Updated PPE Guidance Issued for UK Health and Care Staff

Peter Russell

April 02, 2020

Revised guidance on the use of personal protective equipment (PPE) for frontline NHS and social care workers has been issued to help protect them against COVID-19.

The guidance published by Public Health England (PHE) was agreed by the four Chief Medical Officers, Chief Nursing Officers, and Chief Dental Officers in the UK and is applicable in all parts of the UK.

It reflects the reality that SARS-COV-2 is now widespread in the community, meaning clinicians are more likely to see patients with the virus, some of whom may have minimal or no symptoms.

Health Bodies Acted on Widespread Concerns About PPE

Publication followed concerns from health professionals of a shortage of supplies and a lack of direction on when and how to use the equipment.

The updated guidance was broadly welcomed by health bodies and trades unions.

However, the British Medical Association said supplies of PPE remained an issue with reports this week from doctors in more than 30 hospital trusts about shortfalls in supplies, and concerns from GPs across England who had yet to receive eye protection.

At this evening's Downing Street coronavirus briefing, Matt Hancock, Secretary of State for Health and Social Care, said he would "stop at nothing to make sure that frontline staff have the right equipment so that they're safe and can have the confidence they need to do their jobs".

Dr Yvonne Doyle, medical director for PHE, said: "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 [the World Health Organisation] recommends in circumstances and settings with the highest risk of transmission."
 

Main Points in the New Guidance

The guidance recommends the safest level of PPE to protect NHS healthcare workers and specifies the type of PPE that should be worn in the various healthcare settings where patients are cared for.

Among the main measures in the updated guidance:

  • Any clinician working in a hospital, primary care, or community care setting within two metres of a suspected or confirmed COVID-19 patient should wear an apron, gloves, surgical mask, and eye protection, based on the risk

  • In some circumstances PPE, particularly masks and eye protection can be worn for an entire session and does not need to be changed between patients, as long as it is safe to do so

  • More detail on what PPE to use in different clinical scenarios as well as community settings, such as care homes and caring for individuals in their own homes

  • When carrying out aerosol generating procedures (AGPs) clinicians should wear a higher level of protective equipment, and these are listed in the guidance

  • Use of aprons rather than gowns for non-aerosol generating procedures, including advice on thoroughly washing forearms if there is a risk of exposure to droplets

  • Recommends the use of the UK's "good stock" of FFP3 masks, although FFP2 masks, as approved by the World Health Organisation, can be used safely if needed

Reaction to the Guidance

Prof Carrie MacEwen, chair of the Academy of Medical Royal Colleges, which helped draw up the revised guidance, said: "This is the combined result of experts in infection control working with frontline clinicians to provide the best guidance on the protection and safety of all healthcare staff, in any circumstances, based on scientific evidence; while taking into account the real-life clinical circumstances faced by staff and the concerns they have raised about their own, and their patients', safety."

Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said: "We are pleased our concerns have been listened to and the inherent risk to the front line recognised."

The Royal College of GPs (RCGP) welcomed the updated guidance for its "clarity".

Prof Martin Marshall, RCGP chair, commented: "We understand that initial stocks of PPE have been getting to GP practice. We now need to ensure that this supply is sustained throughout the pandemic, that practices start receiving new equipment recommended in the guidance, such as eye protection soon, and that effective mechanisms are in place for practices to request emergency supplies, should they need them."

The Doctors' Association UK (DAUK) said the new guidance would do little to address concerns that health professionals were being sent to the front line with "little more than a plastic apron".

Dr Samantha Batt-Rawden, DAUK president, said: "Many hoped that guidance on use of flimsy plastic aprons would be upgraded to long sleeve protective gowns as per the World Health Organisation.

"There are also overwhelming concerns that Cardio-Pulmonary Resuscitation (CPR) has been removed as a high risk procedure, when doctors have been told for weeks not to commence resuscitation until healthcare workers are in full PPE due to the high risk of contracting the virus during CPR."

Dr Rinesh Parmar, an intensive care doctor, and DAUK's chair, said: "No amount of guidance is a substitute for ensuring that doctors and other frontline NHS staff have adequate PPE."

Responding to concerns about a lack of supplies of PPE, Matt Hancock, who has just returned from self-isolation after contracting a mild form of COVID-19, said: "With the support of the British military, we've shipped a record quantity of equipment to the front line.

"Just yesterday, 45 million pieces of protective equipment were delivered across health and social care, including more than 5 million aprons and 6 million surgical masks."

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