A unified personal protective equipment ensemble for clinical response to possible high consequence infectious diseases: A consensus document on behalf of the HCID programme

High Consequence Infectious Diseases Project Working Group

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The importance of appropriate personal protective equipment (PPE) as a component of healthcare worker (HCW) protection was highlighted during the Ebola virus disease (EVD) outbreak in West Africa. The large number of HCW deaths in Africa was in part due to lack of resources or prior training in PPE usage. As part of the Ebola legacy, the High Consequence Infectious Disease (HCID) programme was initiated by NHS England and Public Health England (PHE) to improve preparedness for Ebola and other infections that not only endanger the life of the patient, but also pose particular dangers to HCWs. A systematic review identified national standardisation of PPE protocols as a priority, but recognised that a lack of safety data limited the ability to mandate any one protocol. A simulation-based exercise was developed to assess the safety of PPE ensembles in use in the UK during first assessment of a patient with a possible HCID. A mannequin was adapted to expose volunteer HCWs to synthetic bodily fluids (vomit, sweat, diarrhoea and cough), each with a different coloured fluorescent tracer, invisible other than under ultraviolet (UV) light. After exposure, HCWs were examined under UV lights to locate fluorescent contamination, and were screened again after removing PPE (doffing) to detect any personal contamination. The exercise was videoed, allowing retrospective analysis of contamination events and user errors. The simulation testing identified significant HCW contamination events after doffing, related to protocol failure or complications in PPE doffing, providing conclusive evidence that improvements could be made. At a workshop with an expert stakeholder group, the data were examined and a unified PPE ensemble agreed. This ensemble was then tested in the same simulation exercise and no evidence of any HCW contamination was seen after doffing. Following further review by the working group, a consensus agreement has been reached and a unified ‘HCID assessment PPE’ ensemble, with accompanying donning and doffing protocols, is presented here.

Original languageEnglish
Pages (from-to)496-502
Number of pages7
JournalJournal of Infection
Issue number6
Publication statusPublished - Dec 2018

Bibliographical note

Funding Information:
This work was funded by the Health and Safety Executive. Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Funding Information:
Bozena Poller received funding through the Healthcare Infection Society ’s Graham Ayliffe Training Fellowship GATF2017/02/001 ; no other project costs were funded by HIS.

Funding Information:
Bozena Poller received salary funding through the Graham Ayeliffe Training Fellowship (GATF2017/02/001) from Healthcare Infection Society.

Publisher Copyright:
© 2018


  • Ebola
  • Fluorescence visualisation
  • Healthcare
  • High Consequence Infectious Diseases (HCID)
  • Infection control
  • Personal Protective Equipment (PPE)
  • Simulation
  • Training


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