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Covid-19: Give NHS staff working with patients higher grade masks, say medical leaders

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3162 (Published 30 December 2021) Cite this as: BMJ 2021;375:n3162

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  1. Matthew Limb
  1. The BMJ

NHS staff who work directly with patients should have routine access to face masks that offer high protection because covid-19 infections threaten to overwhelm services, doctors’ leaders have said.

Three national organisations said that filtering facepiece respirators (FFP3s) should be made fully available because of the increased transmissibility of the omicron variant. The BMA, the Hospital Consultants and Specialists Association, and the Doctors’ Association UK, concerned at rising hospital admissions and rates of staff sickness, cite growing evidence that airborne transmission of SARS-CoV-2 is a major driver of infection.

They want better protection for all healthcare staff who work with or around patients who have covid-19, saying that the current guidance on FFP3 use and the NHS’s reliance on usual surgical masks leave staff at increased risk of infection.

Jenny Vaughan, who chairs the Doctors’ Association UK, said that staff were deeply concerned that the NHS could be overwhelmed by high numbers of patients needing beds in wards and critical care. “Our frontline workers must be protected,” she said.

Research published earlier this year showed that FFP3 masks for healthcare workers on covid-19 wards reduced hospital acquired SARS-CoV-2 infections.1

The NHS is required to follow UK national guidance on infection and prevention control, which was updated by the UK Health Security Agency on 21 December.2 This says that an FFP3 respirator (or equivalent) must be used by staff when they care for patients with a suspected or confirmed infection that is spread wholly by the airborne route, and when performing aerosol generating procedures on a patient with a suspected or confirmed infection spread wholly or partly by the droplet or airborne route.

FFP3 masks can be used more widely when transmission risk remains unacceptably high, after local risk assessments that should include “evaluation of ventilation in the area, operational capacity, and local prevalence of infection/new SARS-CoV-2 variants of concern.”

But doctors’ leaders said the guidance did not do enough to minimise the risks to all staff who may be exposed to the virus, nor did it guarantee an adequate supply of FFP3 masks.

In an open letter to the UK Health Security Agency, published last week, the Doctors’ Association UK said the distinction between normal patient care and “aerosol generating procedures” was “artificial” and that the latest guidance would confuse NHS trusts over how to fulfil their health and safety responsibilities.3

The letter said, “We now know that breathing is sufficient to generate airborne coronavirus capable of infecting others who are breathing the same air. With omicron rates doubling roughly every two days we must treat every patient we see as being a potential carrier of covid. We believe it is necessary to provide FFP3 masks for all staff working indoors where exhaled air from patients is circulating.”

Claudia Paoloni, president of the Hospital Consultants and Specialists Association, said, “Current guidelines place the emphasis on physical separation and cohorting of patients, but in the real world if a lot of sick patients arrive at the same time then we will see infection control stretched to breaking point.

“The fear, as in 2020, is that we are seeing a cavalier approach to safety where infection control guidelines are once again being driven by supply issues and cost. The current reliance on inadequate, fluid resistant surgical masks is likely to leave staff vulnerable in enclosed hospital settings.”

The BMA has written to the chief executives of all NHS trusts reminding them of their legal obligations to identify and mitigate risks to staff. In the letter, Chaand Nagpaul, BMA council chair, said that trust bosses who were not providing FFP3 masks should explain how the protections they were offering were “sufficient.”

A spokesperson for the Department of Health and Social Care for England said that the guidance on the appropriate levels and standards of personal protective equipment (PPE) were written by clinical experts and would be “amended accordingly if appropriate.”

“The safety of the NHS and social care staff has always been our top priority, and we continue to deliver PPE to protect those on the frontline,” the spokesperson said.

Chris Hopson, chief executive of NHS Providers, said that trusts’ leaders drew on the advice of expert infection control teams whenever local risk assessments were needed. “The national guidance on FFP3 is clear and has been recently updated, and this is what trust leaders will be implementing on the ground,” he said.

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