Re-use the SAME disposable gowns and don’t bin masks between patients: The controversial guidance for NHS medics to tackle the nationwide shortage of PPE
- Controversial guidance has advised NHS nurses and doctors to reuse their PPE
- Health chiefs argued there was no other option because of the PPE shortages
- The guidance says gloves and aprons must be disposed of between each patient
- But it now says masks can be worn for entire sessions – such as a ward round
- And it says medics can use lab coats with an apron instead of full length gowns
- Learn more about how to help people impacted by COVID
Controversial guidance issued to NHS doctors and nurses fighting the coronavirus crisis on the frontline have advised them to reuse PPE.
It said disposable gowns can be re-used and masks should not be binned between patients – but gloves and aprons should still be disposed of as usual.
Medics attacked the guidance, arguing no healthcare worker should risk their life without proper protection, while Labour urged Number 10 to fix the ongoing failure.
But health chiefs argued there is no other option because of the unprecedented shortages of gowns and masks, saying: ‘These are exceptional circumstances.’
Public Health England, which issued the guidance, said it was in line with the World Health Organization’s guidance for optimising the supply of PPE.
So, what does it mean for medics fighting COVID-19? Here, MailOnline reveals what the new guidance says – and how long PPE can be used for.
Public Health England, which issued the guidance, said it was in line with the World Health Organization’s guidance optimising the supply of PPE
WHAT PPE ARE MEDICS SUPPOSED TO WEAR?
Ambulance driver with no patient contact
No PPE needed
Paramedic with direct patient contact
Nurse in intensive care
Nurse with no patient contact
Conducting COVID-19 swabs
Under usual circumstances, medics are told to change their masks between seeing each patient.
But now they can be used for a session of work – which could be a ward round, or any other activity in one clinical setting.
Health chiefs agree disposable respirators and fluid-repellent surgical face masks should be binned if they get damaged or soiled.
But guidance says FFP3/FFP2/N95 respirators ‘have a large capacity’ and sessional use or re-use ‘would not approach anywhere near that capacity’.
The PHE advice also says medics should wash their hands immediately if they have to touch or adjust their masks.
Masks with elastic ear hooks are recommended because they are easier to take off without accidentally touching the face.
And the advice urges medics to bin masks if they are removed, unless they can be reused safely.
For example, the guidance warns some respirators become deformed when they are used so would not fit correctly if put on again.
Masks should also be ‘carefully folded’ if they are being reused, so that outer surface is held against itself to cut down contact with surfaces.
These should then be placed in a clean bag or box, which can be sealed and marked with the medic’s name.
The PHE guidance also warns: ‘There is insufficient evidence to consider homemade masks or cloth masks in health and care settings.’
Fluid-repellent hospital gowns and coveralls are deemed the gold-standard PPE for medics working with infectious diseases.
But PHE guidance says because of the PPE shortage NHS workers can also non-fluid repellent gowns and laboratory coats with a disposable apron.
WHAT DOES PHE SAY ABOUT REUSING PPE?
The PHE guidance says it is ‘generally considered good practice’ to change masks, respirators and eye protection between patients.
But it adds there is ‘no good evidence’ to prove it reduces the risk of infection to the healthcare worker or the patient.
It says: ‘Indeed, frequent handling of this equipment to discard and replace it could theoretically increase risk of exposure.’
The PHE guidance says this is because medics may touch their face more when removing the PPE, raising their risk of becoming ill.
It warns that medics must wash their forearms as soon as the coveralls are taken off, to kill any potential bugs that may have reached the arms if full-length coveralls were not worn.
And it also says they need to be washed in a hospital laundry after one session, with PHE saying hospital laundry capacity ‘may need to be increased’.
UK Infection Prevention and Control guidance recommends healthcare workers use gowns or coveralls for entire sessions.
It also says if the overall becomes ‘visibly soiled’, it must be disposed of and labelled as infectious waste. Other than that, it should stay on until their next break.
It says: ‘Staff should doff the gown or coverall only when going from the clinical to non-clinical area of the ward, or if they are leaving the ward for a break.
‘If leaving a higher risk area/theatre ward with a patient to transfer them to another area staff should retain their gown or coverall and other PPE.’
Staff in ‘proning’ teams – who help turn patients over – should wear gowns for a full session but change gloves and aprons between patients.
Goggles should fit ‘snuggly’ over and around the eyes or glasses, according to the PHE guidance.
Those made for healthcare professionals are typically reusable and are fitted with an anti-fog coating to ensure medics can see.
Public Health England guidance says NHS staff must have certain types of facial hair styles to ensure respirators fit properly
But visors – used in aerosol-generating procedures, such as intubating a patient – can be disposable.
If in ‘extremely short supply’, medics are urged to re-use single-use visors. They must cover the forehead, extend below the chin and wrap around the face.
They should be cleaned using a detergent – the same decontamination process used for any bit of PPE that needs to be donned again.
The PHE guidance adds: ‘They should be rinsed thoroughly to remove any residual detergent or cleaning product and left to dry.’
Visors will degrade with repeated cleaning, according to the guidance, which says they should be ‘resupplied regularly’.
And medics are told goggles or face shield should be removed upon exiting a ward area, as per standard practice.
Non-powdered, nitrile gloves are the kind most commonly recommended for NHS workers.
The PHE guidance says they must be disposed of after each use – and using them for an entire session ‘should be avoided’.
Gloves and aprons are the only things that should not be reused, according to the guidelines issued on Friday.
Crucial 84-tonne shipment of coronavirus PPE from Turkey could be delayed AGAIN: Hospital leaders unite to attack government over ‘bitter experience’ of failed deliveries as supplies ‘could run out TODAY’
Ministers face fresh fury today as a vital shipment of coronavirus protective kit from Turkey looks set to be delayed again – with medics warning they might be forced to stop treating patients.
Hospitals are on the verge of running out of some life-saving supplies after the 84-tonne delivery, including 400,000 protective gowns, failed to arrive last night.
Medical bodies say shortages mean doctors could need to make ‘difficult decisions’ between exposing themselves to the virus or ‘letting a patient die on their watch’.
Housing Secretary Robert Jenrick announced with fanfare on Saturday that the consignment was coming, before Education Secretary Gavin Williams humiliatingly admitted last night that it had been postponed.
Mr Williamson said he ‘hoped’ it would be in the UK today, while Culture Secretary Oliver Dowden predicted this morning that it will leave Turkey today.
However, Chris Hopson, chief of NHS Providers, which represents hospital trusts, said this morning there was ‘low confidence’ the materials will actually arrive.
‘As of an hour ago there is relatively low confidence it will arrive today. If it is going to arrive today is will probably arrive late in the day,’ he told BBC Radio 4’s Today programme.
He accused ministers of raising the hopes of health staff saying they had ‘bitter experience’ of promised PPE either failing to arrive, or turning out to be either faulty or the wrong kit.
Hospital bosses have slammed the government over shortage of PPE amid warnings trusts may run out of protective gowns today as medics threaten to stop treating coronavirus patients over fears for their own safety.
Medical bodies say the shortages mean doctors could be forced into a ‘difficult decision’ between exposing themselves to the virus or ‘letting a patient die on their watch’. It comes as the death toll among health workers including frontline NHS staff and care workers hits 80.
The shortages have led to a chorus of criticism that those fighting in the frontline against the virus are being betrayed as the Government fails to ‘get a grip’ on the escalating crisis.
- Another 596 patients died of the virus, the lowest toll in a fortnight;
- The daily number of those tested languished at 21,600 with just ten days to go to hit the Government’s 100,000 target;
- The death toll of frontline NHS and care home staff, from heart surgeons and nurses to porters and volunteers, reached at least 80;
- Number 10 denied reports schools could reopen as soon as May 11 and said no date had been set for lifting the lockdown;
- Michael Gove attacked ‘grotesque’ claims Boris Johnson was ‘missing in action’ at the start of the crisis after he missed five meetings of the emergency Cobra committee;
- More than 100 top doctors backed calls for the public to be told to wear homemade face masks when they leave the house;
- Chancellor Rishi Sunak was urged to boost his business bailout schemes amid warnings that up to 11.7million could be furloughed or left jobless over the next three months;
- Analysis suggests that more than 2,500 elderly patients are dying of coronavirus in care homes every week.
The death toll of frontline NHS and care home staff, from heart surgeons and nurses to porters and volunteers, has now reached at least 80. Pictured (left to right): Habib Zaidi, 76, GP from Essex; Adil El Tayar, 63, Hereford doctor; Pooja Sharma, 33, Sussex pharmacist; Amged El-Hawrani ENT expert, Burton
Pictured (left to right): Thomas Harvey, 57, London nurse; Alfa Saadu, 68, Essex doctor; Mohamed Shousha 79, London medic; Lynsay Coventry, 54, Essex midwife
Pictured (left to right): Aimee O’Rourke, 39, Kent nurse; Liz Glanister, 68, Liverpool nurse; Areema Nasreen, 36, Walsall nurse; Consultant Anton Sebastianpillai
Pictured (left to right): John Alagos, 23, Watford nurse; Glen Corbin, 59, from London; Rebecca Mack, 29, nurse, Morpeth; Janice Graham, 58, nurse, Scotland
Pictured (left to right): Rahima Sidhanee, 68, London nurse; Josiane Ekoli, 55, Harrogate nurse; Cheryl Williams, ward housekeeper; Ade Raymond, London nurse
Pictured (left to right): Dr Peter Tun, 62, specialist, Reading; Mary Agyapong, pregnant nurse; Dean McKee, 28, carer, London; Amanda Scott, 54, carer, Birmingham
The warnings came as:
Health Secretary Matt Hancock admitted on Friday that medical gowns could run out within days, and official new guidance was issued telling staff to consider reusing some personal protective equipment.
NHS chiefs say they had pinned their hopes on the delivery of 84 tons of equipment from Turkey to ‘avert an absolute crisis over the weekend’.
The RAF flight carrying the supplies was due to land in Britain yesterday morning – but it was delayed for at least 24 hours, meaning some hospitals could run out altogether today.
Niall Dickson, chief executive of the NHS Confederation, which represents health service managers, said: ‘This is very serious and makes a difficult situation worse. ‘It would have been better had the Government not made the announcement in the first place. It now looks more likely that supplies of gowns could run out in some places.’
Organisations representing intensive care doctors said their members are facing ‘increasingly difficult decisions’. They pledged to support any doctors who feel they have to down their tools due to inadequate PPE.
The British Medical Association said the delay was ‘devastating’ and that shortages could force doctors to consider ‘withdrawing from the frontline’.
Chairman Dr Chaand Nagpaul said: ‘Given the Health Secretary’s warning of the possibility of full-sleeved gowns running out altogether in some hospitals this weekend, doctors were banking on the Government’s announcement of imminent extra supplies of PPE from overseas.
Pictured (left to right): Maureen Ellington, Bristol nurse; Gladys Nyemba, Nottingham nurse; Andy Treble, 57, Wrexham hospital; Lourdes Campbell, 54, Bolton NHS
Pictured (left to right): Amrik Bamotra, 63, Ilford hospital; Brian Darlington, 63, Crewe porter; Julianne Cadby, 49, NHS manager; Linnette Cruz, 51, dental nurse
Pictured (left to right): London GP Syed Zishan Haider, 79; Jitendra Rathod, 58, surgeon, Cardiff; Alice Kit Tak Ong, 70, London nurse; Leilani Dayrit, 47, Rugby nurse
Pictured (left to right): Barbara Moore, 54, Liverpool; Edmond Adedeji, 62, locum, Wiltshire; Fayez Ayache, 76, GP in Ipswich; Carol Jamabo, 56, carer in Bury
Pictured (left to right): Carer Catherine Sweeney, 64; Donald Suelto, London nurse; Urologist Abdul Chowdhury, 53; Julie Omar, 52, nurse in Redditch
Pictured (left to right): Elsie Sazuze, 44, carer, Cannock; Gareth Roberts, 63, Cardiff nurse; Sara Trollope, 51, London matron; Amor Gatinao, 50, London nurse
Pictured (left to right): Donna Campbell, 54, from Cardiff; Elbert Rico, 52, porter in Oxford; Oscar King Jr, 45, porter in Oxford; Elvira Bucu, 50, care worker
Pictured (left to right): Nurse Melujean Ballesteros, 60; Technician Kevin Smith, Doncaster; Leilani Medel, 41, nurse in Cardiff; Amarante Dias, 54, nurse in Somerset
Pictured (left to right): Gladys Mujajati, 46, Derby nurse; Care assistant Stephen Agyapong; Patricia Crowhurst, 54, Teesside care; Jane Murphy, 73, Edinburgh A&E
Pictured (left to right): Barbara Sage, 68, Bromley, London; Dr Krishan Arora, 57, London; Sonya Kaygan, 26, care worker; Jenelyn Carter, 41, Swansea nurse
Pictured (left to right): Michael Allieu, London nurse; Radiographer Simon Guest; Wilma Banaag, 63, Watford hospital; Gilbert Barnedo, 48, London nurse
Pictured (left to right): Rajesh Kalraiya, 69, consultant, Romford; Steven Pearson, 51, nurse, Cumbria; Linda Clarke, 66, Wigan midwife; Emily Perugia, 29, carer, London
Pictured (left to right): Barry England, 999 paramedic; Gordon Ballard, manager, London; Mandy Siddorn, 61, technician, Chester; Unnamed at family’s request
Pictured (left to right): Carer Ruben Junior Munoz, Surrey; Andy Stamp, 65, IT admin, Liverpool; Margaret Tapley, 84, NHS nurse; Charles Tanor, 39, carer, West Mids
‘Healthcare workers desperately need proper and effective protection now – by whatever means possible. This really is a matter of life and death. Doctors and healthcare staff… are left fearful for their own health and safety – this is shameful.’
He added: ‘They are treating their own colleagues in intensive care on ventilators and tragically see some of them not survive.’
Professor Neil Mortensen, president elect of the Royal College of Surgeons, said: ‘Like all doctors, surgeons are committed to saving lives. If the gowns run out they will be left between a rock and a very hard place.
‘Do they put themselves, their colleagues and their families in the firing line, or do they take the risk of a patient dying on their watch for want of an operation?’
Mr Hopson of NHS Providers took a swipe at the government for trumpeting the delivery from Turkey before it had arrived. He told Sky News yesterday: ‘It’s been rather unhelpful to focus on a single individual consignment. We have learnt from very bitter experience over the past two to three weeks that you can’t guarantee gowns are going to arrive until they have physically arrived in the UK, the boxes have been unpacked and they have actually been tested.
‘What we have found with other consignments coming in from other countries the boxes have been mislabelled and when you’ve opened them up they have actually got masks in not gowns, we know that several consignments have actually failed safety tests.’
At least 50 NHS workers have now died after contracting coronavirus. NHS chiefs say supplies of gowns are ‘critically low’, and they need around 150,000 a day.
On Friday PPE shortages forced Public Health England to issue new guidance saying doctors and nurses can treat coronavirus patients wearing only plastic aprons.
Previous guidance required full-length waterproof surgical gowns for high-risk procedures. Yesterday a joint statement from the Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists said members should ‘carefully evaluate the risks’ when deciding whether or not to treat patients.
NHS chiefs say supplies of gowns are ‘critically low’, and they need around 150,000 a day. Pictured: Medical staff are seen putting on PPE at a testing centre in Rochdale, Greater Manchester
It said: ‘If shortages continue or worsen, our members will face increasingly difficult decisions. [We] will support those of their members who… decide against exposing themselves to significant risks of Covid-19 infection when PPE is clearly inadequate.’
Education Secretary Gavin Williamson told yesterday’s Downing Street press conference that the 400,000 gowns could arrive from Turkey today.
He said: ‘The whole resources of the Government and the nation are focused on making sure we have a gown supply that is needed by our amazing NHS.’
The Government is under fire for failing to adequately stockpile PPE in January and February, as the crisis loomed. Cabinet Office minister Michael Gove was yesterday forced to defend the decision to send 273,000 items to China in February.
He said: ‘We did sent protective equipment to China but we’ve received far more from China … than we’ve given.’
Lord Deighton, who led planning for the 2012 London Olympics, has been appointed to co-ordinate a ‘national effort’ to make life-saving gowns, gloves and masks.
The Government has issued a ‘call to arms’ for British industry to make essential PPE items, with Burberry, Rolls-Royce and McLaren already producing equipment.
However, other British manufacturers claim their offers of help are being ignored. Labour said the Government is ‘not taking advantage of the huge desire within British manufacturing to help’.
MP Rachel Reeves said: ‘NHS and social care workers are being put in an impossible position. The Government has been too slow to get a grip.’
Education Secretary Gavin Williamson (left) told yesterday’s Downing Street press conference that the 400,000 gowns could arrive from Turkey today. Lord Deighton (right), who led planning for the 2012 London Olympics, has been appointed to co-ordinate a ‘national effort’ to make life-saving gowns, gloves and masks
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