Fear and Lack of Confidence in New COVID-19 PPE Guidance
by Laura Bayley
With widely reported shortages of Person Protective Equipment (PPE), in particular fluid-repellent, full-length, surgical gowns recommended until now by Public Health England (PHE), the government has hastily revised guidance that plastic aprons can be used as alternative. Stocks of gowns are set to run out within hours.
The Royal College of Nursing (RCN) and British Medical Association (BMA) were quick to issue warnings last night that the guidance was not consulted on and that healthcare workers, their patients and the public would be put at risk if patients were being treated by doctors and nurses without adequate PPE.
The RCN had earlier responded to the reported shortages of PPE by publishing guidance for nurses In light of the ongoing supply difficulties (https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2020/april/009-232.pdf?la=en). It is stressed that refusal to treat a patient must be a last resort, when all other avenues have been exhausted. The RCN has now written to the Health and Safety Executive (HSE) to intervene, as nurses are being put at risk.
Considering the various guidance documents on PPE, it would appear that the latest PHE guidance may fall short of what is required by the HSE and World Health Organisation (WHO) guidance and regulations.
The Personal Protective Equipment at Work Regulations 1992 require PPE to be:
- a) properly assessed before use to make sure it is fit for purpose;
- b) maintained and stored properly;
- c) provided with instructions on how to use it safely;
- d) used correctly by employees.
It is questionable that plastic gowns would meet the “fit for purpose” requirement.
The WHO has also produced interim guidance on PPE, stipulating the use of long-sleeved surgical gowns for healthcare workers treating patients with suspected COVID-19 ( https://apps.who.int/iris/handle/10665/331498).
HSE, in partnership with PHE, has published a Rapid Evidence Review on the suitability of PPE ( in https://www.hse.gov.uk/news/assets/docs/face-mask-equivalence-aprons-gown-eye-protection.pdf ) looking specifically into the question of gowns and aprons and concludes, “Gowns may protect better against contamination than aprons”.
The personal health and safety of nurses and healthcare workers must be paramount. Frontline healthcare workers should not be putting themselves, and others, at risk by treating patients without adequate PPE. Guidance on PPE should be driven by evidence, not supply.