New guidance issued on protective equipment for health and social care workers

Guidance on personal protective equipment (PPE) for health and social care workers has been strengthened after controversy over whether people were getting the right kit.

The new guidance covers NHS workers in hospitals, GP and dental surgeries, and those working in care homes and delivering care to people’s homes.

It says that when staff are providing direct patient care within two metres to somebody with confirmed or suspected Covid-19, they should wear appropriate kit.

Previously, the kit was only required if staff were working within one metre of a confirmed or suspected case.

The guidance stresses that when “the potential risk to health and social care workers cannot be established” before caring for a patient, then aprons, surgical masks, eye protection and gloves should be worn.

In primary care, the guidance stops short of recommending GPs use PPE for all patient contacts but suggests this may be necessary depending on “local risk assessment”.

GP receptionists talking to people within two metres are urged to wear a disposable mask.

The guidance makes no changes to the actual kit to be worn in hospitals, stressing that the World Health Organisation (WHO) has approved the guidance as meeting its standards.

There has been an outcry over a lack of PPE as shortages have led to shortfalls on the NHS frontline, and supply problems throughout England have hampered delivery efforts.

Staff have reported being “petrified” over a lack of kit while others have been left in tears as they fear for the safety of themselves and their families.

Some say they have even been threatened with reprisals if they speak out about concerns.

The new guidance says that while gloves and aprons should be disposed of after a single use, masks and eye protection can be used for a session of work.

Gowns can also be worn for a session of work in higher risk areas, it says.

The UK-wide guidance has been agreed by the UK’s four chief medical officers, chief nursing officers and chief dental officers in the UK.

PA infographic about personal protection equipment for health workers
PA infographic about personal protection equipment for health workers

It says WHO recommends the use of FFP2 masks for aerosol-generating procedures, such as dental drilling, intubating patients and surgery, but “the UK has gone further and recommends the use of FFP3 masks”.

But FFP2 masks can be used if FFP3 masks are unavailable.

Dr Yvonne Doyle, medical director of Public Health England said: “Protecting our NHS colleagues on the frontline is vitally important.

“This updated guidance provides a greater degree of clarity so that NHS clinicians caring for patients feel confident in the PPE they need to wear.

“Our standards are amongst the highest in the world and in line with what WHO recommends in circumstances and settings with the highest risk of transmission.”

As part of the review, the Health and Safety Executive concluded that aprons offer a similar level of protection to the gowns recommended by WHO and that FFP2 respirators offer protection against Covid-19.

This afternoon, @PHE_uk has published updated guidance on personal protective equipment for #COVID19.

We hope it will be in important step towards rebuilding trust among key frontline staff.

Read @NHSC_Niall's comment in full

— NHS Confederation (@NHSConfed) April 2, 2020

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said: “We cannot underestimate the loss of confidence among key frontline staff on this issue – today’s guidance is badly needed and we very much hope this will be an important step towards rebuilding trust.

“Apart from the detail, two points are critical – it has the support of WHO, and it has been produced with input from infection control experts across the UK, and from the medical royal colleges, trade unions and professional organisations.”

But he said “guidance is not the whole answer”.

He added: “There have been real problems with distribution, and we have been assured they are being addressed and, to be fair, in many places that is happening.

“But any remaining supply chain problems need to be dealt with without delay.

“We have been promised Amazon-style distribution will be up and running in days, enabling every GP surgery, care home and hospital to order what they need and receive their delivery fast.”

A worker gathers supplies at the NHS National Procurement Warehouse in Larkhall, Scotland
A worker gathers supplies at the NHS National Procurement Warehouse in Larkhall, Scotland

Dr Chaand Nagpaul, chairman of the British Medical Association (BMA), said: “It is four days since the minister Robert Jenrick gave the assurance that no frontline staff should be working without the right protective equipment.

“Yet this week the BMA has received concerns from doctors in over 30 hospital trusts about inadequate PPE supplies and GPs across England who are yet to receive eye protection.

“Doctors are being put in a harrowing position. Faced with a national emergency, they stand committed to meet the immense challenges that lay ahead and to save lives.

“However, the lack of PPE provision is not only risking the health of doctors but also of them becoming vectors of infection and potentially turning them into super-spreaders, carrying the virus to non-Covid 19 patient after patient.”