PE RSONAL PROT ECT IVE EQUIPMENT
New public health guidance on PPE
Public Health England has published new guidance on PPE to protect healthcare workers. Kate Woodhead RGN DMS provides an insight into the key recommendations and issues raised in the healthcare sector.
There has been an element of controversy over the guidance for personal protective equipment for NHS staff for many months, culminating, in January of this year, in a multi-organisational campaign to increase the level of facial protection available for use by healthcare staff in COVID-19 patient interactions and to review the level of ventilation in healthcare facilities. The revised guidance, which has been agreed by all the country’s Chief Medical Officers was published by Public Health England.1
It clearly identifies that the safest level of PPE to protect NHS workers is higher than has been recommended in previous iterations of the infection control and PPE guidelines for the pandemic. The guidance has been produced in the light of the best scientific evidence available currently and WHO has confirmed that it is consistent with what it recommends in circumstances and settings with the highest risk of transmission. Concerns expressed by the Royal College of Nursing (RCN)2 Association3
and the British Medical focus on the emergence
of variants of concern and increased transmissibility to patients and staff through exposure in healthcare settings. The key concerns expressed by the RCN in particular are the effectiveness of surgical face masks during direct, close proximity patient contact and they requested, in January, that the quality of ventilation in healthcare buildings be investigated. The BMA warned of the “significant and growing concerns about the role of aerosol transmission of COVID-19 in healthcare
settings” at a time when the NHS is facing unprecedented pressure. BMA council chair Dr. Chaand Nagpaul said: “Now that we have been assured that supply [of PPE] is no longer an issue, we believe guidance should be updated to take a more precautionary approach to better protect those working on the frontline.”
In an open letter to the UK Government and all the devolved nations,4
a pressure
group, ‘Fresh Air NHS’, called for support for front line healthcare workers, to take all necessary precautions to mitigate airborne transmission of SARS-Cov-2 in healthcare settings. Fresh Air NHS is a group of front line healthcare workers and supporters which has come together to campaign for better
To ensure maximum workplace risk mitigation, organisations should undertake local risk assessments based on the measures as prioritised in the hierarchy of controls.
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protection for healthcare workers against COVID-19.
Healthcare workers vulnerabilities It is thought that approximately 250 health and care workers have died during the pandemic from COVID-19 infection. Fresh Air NHS quotes research to support that healthcare workers (HCWs) are 3-4 times more likely to contract the disease than the general population, with risk varying according to their role in the NHS.5
Notably,
they quote, while HCWs on regular wards are significantly more likely to become infected, intensive care unit staff have 50% lower risk despite working in an environment which was historically considered to be higher risk.6
This correlates with increased
aerosol protection provided by higher grade PPE and increased air-changes in ITUs. In contrast for hospital wards, where infectious coughing patients are also cared for, current guidance does not recommend the use of respiratory-protective PPE. Air exchange is not regulated in these settings either. The inhalation of viral aerosols, whether the susceptible person is near
AUGUST 2021
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