Intended for healthcare professionals


Covid-19: Updated PPE guidance puts NHS staff at risk of infection, say medics

BMJ 2022; 376 doi: (Published 18 March 2022) Cite this as: BMJ 2022;376:o733
  1. Matthew Limb
  1. London

NHS staff face unacceptable health risks as a result of “retrograde” changes to the government’s guidance on preventing spread of SARS-CoV-2 infection, doctors’ leaders have warned.

The BMA said on 16 March it was concerned over updated guidance issued by the UK Health Security Agency covering use of personal protective equipment.1 It said the guidance failed to properly acknowledge that SARS-CoV-2 infection can spread in the air during the routine care of patients as they cough or sneeze and not just when specific processes known as aerosol generating procedures (AGPs) are being undertaken.

“This is a retrograde step as it once again means that healthcare workers will not be routinely provided the right level of protective masks and equipment they need to be safe at work when looking after covid patients,” said Chaand Nagpaul, the BMA’s chair of council.

The BMA said it was crucial that any staff looking after patients with confirmed or suspected covid-19, or in other situations where a local risk assessment required it, had access to respiratory protective equipment such as filtering face piece (FFP3) masks.

Nagpaul said, “All healthcare workers who are caring for covid-19 patients are putting themselves at risk, each and every day, and the very least the government should do is to provide surety that staff will be given the best protection possible.”

Respirators such as FFP3 masks are designed to protect the wearer from ingress of contaminated air and are fitted to ensure no gaps. They offer higher protection than surgical masks, which block the outward escape of droplets from the wearer.

The BMA’s concern follows a supposed clarification of the main messages regarding airborne transmission in the latest infection and prevention and control guidance issued on 15 March 2022.

The guidance said that respiratory protective equipment (FFP3 masks) are recommended when caring for patients with a suspected or confirmed infection spread “predominantly” by the airborne route (during the infectious period).

The word “predominantly” has been added to the previous guidance update, which was issued on 17 January 2022, and is the crux of doctors’ concern, one leading scientist said.

Trish Greenhalgh, professor of primary care health sciences at Oxford University, said the change introduced ambiguity and would allow NHS trusts to “withhold respirator-grade protection on the (flawed) grounds that covid-19 is not ‘predominantly’ spread this way.”

She told The BMJ, “The new version of the guidance has introduced what’s known as ‘systematic vagueness,’ thereby allowing healthcare organisations to wriggle out of their responsibilities.”

Greenhalgh said that the January version was clearer in describing airborne transmission of SARS-CoV-2, driven by aerosols released during coughing and breathing, and the need to wear respiratory protective equipment.

She backed the BMA’s concerns and said there was strong scientific evidence in favour of supplying respirators to everyone working in the vicinity of patients who may have covid-19 because, in such settings, the “virus is highly likely to be suspended in the air.”

“The airborne nature of the virus and the predominantly airborne route of transmission has been well established through multiple study designs,” she told The BMJ. “Observational studies have shown a dramatic reduction in nosocomial infections with covid-19 following the introduction of respirators,” she said.

The UK Infection Prevention and Control Cell, which is responsible for the guidance, said that adding the word predominantly was made to provide clarity in response to stakeholder feedback that the previous wording led to confusion in clinical settings and did not accurately reflect how infections spread.

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