Doctors washing and reusing protective equipment as stocks run out

Doctors are being forced to wash personal protective equipment (PPE) to reuse it and are dipping their hands in a bucket of steriliser because hand gel has run out.

Comments gathered by the British Medical Association (BMA) and shared with the PA news agency show how, as recently as Monday, medics were being forced to work without adequate PPE, with some turning to bin liners instead.

Some doctors have been told by their NHS trusts to reuse gowns and some have donated their share of PPE to nurses and healthcare assistants due to shortages.

On Monday, an obstetrics and gynaecology trainee in the South East said there has been no eye protection for the last three weeks and there were no facilities to clean footwear.

"Surgical masks are not fluid resistant," they said. "There are no reinforced gowns for high volume procedures (e.g. C-section).

"PPE equipment is in short supply – and often locked away. We have bought more than £4,000 worth of PPE over the last four weeks as a group of trainees."

On the same day, an anaesthetics trainee in Scotland said: "We're having to wash our visors in disinfectant because we don't have enough.

"We also ran out of hand gel briefly and were provided with a bucket of steriliser to dip our hands in."

A core medicine trainee in the East of England said: "Trust is now asking us reuse single-use gowns not only between patients but also when we leave and return from breaks."

A foundation year doctor on a Covid-19 ward for the elderly in the North West said on Monday: "After the death of two of our nursing colleagues, the trust, on the same day, announced that gowns would no longer be amply provided, and we had to ration the remaining supplies amongst our staff, on our ward.

"We decided to let our nurses and healthcare assistants have priority with the gowns, as they have more patient contact-time. As the gowns completely ran out, some staff used bin bags instead."

Meanwhile, an A&E doctor in the East of England said there were no gowns or scrubs on their most recent shift.

A GP from Berkshire said: "Unable to get basic PPE apart from aprons and gloves. Some surgical masks, no eye protection. We managed to buy 50 visors before the rush, and had six pairs of safety glasses left from the swine flu epidemic, which the nurses are using as they have closest contact with patients. They wash and reuse these after each session.

"Our local amateur dramatics group is making us scrubs for use in the 'hot hub' where we are seeing likely Covid patients to assess if they need hospital admission."

Care minister Helen Whateley said on Wednesday that there has been a "global scramble for PPE" and distributing it to care providers and GPs has been a "massive logistical effort".

She added: "It is a precious resource ... we have to make sure it is used when you need it to either protect a member of the workforce or protect a patient, because people have been crying out wanting to use PPE all the time for everything and actually that is not the best way."

The comments come after a leaked Public Health England (PHE) document, seen by the BBC, shows national planning to reuse protective masks and gowns amid a "reduced ability to re-supply" PPE.

It is understood that the chief medical officers and chief nurses of the four UK nations recently discussed the issue.

For the meeting, a draft document written by PHE and dated April 13 suggested solutions for "acute supply shortages" of PPE.

"These are last-resort alternatives, but, given the current in-country stock and the reduced ability to re-supply, we are suggesting that these are implemented until confirmation of adequate re-supply is in place", it said.

The plans suggested a series of "last-resort arrangements", including buying "building" or "sportswear" eye protection with extensions to cover the side of the eyes if there are no available goggles or face shields, and using washable laboratory coats and patient gowns where there are no available disposable gowns or coveralls.

It also suggests re-purposing face masks using various disinfection or sterilisation methods, including steam and UV disinfection.

The document said some of the measures would need to be reviewed and approved by the Health and Safety Executive (HSE).

In the United States, the Food and Drug Administration (FDA) has approved the use of vaporised hydrogen peroxide to decontaminate certain masks and respirators for use by staff.

Dr Chaand Nagpaul, chairman of the British Medical Association (BMA), said: "The Government must be honest about PPE supplies.

"If (Public Health England) is proposing the reuse of equipment, it needs to be demonstrably driven by science and the best evidence in keeping with international standards, rather than by availability, and with absolutely no compromise to the protection of healthcare workers."

In a statement, Dr Susan Hopkins, Covid-19 incident director at PHE, said: "PPE is a precious resource and it is crucial that everyone in health and social care has access to the right protective equipment.

"All options are being considered to ensure this, including the safe reuse of items, but no decisions have been made."

An HSE spokesman said: "In line with the Government's PPE strategy, it is right that, where possible, strategies for optimising the supply of PPE should be explored.

"We are discussing with Public Health England ways in which pressure can be eased on the supply chain. This includes potentially reusing certain equipment where it is safe to do so."