After many weeks of debate, lobbying and reports of shortages of personal protective equipment (PPE), this week has seen something of a breakthrough in the debate over what constitutes adequate protection for hospital staff. On Thursday 2 April, Public Health England published improved and upgraded PPE guidance, following a rapid review which we, alongside other Royal Colleges, fed into. We welcomed the resulting new guidance, which recommends use of gowns instead of aprons, and makes clear the need for FFP3 level masks in higher risk situations, such as those involving aerosol generating procedures.
The urgent need to better protect NHS staff was brought home this week by the deaths of two surgeons. In the context of such awful news, it is entirely understandable that many staff are fearful. Indeed, in any situation where appropriate PPE is not available, I have advised surgeons and their teams not to put themselves, their colleagues or patients at unnecessary risk. If we do not look after our own health, how can we hope to look after our patients.
In recent weeks, to address the clamour for clear advice, an array of PPE guidance was published by professional bodies. Now that national guidance is available, supported by the Royal Colleges, I urge every member of the surgical team to read it, alongside advice from their specialty associations. Teams should ensure they are familiar too with instructions and procedures within their Trust, and infection control advice.
The next test for government is whether they can provide adequate equipment, in the right place, to fulfil the new guidance. Just as government has a duty to follow through, so we have a professional responsibility to use what is ultimately a scarce resource, responsibly.
Policy-making in this fast-moving environment is not easy. Evidence emerges daily from other countries further ahead than we are in the epidemic. The answer is to take a risk-based approach, and acknowledge that we while we cannot eliminate the risk for staff altogether, we should distinguish between high risk and low risk activities and settings.
One factor hindering our assessment of risk, is lack of access to swift and accurate tests, to ascertain the covid-19 status of a patient. Without this, it is hardly surprising if staff consider all patients as suspected of having covid-19. With access to adequate testing, staff will be much better placed to use PPE appropriately.
In the meantime, the decisions teams have to take daily on the frontline in our hospitals are difficult and stressful. To help them, we have published a best practice guide to support surgeons and surgical teams. It includes broad recommendations which can be adapted to support individual circumstances based on surgeons’ and teams’ professional judgement, including on appropriate use of PPE.
It’s critical that NHS staff are protected through this crisis, not only because they deserve protection at work, but also because the NHS is nothing without them. Guidance in itself doesn’t protect anyone. Staff now need the resources to implement the guidance, and access to testing, to make informed decisions about risk.
Derek Alderson is President of the Royal College of Surgeons of England.
Competing interests: None declared.