It was a very difficult time. We did not know what to expect – we’d had MERS and SARS, and also looked at Ebola; there had been preparations, but this was still an ‘unknown’. We used our past learning and emergency planning…but people were not used to seeing the full hazmat PPE around the Trust and there was a lot of fear.

She commented that the Government PPE guidance changed weekly on the use of PPE – including a briefing on the implementation of face coverings, which proved particularly challenging. The Trust was given very short notice to implement the changes and briefing the whole of the Trust quickly was a difficult task. “We were learning as we went along. It was a turbulent time during April and May; the number of patients were going up; the Nightingale hospitals were being built; nobody knew what was happening or where it was going to end, and people were scared. We’d seen the pictures in the media, from Italy, of people in ICUs, and tanks in the streets in Spain, keeping people at home. “A really important step, therefore, was the introduction of the staff welfare team. They walked around the hospital in tabards trying to reassure the staff – letting them know that plans were in place and talking to them about PPE,” Tweed reported. “We talked about having PPE stations, as people came on site, where they could don a face mask; there would be hand gel, boxes of PPE and dustbins for the used PPE as they left. Then we realised that there would be queues of people waiting and this might affect social distancing. There were so many things to think about,” she commented. The Trust also had to contend with changes to procurement. Previously, they had ordered through NHS Supply Chain, but there was a move to a national, centralised system where stock was ‘pushed’ out to hospitals. “We had no idea what was coming – the make, the manufacturer or even how much was coming. We were working on days’ supply of stock. Over Easter, this was extremely worrying as, on the Friday, we were told we only had enough stocks to last until the Monday. We had no idea what was going to happen on the Tuesday, if we couldn’t get more stock of PPE from the national supply. “We kept hearing about an ‘aeroplane coming from Turkey that was going to be packed to the rafters with PPE’. But we had


no idea of the specification, details of the manufacture, CE mark or quality. We heard that the plane had landed and there was a lot of celebration, until we received the stock. At that point, we gulped – it wasn’t quite what we expected but at least we still had stock,” Tweed commented. She observed that parent companies, outside the UK, seemed to want to keep supplies in their own country. “This really hit hard in April, when we

couldn’t get alcohol gel from our regular supplier. “We had to look at different contingency plans – such as buying in bulk and packing it into bottles; it caused a lot of angst. Then the gin companies came to the rescue and changed their production lines over to making alcohol gel. “There was also fantastic public kindness – people supported us with making PPE. The only problem was, despite using specifications, they weren’t always perfect; the foam around the head piece of the visors was often too thick which meant they fogged up. This meant we really had to look carefully at the quality of what was being sent into the Trust,” she continued. HSE and PHE eventually issued guidance, but there was a period of uncertainty for the Trust, according to Tweed: “Everyone was nervous about giving the go-ahead on decontaminating PPE. I feel we have all had a lucky escape. We reached the point where disaster could have happened; we just managed,” she commented. The Trust looked at what was happening across the rest of the world and found that the CDC was ahead of the game. “The CDC had looked at SARS and MERS and undertaken a body of work on decontamination of single-use PPE, publishing a number of papers on FFP masks. We looked at whether we could adapt their approach. This wasn’t to be used in anger. This was just for a crisis situation. If we ran out of PPE what would we do? We had to protect staff and treat patients,” she commented.

Tweed explained that the Trust set up PPE champions and an expert group, which looked at the amount of PPE in the Trust and whether people were using it correctly. The staff welfare team were also part of this group and fed back to the group on how staff were feeling, how they could be supported, and what would make them feel comfortable about accepting new guidelines.

The Decontamination Division also looked at how they could decontaminate the PPE. The biggest shortage was sterile gowns – as surgery increased, there was a national shortage. There were also shortages of FFP3 masks. “The fit test was crucial – the masks only suited certain face sizes, so the decontamination division had their work cut out. Papers from the US said you could use UVC, HPV and high temperature water, but we also needed to look at the logistics and staff acceptability. If you decontaminate an FFP mask there is a lot more acceptance if it goes back to the same member of staff. We had to look at how we could ensure this and stop cross-contamination from mask touching mask. “The logistics of collecting, decontamination and preventing re-contamination all needed to be considered and the whole process was very intricate,” Tweed explained, adding that exchanging knowledge and experiences with other Trusts was also really important. Procedure and protocols were written, and care was taken to ensure staff were reassured. Occupational safety was heavily involved with this, undertaking risk assessments and management. Managing staff fears around potential reuse of PPE, at the trial stage, proved to be extremely important as adverse coverage in the media and social media, prompted by the concerns of some staff, proved to be a challenge. However, Tweed pointed out that PHE

had undertaken a thorough investigation of the potential for reuse and most Trusts now have an action plan in place. Trials have shown that certain items of PPE can


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