NHS staff need adequate RPE and they need it NOW

Photo of @alitwyGovernments in England, Scotland and Wales recently withdrew covid sick leave for NHS staff. (A summary of the key changes can be seen here.) These changes to sick pay provision for staff on covid related sick pay is hard to understand at a time when Covid-19 infections are going up exponentially and many NHS organisations are reporting increasing numbers of staff off sick. The only explanation is that the UK Government is continuing to follow their blinkered approach to “living with covid” holding firm to their belief that “covid is over” despite numerous data indicating this is not the case. The denial of the reality of covid is also evident in approaches to providing personal protective equipment (PPE) to healthcare workers.

Evidence is emerging that your chances of on-going issues (Long Covid) following a covid infection increase with each re-infection. Given this you might expect that NHS organisations were ensuring their infection control guidelines guaranteed staff were fully protected against Covid-19. However, in many Trusts this does not appear to be the case. Throughout the pandemic many NHS organisations seem to have focused on following Government guidelines about PPE requirements and ignored their obligations under Health and Safety Legislation. This has resulted in on-going shortcomings in protecting staff at work. This is discussed eloquently by Professor Raymond Agius (@ProfEmer) and colleagues in a BMJ blog.

Box 1 details the requirements set out in most recent iteration of the National infection prevention and control manual for England (published 8th June 2022). Even now, over two years into the pandemic, infection control guidance remains unfit for purpose. Evidence of increased aerosol transmission for Delta and Omicron variants means that surgical masks are no longer adequate protection for health care staff rather respirators (FFP2 or FFP3 masks) are required. The authors of this paper conclude:

“Reducing contacts, always wearing well-fitted FFP2 respirators when indoors, using ventilation and other methods to reduce airborne virus concentrations, and avoiding situations with loud voices seem critical to limiting these latest waves of the COVID-19 pandemic.”

Box 1: Extract from National infection prevention and control manual for England 

Respiratory Protective Equipment (RPE) i.e. a filtering face piece (FFP) must be considered when a patient is admitted with a known/suspected infectious agent/disease spread wholly or partly by the airborne route and when carrying out aerosol generating procedures (AGPs) on patients with a known/suspected infectious agent spread wholly or partly by the airborne or droplet route.

Staff in primary care/outpatient settings or care homes would not normally be required to wear an FFP3 respirator for routine care unless an AGP is being performed when staff should wear a fit tested, FFP3 respirator.

The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment e.g. task being undertaken, the presenting symptoms, the infectious state of the patient, risk of acquisition and the availability of treatment.

A fundamental flaw with the current UKHSA (@UKHSA) guidance (Box 1) is the premise that so-called aerosol generating procedures (AGPs) determine whether respirators should be worn. A coughing patient, and perhaps even an infectious patient who is simply breathing generates more exposure than someone on a ventilator. NHS staff need adequate RPE and they need it NOW.

Employers’ obligations under the Health and Safety Legislation require them to:

“Undertake a suitable and sufficient risk assessment proportionate to the risk arising from exposure at work and appropriate to the nature of the work, and this obligation overrides IPC guidance”.

We now have overwhelming evidence that Covid-19 is airborne and the need for appropriate respiratory protective equipment (RPE) in controlling this risk (Ferris et al. 2021; Lawton et al 2021). Given this, all NHS organisations should be providing staff with RPE (FFP2 or FFP3 masks). Failure to do so means these employers are not meeting their legal obligations under Health and Safety Legislation. This is the case even if they are following national guidelines on infection control.

A poll I carried out this week on Twitter with 309 respondents suggests shockingly few Trusts are providing adequate protection for their staff:

  • 2% of Trusts mandated a fitted FFP3 mask (respirator)
  • 2% required an unfitted FFP3 mask (respirator)
  • 79% require a surgical mask
  • 17% have no mask mandate at all

The Royal College of Nursing recently called for mask mandates to be reintroduced to all health care settings. Unions need to be calling for RPE to be provided for healthcare staff wherever they work. Alongside this staff need to be empowered and supported to refuse to work if RPE is not provided for them.

Healthcare staff have worked on the frontline throughout the pandemic often putting themselves and their families at risk. Not providing them with adequate RPE is a dereliction of duty. Failing to do so is illegal and will result in many more staff developing Long Covid and potentially leaving the NHS.

With thanks to Professor Raymond Agius (@ProfEmer) for reviewing this blog ahead of publication.

Alison Twycross

Editor-in-Chief: Evidence Based Nursing

Chair: Long Covid Nurses and Midwives UK

Twitter: @alitwy



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