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Ministry of Health and Family Welfare
Directorate General of Health Services
[Emergency Medical Relief]
(Updated on 15th
May 2020)
Novel Coronavirus Disease 2019 (COVID-19): Additional guidelines on rational use of Personal
Protective Equipment (setting approach for Health functionaries working in non-COVID areas)
1. About this guideline
This guideline is for health care workers and others working in Non COVID hospitals and Non-
COVID treatment areas of a hospital which has a COVID block. These guidelines are in continuation
of guidelines issued previously on ‘Rational use of Personal Protective Equipment’
(https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf). This
guideline uses “settings” approach to guide on the type of personal protective equipment to be used
in different settings.
2. Rational use of PPE for Non COVID hospitals and Non-COVID treatment areas of a hospital
which has a COVID block
The PPEs are to be used based on the risk profile of the health care worker. The document describes
the PPEs to be used in different settings.
2.1.Out Patient Department
S.No. Setting Activity Risk Recommended
PPE
Remarks
1 Help desk/
Registration
counter
Provide
information to
patients
Mild risk Triple layer
medical mask
Latex examination
gloves
Physical distancing
to be followed at all
times
2 Doctors
chamber
Clinical
management
Mild risk Triple layer
medical mask
Latex examination
gloves
No aerosol
generating
procedures should
be allowed.
3 Chamber of
Dental/ENT
doctors/
Ophthalmology
doctors
Clinical
management
Moderate
risk
N-95 mask
Goggles
Latex examination
gloves
+ face shield
Aerosol generating
procedures
anticipated.
Face shield, when a
splash of body fluid
is expected
4 Pre- anesthetic
check-up clinic
Pre-anesthetic
check-up
Moderate
risk
N-95 mask
Goggles*
Latex examination
gloves
* Only
recommended when
close examination of
oral cavity/dentures
is to be done
5 Pharmacy
counter
Distribution of
drugs
Mild risk Triple layer
medical mask
Latex examination
gloves
Frequent use of hand
sanitizer is advised
over gloves.
Page 2 of 4
6 Sanitary staff Cleaning
frequently
touched surfaces/
Floor
Mild risk Triple layer
medical mask
Latex examination
gloves
#All hospitals should identify a separate triage and holding area for patients with Influenza like illness
so that suspect COVID cases are triaged and managed away from the main out-patient department.
2.2.In-patient Department (Non-COVID Hospital &Non-COVID treatment areas of a hospital which
has a COVID block)
S.No. Setting Activity Risk Recommended
PPE
Remarks
1 Ward/individual
rooms
Clinical
management
Mild risk Triple layer
medical mask
Latex examination
gloves
Patients stable. No
aerosol generating
activity.
2 ICU/ Critical
care
Critical care
management
Moderate
risk
N-95 mask
Goggles
Nitrile
examination
gloves
+Face shield
Aerosol generating
activities performed.
Face shield, when a
splash of body fluid
is expected
3 Ward/ICU
/critical care
Dead body
packing
Low Risk Triple Layer
medical mask
Latex examination
gloves
4 Ward/ICU/
Critical care
(Non-COVID)
Dead body
transport to
mortuary
Low Risk Triple Layer
medical mask
Latex examination
gloves
5 Labor room Intra-partum care Moderate
Risk
Triple Layer
medical mask
Face shield
Sterile latex
gloves
Coverall
N-95 mask*
Patient to be masked
in the Labor room, if
possible.
*If the pregnant
woman is a resident
of containment zone
6 Operation
Theater
Performing
surgery,
administering
general
anaesthesia
Moderate
Risk
Triple Layer
medical mask
Face shield (-
wherever feasible)
Sterile latex
gloves
+ Goggles
Already OT staff
shall be wearing
For personnel
involved in aerosol
generating
procedures
Page 3 of 4
N-95 mask* *If the person being
operated upon is a
resident of
containment zone
7 Sanitation Cleaning
frequently
touched surfaces/
floor/ changing
linen
Low Risk Triple Layer
medical mask
Latex examination
gloves
2.3.Emergency Department (Non-COVID)
S.No. Setting Activity Risk Recommended
PPE
Remarks
1 Emergency Attending
emergency cases
Mild risk Triple Layer
medical mask
Latex examination
gloves
No aerosol
generating
procedures are
allowed
2 Attending to
severely ill
patients while
performing
aerosol generating
procedure
High risk Full complement
of PPE (N-95
mask, coverall,
goggle, Nitrile
examination
gloves, shoe
cover)
2.4.Other Supportive/ Ancillary Services
S.No. Setting Activity Risk Recommended
PPE
Remarks
1. Routine
Laboratory
Sample collection
and transportation
and testing of
routine (non-
respiratory)
samples
Mild risk Triple layer
medical mask
Latex
examination
gloves
Respiratory
samples
Moderate
risk
N-95 mask
Latex
examination
gloves
2 Radio-
diagnosis,
Blood bank,
etc.
Imaging services,
blood bank services
etc.
Mild risk Triple layer
medical mask
Latex
examination
gloves
3 CSSD/Laundry Handling linen Mild risk Triple layer
medical mask
Latex
examination
Page 4 of 4
gloves
4 Other
supportive
services incl.
Kitchen
Administrative
Financial
Engineering** and
dietary**
services,etc.
Low risk Face cover ** Engineering and
dietary service
personnel visiting
treatment areas will
wear personal
protective gears
appropriate to that
area
2.5.Pre-hospital (Ambulance) Services
S.No. Setting Activity Risk Recommended
PPE
Remarks
1 Ambulance
Transfer to
designated
hospital
Transporting
patients not on
any assisted
ventilation
Low risk Triple layer
medical mask
Latex examination
gloves
Management of
SARI patient
High risk Full complement
of PPE (N-95
mask, coverall,
goggle, latex
examination
gloves, shoe
cover)
While performing
aerosol generating
procedure
Driving the
ambulance
Low risk Triple layer
medical mask
Latex examination
gloves
Driver helps in
shifting patients to
the emergency
Points to remember while using PPE
1. Standard precaution to be followed at all times
2. PPEs are not alternative to basic preventive public health measures such ashand hygiene,
respiratory etiquettes which must be followed at all times.
3. Always follow the laid down protocol for disposing off PPEs as detailed in infection
prevention and control guideline available on website of MoHFW.
In addition, patients and their attendants to be encouraged to put on face cover.
In case a COVID-19 patient is detected in such Non-COVID Health facility, the MoHFW guidelines
for the same has to be followed (Available at:
https://www.mohfw.gov.in/pdf/GuidelinestobefollowedondetectionofsuspectorconfirmedCOVID19ca
se.pdf)

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Updated additionalguidelinesonrationaluseofpersonalprotectiveequipmentsettingapproachforhealthfunctionariesworkinginnoncovid19areas

  • 1. Page 1 of 4 Ministry of Health and Family Welfare Directorate General of Health Services [Emergency Medical Relief] (Updated on 15th May 2020) Novel Coronavirus Disease 2019 (COVID-19): Additional guidelines on rational use of Personal Protective Equipment (setting approach for Health functionaries working in non-COVID areas) 1. About this guideline This guideline is for health care workers and others working in Non COVID hospitals and Non- COVID treatment areas of a hospital which has a COVID block. These guidelines are in continuation of guidelines issued previously on ‘Rational use of Personal Protective Equipment’ (https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf). This guideline uses “settings” approach to guide on the type of personal protective equipment to be used in different settings. 2. Rational use of PPE for Non COVID hospitals and Non-COVID treatment areas of a hospital which has a COVID block The PPEs are to be used based on the risk profile of the health care worker. The document describes the PPEs to be used in different settings. 2.1.Out Patient Department S.No. Setting Activity Risk Recommended PPE Remarks 1 Help desk/ Registration counter Provide information to patients Mild risk Triple layer medical mask Latex examination gloves Physical distancing to be followed at all times 2 Doctors chamber Clinical management Mild risk Triple layer medical mask Latex examination gloves No aerosol generating procedures should be allowed. 3 Chamber of Dental/ENT doctors/ Ophthalmology doctors Clinical management Moderate risk N-95 mask Goggles Latex examination gloves + face shield Aerosol generating procedures anticipated. Face shield, when a splash of body fluid is expected 4 Pre- anesthetic check-up clinic Pre-anesthetic check-up Moderate risk N-95 mask Goggles* Latex examination gloves * Only recommended when close examination of oral cavity/dentures is to be done 5 Pharmacy counter Distribution of drugs Mild risk Triple layer medical mask Latex examination gloves Frequent use of hand sanitizer is advised over gloves.
  • 2. Page 2 of 4 6 Sanitary staff Cleaning frequently touched surfaces/ Floor Mild risk Triple layer medical mask Latex examination gloves #All hospitals should identify a separate triage and holding area for patients with Influenza like illness so that suspect COVID cases are triaged and managed away from the main out-patient department. 2.2.In-patient Department (Non-COVID Hospital &Non-COVID treatment areas of a hospital which has a COVID block) S.No. Setting Activity Risk Recommended PPE Remarks 1 Ward/individual rooms Clinical management Mild risk Triple layer medical mask Latex examination gloves Patients stable. No aerosol generating activity. 2 ICU/ Critical care Critical care management Moderate risk N-95 mask Goggles Nitrile examination gloves +Face shield Aerosol generating activities performed. Face shield, when a splash of body fluid is expected 3 Ward/ICU /critical care Dead body packing Low Risk Triple Layer medical mask Latex examination gloves 4 Ward/ICU/ Critical care (Non-COVID) Dead body transport to mortuary Low Risk Triple Layer medical mask Latex examination gloves 5 Labor room Intra-partum care Moderate Risk Triple Layer medical mask Face shield Sterile latex gloves Coverall N-95 mask* Patient to be masked in the Labor room, if possible. *If the pregnant woman is a resident of containment zone 6 Operation Theater Performing surgery, administering general anaesthesia Moderate Risk Triple Layer medical mask Face shield (- wherever feasible) Sterile latex gloves + Goggles Already OT staff shall be wearing For personnel involved in aerosol generating procedures
  • 3. Page 3 of 4 N-95 mask* *If the person being operated upon is a resident of containment zone 7 Sanitation Cleaning frequently touched surfaces/ floor/ changing linen Low Risk Triple Layer medical mask Latex examination gloves 2.3.Emergency Department (Non-COVID) S.No. Setting Activity Risk Recommended PPE Remarks 1 Emergency Attending emergency cases Mild risk Triple Layer medical mask Latex examination gloves No aerosol generating procedures are allowed 2 Attending to severely ill patients while performing aerosol generating procedure High risk Full complement of PPE (N-95 mask, coverall, goggle, Nitrile examination gloves, shoe cover) 2.4.Other Supportive/ Ancillary Services S.No. Setting Activity Risk Recommended PPE Remarks 1. Routine Laboratory Sample collection and transportation and testing of routine (non- respiratory) samples Mild risk Triple layer medical mask Latex examination gloves Respiratory samples Moderate risk N-95 mask Latex examination gloves 2 Radio- diagnosis, Blood bank, etc. Imaging services, blood bank services etc. Mild risk Triple layer medical mask Latex examination gloves 3 CSSD/Laundry Handling linen Mild risk Triple layer medical mask Latex examination
  • 4. Page 4 of 4 gloves 4 Other supportive services incl. Kitchen Administrative Financial Engineering** and dietary** services,etc. Low risk Face cover ** Engineering and dietary service personnel visiting treatment areas will wear personal protective gears appropriate to that area 2.5.Pre-hospital (Ambulance) Services S.No. Setting Activity Risk Recommended PPE Remarks 1 Ambulance Transfer to designated hospital Transporting patients not on any assisted ventilation Low risk Triple layer medical mask Latex examination gloves Management of SARI patient High risk Full complement of PPE (N-95 mask, coverall, goggle, latex examination gloves, shoe cover) While performing aerosol generating procedure Driving the ambulance Low risk Triple layer medical mask Latex examination gloves Driver helps in shifting patients to the emergency Points to remember while using PPE 1. Standard precaution to be followed at all times 2. PPEs are not alternative to basic preventive public health measures such ashand hygiene, respiratory etiquettes which must be followed at all times. 3. Always follow the laid down protocol for disposing off PPEs as detailed in infection prevention and control guideline available on website of MoHFW. In addition, patients and their attendants to be encouraged to put on face cover. In case a COVID-19 patient is detected in such Non-COVID Health facility, the MoHFW guidelines for the same has to be followed (Available at: https://www.mohfw.gov.in/pdf/GuidelinestobefollowedondetectionofsuspectorconfirmedCOVID19ca se.pdf)