Concerns raised over emergency PPE reuse guidance | Nursing Times

Nursing leaders have objected to new coronavirus guidance recommending the reuse of certain items of personal protective equipment (PPE) in the event of severe supply shortages.

Public Health England (PHE) has told clinicians to consider reusing masks, gowns and visors marked single use or seeking alternative kit when treating Covid-19 patients if stock runs dangerously low.

“These are exceptional circumstances and do not reflect HSE’s standard approach”

PHE guidance

The new emergency guidance – named Considerations for acute PPE shortages – had been sanctioned by the Health and Safety Executive (HSE) and aligned with World Health Organization advice, said PHE.

“Some of the PPE in the NHS Covid-19 ensemble is designated by the manufacturers as being single use,” stated the guidance.

“However, the HSE recognises that some compromise is needed to optimise the supply of PPE in times of extreme shortages.”

Although the guidance stressed: “These are exceptional circumstances and do not reflect HSE’s standard approach.”

The PHE said reusing PPE in the manner laid out should be considered as “temporary measures until the global supply chain is adequate to meet the UK’s needs”.

However, the Royal College of Nursing warned that the updated advice had not been approved by the college.

RCN chief executive and general secretary

Donna Kinnair

Dame Donna Kinnair, RCN chief executive and general secretary, said: “This guidance was developed without full and formal consultation with the Royal College of Nursing.

“It is unacceptable that any healthcare setting in the UK does not provide PPE as required by HSE and set out in the existing guidance.

“Only sound scientific evidence or safety concerns should change the guidance.”

She said the RCN had written to the HSE to voice its concerns about the guidance “in the strongest terms”.

“Nursing staff need to be afforded proper protection full stop,” added Dame Donna.

The Healthcare Infection Society and the Infection Prevention Society also claimed to have not been consulted on the guidance and said some of the recommendations “conflict with IPC [infection prevention and control] best practice”.

The RCN has today published the findings of a snapshot survey of almost 14,000 UK nursing professionals carried out of the Easter weekend to gauge levels of PPE shortages.

Key findings include:

  • 51% of those treating possible or confirmed Covid-19 patients in high-risk areas reported being asked to re-use items of PPE marked ‘singe-use’ by manufactures;
  • Of those treating Covid-19 patients elsewhere, 39% said they were being asked to re-use PPE designed for a single use;
  • Almost a third of nursing staff treating Covid-19-positive patients not on ventilators reported an immediate lack of face and eye protection;
  • Only half of nursing staff believed they had enough alcohol hand rub;
  • One in 10 nurses were relying on face or eye protection they had bought or homemade.

The issuing of the guidance by PHE came amid concerns that supplies of crucial gowns could run out over this weekend.

Dame Donna told the Health and Social Care Select Committee coronavirus inquiry yesterday that the RCN was “currently very worried about the shortage of PPE, particularly gowns in hospitals”.

Current practice is for nurses to wear disposable long sleeved fluid repellent gowns or coveralls in high risk areas, defined as units where aerosol generating procedures (AGPs) are being performed on confirmed or suspected Covid-19 patients, such as in intensive care units.

However, PHE has now said that clinicians can consider “shifting disposable gowns or coveralls to reusable options” in the event of inadequate supplies.

Among the alternative options available is for the use of washable laboratory coats or long-sleeved patient gowns with a disposable plastic apron over the top.

Stocks of the recommended disposable long sleeved fluid repellent gowns should be preserved for the delivery of AGPs themselves or surgical procedures on coronavirus patients, said PHE.

“Only sound scientific evidence or safety concerns should change the guidance”

Donna Kinnair

Meanwhile, under the new guidance, FFP3/FFP2/N95 respirators can now be taken off and used again by the same healthcare professional if unsoiled and stored in a clean sealable bag or box.

Single-use visors can also be re-used if they are in “extremely short supply”, said the guidance.

Gloves and aprons cannot be reused.

Responding to new guidance, Niall Dickson, chief executive of the NHS Confederation, said he believed the government was right to make contingency plans, but warned that the intervention would “inevitably raise further concern and undermine confidence” among the health workforce.

Niall Dickson

He said the global shortage of fluid repellent gowns was a “massive worry” and urged the government to place the securing of supplies of all PPE as its “number one priority”.

“The alert may be the best that can be done now, and the alternatives do provide protection, but they are not what anyone would regard as satisfactory,” added Mr Dickson.

Sara Gorton, head of health at the union Unison, said the guidance must only be implemented in a “worst-case scenario” and said no organisation should use it as an excuse to ration supplies of gowns when they still had stocks.

“That would cause a damaging breakdown of trust at a time when staff are working under intense pressure,” she added.

“Managers must be truly honest with health workers and their union reps over the weekend.

“If gowns run out, staff in high risk areas may well decide that it’s no longer safe for them to work.”

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