John Johnson | Editor
There has been a lot of ‘chatter’ on social media and the mainstream media about the PPE being given to frontline medical staff and trying to get a firm grasp on the situation is hard.
At the moment, we can only go by what we are seeing and hearing from the ‘front line’ of the fight against COVID-19.
A source recently sent us a document from Public Health England that was addressed to the Chief Executives of all NHS trusts and foundation trusts as well as being directed to ‘CCG Accountable Officers’, ‘GP practices and Primary Care Networks’ and ‘Providers of community health services’.
The five-page document, dated 28th March 2020, outlines the stance taken by Public Health England concerning the PPE that should be worn by medical staff who are coming into contact with patients suspected of having COVID-19.
Under the heading: ‘Changes to the guidance’, Professor Stephen Powis, National Medical Director for NHS England and NHS Improvement said:
‘Changes to the guidance
‘Ensuring that frontline colleagues have the highest level of protection possible is our top priority. In January, following COVID-19 classification as a high consequence infectious disease, infection control guidance to protect staff from this new threat was agreed across all four UK nations. It draws on World Health Organization (WHO) guidance, consistent with the latest evidence from systematic reviews.
‘However, in March, when it was clear that COVID-19 was more prevalent, and more was understood about the behaviour of the virus and its clinical outcomes, the four nations agreed that COVID-19 should no longer be classified as a high consequence infectious disease. As a result, the guidance was updated.
‘PPE for high-risk procedures
‘Recommended PPE to be used by healthcare workers delivering or assisting with an aerosol-generating procedure including in Intensive Care Units or the hot zone of an Emergency Department:
- FFP3 respirator
- long-sleeved disposable gown
- eye protection (disposable goggles or full-face visor).
‘PPE for other settings
‘Recommended PPE to be used by healthcare workers within one metre of a patient with possible or confirmed COVID-19, including staff working in hospitals, primary care, ambulance trusts, community care settings, care homes:
- fluid repellent facemask
- eye protection if there is a risk of splashing or exposure to respiratory droplets.
‘Comparison with WHO guidelines
‘The UK recommends FFP3 respirators when caring for patients in areas where high-risk aerosol-generating procedures (AGPs) are being performed. These should be fit tested for all staff and not just fit-checked. The WHO recommends FFP2 respirators for AGPs. If for any reason FFP3 masks are not available, we recommend using the FFP2 masks as a safe alternative but please note these should also be fit-tested.
‘Consistent with the WHO guidelines, full sleeve gowns are recommended for high-risk procedures (e.g. during AGPs) or where there is a risk of extensive splashing of blood and/or other body fluids. In all other settings, the UK has a longstanding bare below the elbow policy as part of our long-term strategy to manage healthcare associated infections. COVID-19 is not airborne, it is droplet carried. We know the cross contamination from gowns for infection can be carried by the gown sleeves and the advice therefore is bare below the elbows and you scrub your hands, your wrists and your forearms.
‘In addition to wearing PPE, clinicians should practice usual infection prevention and control measures, including environmental cleaning and hand hygiene to reduce the risk of onward transmission.
‘The guidance going forward
‘We are keeping the guidance under constant review. Over the next few days Public Health England, NHS England and NHS Improvement and the Department of Health and Social Care in conjunction with the Devolved Administrations will work with the Academy of Medical Royal Colleges to ensure the guidance is clearer for clinical colleagues working in a variety of NHS settings performing a range of different clinical procedures. We aim to organise the recommendations using a ‘place-based’ approach so it is easy to understand the appropriate PPE needed for the potential risk. We will publish an update to the guidance within days.
‘We are grateful for all the feedback about PPE supply and delivery. Please rest assured that all issues are being urgently dealt with’.
In a post shared (not by the author of the post) in our ‘Emergency Services News | Community‘ a health care professional, speaking about her own experiences, said:
‘I’m going to try and keep this as snappy as possible, but this needs to be out there.
‘It is widely documented in the media that we need more PPE. However, the procurement of more PPE is fruitless unless the UK government adheres to the evidence based guidelines provided by WHO, so that the correct PPE is procured.
‘World Health Organisation (WHO) guidelines on the appropriate PPE for those looking after patients who are suspected or confirmed to have COVID-19 consists of:
‘A medical mask (FFP3 only required in aerosol generated procedures).
‘Eye protection (goggles or face shield).
‘At the beginning of the pandemic the UK government adhered to these guidelines. Then the shortage came. Now the UK government has turned away from WHO guidelines, WITHOUT providing any evidence to support this decision.
‘The below picture demonstrates what is now deemed acceptable in all areas apart from critical care settings: A mask. An apron. Gloves.
‘The UK government either needs to provide the clinical evidence to reassure us that this adequately protects us, or it needs to adhere to WHO guidelines.
‘We are scared to go to work, but we would never abandon our patients in their time of need, regardless of the risk.’
The above two accounts give a glimpse into the directions being given from top management.
But it also gives a very stark glimpse into the panic being felt by some healthcare professionals who feel like they are not being given the right PPE to protect themselves from COVID-19.
Assuming that the healthcare professional in the picture is going to be treating COVID-19 patients or is going to be coming within a 1-metre radius of a patient suspected of having COVID-19, then she does not have the correct PPE.
But if members of the public are keeping to a 2-metre rule, then that would suggest that medical staff going inside the ‘1 metre’ radius should have ‘High-risk PPE’.
But from what we have seen and heard, then this is clearly not happening.
And what about frontline ambulance crews? They are not all being given the ‘high-risk PPE’, and yet, without a doubt, they WILL be treating patients who have got COVID-19 — even if the patients do not know that they have it.
Surely emergency ambulance crews should be given ‘high-risk’ PPE which should be worn at the discretion of the crews? And surely the same should apply to the other sections of the emergency services?
If you work in the healthcare sector, then let us know what your experiences have been with PPE by adding your comments below.
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