Selecting and using PPE in veterinary practice

If you use personal protective equipment (PPE) to minimise a risk to health and safety, you must provide appropriate PPE to workers and other people at the workplace unless the PPE has been provided by another person, such as the owner of a horse business. Workers and other persons at the workplace must wear PPE in accordance with any information, training or reasonable instruction that you provide. Read more about duties to provide and wear PPE.

When selected and used properly, PPE forms part of a veterinarian's risk management approach to managing infection risks from exposure to Hendra virus and other zoonoses. PPE when used on its own tends to be the least effective way to manage risks. It should be used to supplement higher level control measures.

How to select PPE

You should wear a complete set of PPE when you are dealing with suspected or confirmed Hendra virus infection in horses to protect against both human health and biosecurity risks. This includes gloves, eye and face protection, protective clothing, respiratory protective equipment and protective footwear.

Within each of these categories of PPE there is a range of makes and models that provide varying levels of protection. You should select items of PPE that provide you with the best protection for the circumstances you are dealing with. For example, safety glasses may provide suitable protection where there is a low level of contact with blood and body fluids but a face shield or safety goggles provides more protection where a higher level of contact with blood and body fluids is anticipated.

The following table provides general information about issues you should consider when selecting PPE to protect against zoonoses.

Table 1 Issues to consider when selecting PPE

Issue	For consideration
Human health risks	The level of contact with blood and body fluids and other sources of infection.
Biosecurity risks	The potential for infection to spread between animals and off the property.
Infectious agent	Pathogenicity. Virulence. Mode of transmission. Transmissibility.
Task	The nature, duration and physical requirements of the task. Concurrent exposure to other hazards (e.g. hazardous chemicals).
Horse	Suspected or confirmed infectious agents. Clinical signs. Temperament.
Work environment	Climate (e.g. heat, humidity, rain). Physical conditions (e.g. slippery or uneven surfaces).
Worker	Individual factors (e.g. size). Medical conditions (e.g. latex allergy).
PPE performance	Properties (e.g. reusable/disposable, fluid resistance, tensile strength, ease of decontamination, level of protection). Compatibility between items of PPE when worn as an ensemble. Compliance with Australian Standards. How it performs in the environmental conditions in which you work.

How to use PPE

You should use disposable (single-use) PPE where possible. Do not reuse items that are intended for single use only.

Make sure that reusable PPE (e.g. eye/face protection, rubber boots) is maintained, repaired and replaced so that it continues to minimise risk.

You should establish an entry and exit procedure to provide a clear process for applying infection prevention and control procedures. Select an entry/exit point and identify a 'clean area' (the cold zone), a 'dirty area' (the hot zone where Hendra virus contamination may be present) and a transition area in-between. The transition area should be clearly identified (e.g. by using a ground sheet or tarpaulin). To minimise cross-contamination, separate the transition area into clean and dirty sides. Put on PPE, prepare sampling equipment and prepare disinfectant solutions on the clean side, before entering the hot zone. Once inside the hot zone, avoid adjusting or touching the PPE. On leaving the hot zone, return to the transition area and carefully remove PPE, decontaminate equipment and perform hand hygiene on the dirty side. If repeat visits are likely or other colleagues may visit, mark the site clearly so that the same site is used each time.

Where multiple items of PPE are worn together as an ensemble, use a consistent sequence for putting on and removing PPE to make sure that the items fit together properly and to minimise the risk of accidental contamination.

If an item of PPE becomes heavily contaminated, moist or damaged during use or if the protective barrier is breached (e.g. fluid strikethrough), return to the transition area and remove and replace the item.

Take care when removing PPE to avoid contamination. For example, do not touch potentially contaminated surfaces of PPE and perform hand hygiene before removing PPE from the face. Should contamination occur, wash or rinse the affected area thoroughly. Perform hand hygiene again once all PPE has been removed.

Disposable PPE that is worn for clinical situations involving suspected or confirmed Hendra virus infection should be disposed of as clinical waste. PPE designed for reuse should be decontaminated with suitable detergents and disinfectants after it has been used. Wear disposable gloves when decontaminating items of PPE and wash your hands thoroughly after removing gloves.

PPE has the potential to create health and safety risks for the user, especially when multiple items of PPE are worn together as an ensemble. Risks include thermal discomfort, heat stress, fatigue, reduced manual dexterity, restricted vision, and physical injury inflicted by a fractious horse. Be aware of these risks and take reasonably practicable steps to ensure health and safety. For example:

To minimise thermal discomfort and heat stress, ensure adequate hydration, wear lightweight and breathable underclothing, work in the shade or under a portable shade structure, use cooling fans or other ventilation devices, where possible schedule outdoor work to avoid the hottest part of the day, schedule regular rest breaks, and consider using a powered-air purifying respirator (PAPR). Cooling workwear worn under protective clothing, such as cooling vests and shirts, can provide a cooling effect.
To minimise fogging of eye and face protection, select equipment with anti-fogging properties, use vented safety eyewear (provided this does not increase the infection risk) and make sure that respiratory protective equipment is properly fitted to minimise leakage of exhaled air.
To minimise the risk of injury, be alert to the horse's behaviour and use methods of restraint as necessary. You could also consider providing advice to clients on ways in which they can de-sensitise their horses to PPE so that the horse is less anxious when you attend.

Types of PPE

Gloves

Purpose	Gloves are used to prevent hand contamination and the spread of infection between animals and off the property.
Type	Gloves include: reusable heavy duty gloves disposable latex, nitrile or vinyl gloves cut resistant gloves.
When to use	You should wear gloves: for any contact with an animal's blood, body fluids, mucous membranes and non-intact skin. when handling contaminated equipment, instruments, linen and waste. when administering an injection or performing venipuncture if contact with blood is likely or if you have non-intact skin on your hands. if Hendra virus is a primary or differential diagnosis or if infection is confirmed. to protect against other identified health and safety or biosecurity risks.
Level of protection	Gloves provide varying levels of protection, such as: single gloving provides a basic level of protection. double gloving may provide a higher level of protection. reusable heavy duty rubber gloves and disposable nitrile gloves may protect against concurrent exposure to hazardous chemicals (e.g. disinfectants). cut-resistant gloves worn over disposable gloves provide additional protection for high risk tasks such as necropsy.
Selection	Consider the following when selecting gloves: the level of contact with blood and body fluids glove properties (e.g. puncture resistance) the required level of manual dexterity the extent of the area to be protected (e.g. hand, wrist, forearms) concurrent exposure to other hazards (e.g. hazardous chemicals) compatibility with other PPE (e.g. wrist coverage when worn with overalls) the worker (e.g. size, latex allergy).
Use	Practical considerations when using gloves include: if using duct tape to seal gloves to overalls, make sure this does not tear the gloves or overalls during removal as this may cause contamination. consider using extended cuff gloves to protect the wrist. change gloves if they become torn or damaged during use. always perform hand hygiene immediately after removing gloves. if using latex gloves, select a low protein, powder-free make to minimise the risk of latex allergy.

Eye and face protection

Purpose	Eye and face protection is used to prevent contamination of the face and mucous membranes
Type	Eye and face protection includes: safety glasses safety goggles face shield surgical/medical mask or respirator.
When to use	You should wear eye and face protection: when contamination of the eyes, nose, mouth and face is likely. if Hendra virus is a primary or differential diagnosis or if infection is confirmed. to protect against other identified health and safety or biosecurity risks.
Level of protection	Eye and face protection provides varying levels of protection. Safety glasses provide the eyes with a minimum level of protection. Safety goggles and face shields provide the eyes with a higher level of protection but face shields do not provide a tight seal. Surgical/medical masks and respirators provide varying levels of protection to the eyes, nose, mouth and face, depending on the level of fluid resistance and face cover. Fluid resistant surgical/medical masks and respirators provide a higher level of protection against splashes.
Selection	Consider the following when selecting eye and face protection: the level of contact with blood and body fluids the potential for sprays and splashes PPE properties (e.g. anti-fogging, anti-glare, UV protection, scratch/puncture resistance, ease of decontamination) the visual requirements of the task environmental conditions (e.g. heat, humidity) concurrent exposure to other hazards (e.g. hazardous chemicals) the worker (e.g. use of prescription eyewear).
Use	Practical considerations when using eye and face protection: spectacles, sunglasses and contact lenses do not provide eye protection some makes and models of eye and face protection can be worn over spectacles or fitted with prescription lenses vented goggles help prevent fogging but may provide a lower level of splash protection non-vented and indirectly vented goggles provide a higher level of splash protection but non-vented goggles may increase the risk of fogging.

Protective clothing

Purpose	Protective clothing is used to prevent contamination of the skin and personal clothing and the spread of infection between animals and off the property
Type	Protective clothing includes: reusable cloth overalls (coveralls) disposable gowns disposable overalls.
When to use	You should wear protective clothing: when contamination of the skin and clothing with blood and body fluids is likely. if Hendra virus is a primary or differential diagnosis or if infection is confirmed. to protect against other identified health and safety or biosecurity risks.
Level of protection	Protective clothing provide varying levels of protection. Reusable cloth overalls: provide a low level of protection and are not fluid resistant may not be suitable for high risk situations require additional handling during laundering do not protect the head and neck. Disposable fluid-resistant overalls and gowns: provide a higher level of protection are generally lighter and better suited to hot and humid conditions than impermeable overalls may allow fluid penetration if there is a high level of contact with blood and body fluids or if pressure is applied. Impermeable (impervious) overalls provide the highest level of protection but increase the risk of thermal discomfort and heat stress. Protective clothing that includes head and neck protection should be worn in high risk situations and where a high level of contact with blood and body fluids is likely.
Selection	Consider the following when selecting protective clothing: the level of contact with blood and body fluids the level of contamination of the work environment PPE properties (e.g. barrier protection, fluid resistance, fabric and seam strength, comfort, breathability, zipper protection, ease of use) body coverage (e.g. partial/full body, head/neck protection) environmental conditions (e.g. heat, humidity) the physical demands of the task duration of wear the worker (e.g. size, heat acclimatisation).
Use	Practical considerations when using protective clothing: launder reusable overalls after each use and carefully manage infection risks from handling contaminated laundry. wear lightweight and breathable clothing underneath overalls. when working in hot and humid conditions or wearing protective clothing for extended periods, consider wearing a cooling device such as a cooling vest worn under protective clothing. a disposable apron or plastic sleeves worn over protective clothing may provide more protection however additional layers may restrict movement and increase the risk of thermal discomfort and heat stress. if using a gown or overalls that do not include an integrated hood, a disposable surgical cap or hood, or a PAPR with an integrated hood or helmet, may be used to protect the head/neck. impermeable overalls should be used with great care to avoid thermal discomfort and heat stress.

Respiratory protective equipment (RPE)

Purpose	Particulate RPE is used to prevent inhaling infectious aerosols and other particles and contamination of the nose and mouth.
Type	RPE includes: disposable P2 respirator reusable half-face piece respirator with a particulate filter reusable full face piece respirator with a with a particulate filter powered air purifying respirator (PAPR) with a particulate filter.
When to use	You should wear RPE: when exposed to potentially infectious aerosols, especially those involving the respiratory tract. if Hendra virus is a primary or differential diagnosis or if infection is confirmed. to protect against other identified health and safety or biosecurity risks.
Level of protection	RPE provides varying levels of protection. A disposable P2 respirator provides the minimum level of protection against infectious aerosols. Refer to AS 1715 Selection, Use and Maintenance of Respiratory Protective Equipment for guidance on the level of protection provided by half face, full face and PAPR respirators when used with P1, P2 and P3 filters.
Selection	Consider the following when selecting RPE: level of exposure to aerosols concurrent exposure to other hazards (e.g. hazardous chemicals) environmental conditions (e.g. heat, humidity) the physical demands of the task the duration of wear the worker (e.g. size, facial hair, health conditions that impact on respirator use).
Use	Practical considerations when using RPE. Surgical/medical masks and nuisance dust masks do not protect against infectious aerosols. If using a disposable P2 respirator: makes/models that feature an exhalation valve may increase user comfort makes/models that are fluid resistant (a 'surgical P2 respirator') provide increased protection against fluid strikethrough replace the respirator if it becomes moist or if respiratory effort increases, taking care to avoid contamination do not reapply or reuse the respirator. If using a reusable respirator: decontaminate the respirator after use and store in a sealed container replace the filter in accordance with the manufacturer's instructions. Facial hair, including beards, moustaches, sideburns and stubble, will stop a respirator from sealing properly. Workers who wear tight-fitting respirators, must be clean shaven to allow a good seal between the respirator and the face. A PAPR may provide increased user comfort during physically demanding work, long wear durations and in hot and humid environments. If using a tight fitting respirator, provide workers with a respirator fit-test (PDF, 0.86 MB) and make sure they pass a fit-test for the respirator they wear. Provide workers with instruction on how to correctly fit a respirator and perform a fit check. Additional types of filters may be required if there is concurrent exposure to other hazards (e.g. hazardous chemicals).

Protective footwear

Purpose	Protective footwear is used to prevent contamination of everyday footwear and the spread of infection between animals and off the property
Type	Protective footwear includes shoe/boot covers and rubber boots.
When to use	You should wear protective footwear: when contamination of footwear with blood and body fluids is likely. if Hendra virus is a primary or differential diagnosis or if infection is confirmed. to protect against other identified health and safety or biosecurity risks.
Level of protection	Protective footwear provides varying levels of protection: shoe covers provide a minimum level of protection. water resistant boot covers and rubber boots provide a higher level of protection.
Selection	Consider the following when selecting protective footwear: the level of contact with blood and body fluids the level of contamination of the work environment environmental conditions (e.g. rain, uneven terrain) biosecurity requirements worker (e.g. size).
Use	Practical considerations when using protective footwear. Shoe/boot covers may be suitable for indoor environments but can easily tear in outdoor environments. Steel capped rubber boots protect against physical injury. Decontaminate footwear after use and remove all visible soil.

Selecting and using PPE in veterinary practice

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