields which have a gap between the forehead and the headpiece are unsuitable for use in the operating theatre, birthing suite, or when aerosol-generating procedures are performed on COVID-19 cases, unless additional eye protection is worn under the face shield. These shields are, however, an appropriate form of eye protection in non-high-risk areas.
Wearers of prescription glasses can wear a face shield or one of various brands of goggles which may be worn over prescription glasses, or alternatively, safety glasses with prescription lenses.
Comparing different types of eye protection
Fitted wrap-around goggles/safety glasses have these advantages:
- flexible frames easily fit facial contours
- good eye protection is provided by enclosing the eyes
- prescription safety lens may be fitted.
and these disadvantages:
- prolonged wear may increase the risk of skin injuries, particularly if the seal is tight
- they do not cover other areas of face or mask/respirator
- they do not deter the wearer from touching the front of their face, mask, or respirator
- they may not be able to be worn over prescription glasses
- reusable safety glasses require cleaning and disinfection after use
- lenses may degrade or become scratched over time
- higher risk of fogging
- reflections on the shield can impede vision.
Face shields have these advantages:
- can be worn over prescription glasses
- adjustable head band attaches firmly and fits snugly against the forehead
- provide additional protection of face and mask/respirator from contamination (blood or body fluid splash, spray, droplet, cough, or sneeze)
- the wearer’s eyes are more visible, which may be important when caring for some patients
- less risk of fogging
- the wearer is less likely to touch their face or mask.
and these disadvantages:
- gaps to the sides and underneath may allow virus-contaminated droplets to reach mucous membranes.
Note: Face shields do not filter air and are not an alternative to wearing a mask or respirator.
How to remove protective eyewear
When doffing eye protection, the wearer should avoid touching their face near their eyes. Hold glasses by the arms and goggles and face shields by the headband at the back of the neck.
How to clean and disinfect protective eyewear
Protective eyewear labelled as ‘single use’ should be discarded after use and not reused.
Reusable protective eyewear should ideally be issued for individual person use. It must be cleaned and disinfected before and after use or reuse. Manufacturers’ instructions should be followed.
Eyewear can be cleaned and disinfected individually at the point of use or returned to a central point for batch cleaning of multiple units of eyewear.
Gowns protect clothing and skin against blood and body fluids; long-sleeved gowns offer the highest level of protection.
The type and level of gown should be selected according to a risk assessment of clinical requirements (for example, sterile versus non-sterile) and blood or body fluid (including respiratory secretions) exposure risk such as spray, splash, or high volume.
Disposable gowns that are visibly soiled or wet should be taken off and discarded. Reusable gowns that are visibly soiled or wet should be taken off and laundered in compliance with Australian Standards AS/NZS 4146:2000 (Laundry practice).
Gloves provide protection and may be used in standard and contact precautions.
- Gloves used in healthcare, residential aged care and supported accommodation settings must be of medical grade in compliance with Australian Standards AS/NZS 4011 and ISO 11193 (Single-use medical examination gloves). Vinyl gloves are not recommended for clinical care.
- Gloves must not be washed or have alcohol-based hand rub applied as this may damage the glove’s integrity.
- Double gloving is not recommended.
Gloves must be changed:
- after procedures
- when contaminated with blood or body fluids or other substances
- between patients.
4.7. Extended use of PPE
Extended use of PPE refers to wearing the same PPE for repeated close episodes with more than one patient, without removing them between each patient. Extended use of PPE is only permitted when caring for a cohort of patients with the same confirmed infectious condition and if the patient does not have another infectious condition.
In these situations, extended use of PPE can be less of a risk than frequent donning and doffing.
A surgical mask or P2/N95 respirator can be worn continuously for up to four hours. A mask should be disposed of after four hours or earlier if it becomes damp or contaminated, hard to breathe through, loses its shape and no longer conforms to the face or before going on a break.
Gowns do not need to be removed between patients unless they are visibly soiled or high risk/close contact tasks are being performed.
Extended use of PPE does not apply to gloves.
All PPE is required to be changed when leaving the COVID-19 clinical area or moving between COVID-19 clinical areas and non-COVID-19 areas.
Preventing PPE-related facial injuries
Prolonged use of tight-fitting facial protection, including respirators, face shields and goggles can contribute to skin injury. This is due to pressure and shear forces, friction, and the accumulation of moisture under the respirator. Skin that is excessively moistened by sweat and humidity is susceptible to irritation. Dry skin may become inflamed by cracks and fissures. Skin conditions such as rosacea, dermatitis, atopic eczema, dry/chapped lips, and acne can be exacerbated by the heat and sweating which occurs when wearing PPE.
Employers and employees should work together to minimise the risk of facial skin injury related to respirator use.
- support workers who wear respirators to monitor for skin injury
- act when workers report discomfort or skin injuries
- provide fit testing for every worker who wears a respirator
- provide sufficient supplies of a fitted respirator for each worker
- provide appropriate training for workers in performing fit checking, using respirators, and preventing facial injuries when wearing respirators.
- report discomfort or skin injury arising from their respirator to their supervisor
- seek a medical assessment and referral to a dermatologist if an allergic reaction to PPE occurs
- if a dressing is placed between the skin and respirator, ensure it does not interfere with the function of the respirator. The dressing should be worn during fit testing to confirm an effective seal.
The best prevention for respirator-related skin injury is to limit use to those times when a respirator is required for protection such as when working with identified COVID-19 risk.
Wherever possible, remove mask every 2 to 4 hours for up to 15 minutes and align with break times.
Maintain good skin care practices:
- Keep the skin clean and hydrated by drinking plenty of fluids.
- Avoid alkaline soaps/cleanser/toner and irritant chemical solutions.
- Keep facial skin care regime simple and avoid wearing makeup when wearing respirators.
- Moisturise using pH balanced products, use lip balm and avoid fragranced products.
- Apply liquid skin sealant/protectant, moisturising lotion, or barrier creams on skin surfaces that will be in contact with PPE. This may help prevent friction injuries without interfering with the fit of respirators or eye protection. Apply at least 30 minutes before wearing PPE. Allow to fully dry before applying PPE.
Using hydrocolloid or foam facial dressings
A thin hydrocolloid or foam dressing may be placed on facial pressure areas caused by PPE. Ensure dressings are wrinkle-free so that the respirator seal is not impaired. Some adhesives may be irritating for some people—cease use and seek treatment if symptoms of contact dermatitis occur.
Dressings may reduce the fit of respirators. Fit testing should be repeated with any dressings in place. Certain respirators are compatible with certain types of dressings. For more information, see .
Staff who develop a pressure injury may need to be trialled with a different type of respirator or eye protection or may need to be re-deployed to a different area which does not necessitate prolonged use of respirators.
Where there is difficulty managing a pressure-related skin injury or achieving an adequate fit, further options will need to be discussed with management, an infection prevention and control consultant, or an occupational health medical practitioner, general practitioner, or dermatologist.
4.8. Controlling heat stress while wearing PPE
PPE can reduce the body’s ability to cool off by evaporating sweat. Wearing PPE in hot weather, usually outdoors, may lead to heat stress. The effects of PPE-related heat stress may range from discomfort through to a life-threatening condition such as heat stroke.
The individual and the employer should minimise the risk of developing a heat-related illness.
Some key risk factors for developing a heat-related illness are:
- air temperature, wind and air movement, and radiant heat (from the sun or other sources)
- workload and task complexity
- period of exposure, long shift
- availability of a cool rest area and drinking water
- physical fitness of the worker (including acclimatisation and any pre-existing conditions)
- clothing (including the use of respiratory protection)
- the individual’s understanding of heat strain risk.
Strategies for managing common risks related to wearing PPE in the heat:
- Use a PPE spotter or buddy system.
- Regularly check surgical masks or respirators for moisture due to sweating and for signs of pressure injuries.
- Select the lightest level of gown for the required protection as determined by the risk of splash or spray.
- Wear a single layer of lightweight/cool clothing under PPE.
Reviewed 22 November 2023