Keeping safe at work: What you need to know about RPE

New! Dr Evonne T Curran’s latest blog looks at the LACK of evidence that covid is transmitted via droplets – click here to read the blog.

Make sure you read Dr Evonne T Curran’s blog: Patient Healthcare Worker and Visitor Safety during an outbreak (and a begging bowl)

Dr Evonne T Curran’s previous blog can be found here: Erroneous assumptions: It’s droplets…

Covid is airborne

There is now overwhelming evidence that Covid-19 is airborne and that this means there is need for appropriate respiratory protective equipment (RPE) for healthcare professionals to control the risk (Ferris et al. 2021Lawton et al 2021). However, a poll on Twitter in July 2022 suggests this may not be the case in many/most NHS organisations. Some of the key issues relating to this omission are outlined in an Evidence Based Nursing (EBN) blog.

State of play in NHS organisations

Given what we know about how Covid-19 is transmitted you might expect that NHS organisations were ensuring their infection protection and control guidelines ensured staff were fully protected. However, as evidence in Figure 1 this does not appear to be the case in many Trusts. Rather throughout the pandemic many NHS organisations appear to have focused on following Government guidelines about PPE requirements and ignored their obligations under Health and Safety Legislation as discussed in this BMJ blog.

Figure 1: Results of Twitter poll

National infection control guidelines not fit for purpose

The Royal College of Nursing recently published the results of their independent review of the methodology used to undertake the rapid review that informed current UK infection prevention and control guidance for Covid 19. The authors of the review concluded that the methodology used was flawed and not fit for purpose calling on the UK Health Security Agency (UKHSA) to undertake a rigorous systematic review and update their current guidance as a matter of urgency.

Having guidelines which are fit for purpose is important because evidence is emerging that your chances of on-going issues (Long Covid) following a covid infection increase with each re-infection. We also now know that healthcare workers are more likely to be infected with covid-19 (Grant et al. 2020Smallwood et al. 2022) with the highest infection rates seen among nurses (Bandyopadhyay et al 2020Smallwood et al. 2022).

Employers’ obligations under Health and Safety Legislation

Employers’ obligations under 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”.

World Health Organization advice

Current advice from the World Health Organization states: Respirators (FFP2/3 masks) should be worn in the following situations:

In healthcare facilities where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained.

Based on health workers’ values and preferences and on their perception of what offers the highest protection possible to prevent SARS-CoV-2 infection.

What should NHS organisations be doing

Given this, all NHS organisations should be providing staff with RPE (fitted 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.

If this is not the case in your organisation here are some things you can do:

    • If you work in health or social care, send a copy of the EBN blog to your line manager, lead for infection protection and control in your Trust, your chief nurse and chief executive.
    • If you are in England, please write to your MP (and consider copying in the Health Secretary) you can find out who your MP is here.
    •  If you are in Scotland, write to your constituency MSP, but please also consider copying in your regional MSPs (especially if they are in different political parties) and also the Health Secretary at the Scottish Parliament. For information about your representative in the Scottish Government look here.
    • If you are in Wales write to your assembly members. Details about representatives at the Welsh Government/Senedd can be accessed here.
    • If you are in Northern Ireland details of your representatives can be found here.