COVID-19: PPE for doctors

Get clarification on PPE use in primary and secondary care, including procurement, use, safe working and CPR.

Location: UK
Audience: All doctors
Updated: Thursday 15 October 2020
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Official guidance on PPE

New UK-wide guidance on infection prevention and control was issued on 21 August 2020. This includes guidance on PPE.

Public Health England has produced guidance on putting on and taking off PPE, including videos on how to follow best practice. This includes putting on and taking off coveralls.

The extended use of face masks in healthcare settings is required in England and Scotland.

Government produced guidance on undertaking risk assessments if exposed to COVID-19 while not wearing PPE, or having had a breach of PPE while providing care to a patient.

 

What PPE should I expect to have for different clinical settings?

Infection prevention and control guidance issued on 21 August separates the management of patients into three COVID-19 pathways: ‘high’, ‘medium’ and ‘low’ risk, with different PPE requirements for each.

High risk clinical settings

Defined as where:

  • untriaged individuals present for assessment or treatment (symptoms unknown) or;
  • confirmed COVID positive individuals are cared for or;
  • symptomatic or suspected COVID individuals including those with a history of contact with a COVID case, who have been triaged/clinically assessed and are waiting test results present or;
  • symptomatic individuals who decline testing present.

Recommended high risk PPE

  • Single use gloves.
  • Single use apron (or gown if risk of spraying/splashing).
  • FRSM type IIR mask for direct patient care.
  • Eye/face protection.

Medium risk clinical settings

Defined as where:

  • triaged/clinically assessed individuals are asymptomatic and are waiting a COVID test result with no known recent contact with a COVID case or;
  • testing is not required or feasible on asymptomatic individuals and infectious status is unknown or;
  • asymptomatic individuals decline testing.

Recommended medium risk PPE

  • Single use gloves.

  • Single use apron (or gown if risk of spraying/splashing).

  • FRSM type IIR mask for direct patient care.

  • Eye/face protection.

When carrying out aerosol generating procedures, or in areas where AGPs are being conducted you should expect to have a:

  • single use gown
  • FFP3 respirator or hood.

Low risk clinical settings

Defined as where:

  • clinically assessed individuals with no symptoms or known recent COVID contact who have isolated/shielded AND have a negative COVID test within 72 hours of treatment and, for planned admissions, have self-isolated from the test date or;
  • individuals who have recovered from COVID and have had at least three consecutive days without fever or respiratory symptoms and a negative COVID test or;
  • patients or individuals are regularly tested and remain negative.

Recommended low risk PPE

  • Single use gloves.
  • Single use apron (or gown if risk of spraying/splashing).
  • Surgical mask type II for extended use and FRSM type IIR for direct patient care.
  • Eye/face protection if required for care procedure/task where anticipated blood/body fluids spraying/splashes.

CPR

We are aware of concerns that chest compressions as part of CPR is not classified as an AGP (aerosol generating procedure) in Public Health England guidance.

Members of the BMA remain concerned that they are being asked to resuscitate patients without adequate protection due to a lack of national consensus on this issue. 

The guidance from Resuscitation Council UK provides a clear process for both protecting patients and healthcare workers – treating chest compressions as a procedure requiring full PPE.

This involves one staff member shocking the patient up to three times with a defibrillator, whilst wearing fluid resistant surgical mask, disposable apron, disposable gloves and disposable eye protection, giving others – if they are not already wearing it – time to put on full protective PPE; namely FFP3 respirator, disposable gown, disposable gloves and disposable eye protection.

Our position is that chest compressions as part of CPR should be reinstated to the list of aerosol generating procedures by PHE.

Read RCUK's position

Some resources and useful algorithms from RCUK

 

Using your own PPE

Your employer must provide you with a safe working environment and with appropriate PPE for the area in which you are working.  

For the level of PPE you need in different clinical settings, please see the response above.   

You should not have to purchase your own PPE. However, if there is no alternative, you may decide to buy and wear the correct level of PPE for the area you are working in. You should not face criticism or more serious action if you do this 

The BMA is continuing to press the government to ensure that you can work safely and can protect yourself, your colleagues, your patients and your family. 

Please contact us on [email protected] for further clarification and support. You may also find it helpful to contact our wellbeing support services on 0330 123 1245 which are open 24 hours a day, 7 days a week.   

Note: If you are a doctor in a supervisory or managerial role you may be in breach of GMC guidance if you take steps to prevent or discourage the use of appropriate and necessary PPE. Employers and/or individual employees may also be in breach of health and safety legislation if such steps are taken. 

 

Using respiratory protective equipment including face masks

The Health and Safety Executive has produced guidance outlining the correct use of respiratory masks, including fit-testing:

"Tight-fitting respirators (such as disposable FFP3 masks and reusable half masks) rely on having a good seal with the wearer’s face. A face fit test should be carried out to ensure the respiratory protective equipment (RPE) can protect the wearer.

To ensure you put on tight-fitting RPE correctly, use a mirror or ask a colleague. Fit-testers should follow government advice on social distancing, as they can make observations from this distance and deliver any instructions verbally.

The user should then carry out a pre-use seal check or fit check."

 

Steps for maintaining good hand hygiene

The WHO advises healthcare workers to perform hand hygiene at five key moments.

This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings.

This approach recommends health-care workers to clean their hands:

  • before touching a patient
  • before clean/aseptic procedures
  • after body fluid exposure/risk
  • after touching a patient
  • after touching patient surroundings.

 

What is being done nationally to ensure stocks of PPE are replenished?

It is vital for both staff and the patients they care for that they are provided with adequate protection from infection. Employers and commissioners have both a legal and ethical responsibility to protect their staff. They must ensure that adequate protective equipment is available and that staff are trained in its use.

The Government says that services across the NHS are urgently being sent stocks of PPE to help them manage cases and potential cases of COVID-19 and keep staff safe. Deliveries may be provided outside or normal working hours to ensure stocks are replenished.

The BMA continues to raise concerns about PPE supplies and to support individual members where they do not have the right PPE for the setting in which they’re working.

 

I wear a beard for religious reasons - am I required to remove it?

FFP3 masks are recommended to protect staff who may be exposed to COVID-19 from aerosolised pathogens. These require the removal of beards to fit effectively.

A policy requiring beard removal will have more of an impact on doctors who have a religious obligation to wear a beard. Under the Equality Act 2010, a policy that may have a negative impact on a certain group is justifiable if it is a proportionate way of meeting a legitimate organisational need (eg health and safety).

In deciding if a requirement to shave is proportionate, your employer must consider the impact shaving would have upon you (eg the psychological impact of abandoning a religious practice) and balance this against the needs to protect the health and safety of others. In our view any requirement to remove a beard is likely to be highly exceptional. If there is an alternative way to meet those needs then it is unlikely to be proportionate.

You should ask if alternative PPE can be made available for you, such as a PAPR (powered air purifying respirator) hood that provides the same protection as FFP3. Be aware it may difficult for your employer to access them at this time. You will also need to be trained on how to use, clean and re-use it effectively.

Or, you could also ask whether, because of your religious obligations, you can be exempted from tasks that require the highest level PPE.

If you need employment advice on your particular circumstances contact the BMA.

Need help? For 24/7 emergency COVID advice please call us. For all other non-emergency enquiries normal opening times apply.
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