Who this guidance is for
This guidance is intended for all care workers working in care homes in England. It can also be applied to visitors or essential care-givers within the care home setting.
This guidance is of general nature and is intended to be compatible with legislation. In the case that information in this guidance differs from a requirement in legislation, the legislation should be followed. The guidance remains under review and may be updated in line with the changing situation as required.
Employers and managers must provide workers with safe conditions of work, complying with all applicable legislation, including the Health and Safety at Work Act 1974 and the Health and Social Care Act 2008: code of practice on the prevention and control of infections.
This guidance has been developed in consultation with the Department for Health and Social Care (DHSC) PPE Task and Finish group, which represents the adult social care sector. This included a review of ‘how to work safely’ resources assessed in view of new and emerging coronavirus (COVID-19) variants to ensure that guidance and advice remains stringent, comprehensive and reflective of the latest evidence.
What you need to know
Care home providers will need to consider how to put this guidance into practice in the context of their own circumstances. This guidance provides a minimum standard on PPE use, and organisations who adopt practices that differ from those recommended/stated in the national guidance are responsible for ensuring safe systems of work, including the completion of a risk assessment approved through local governance procedures.
For the purpose of this document, the term ‘personal protective equipment’ (PPE) is used to describe products that are either approved by the Health and Safety Executive (HSE) under personal protective equipment legislation or by the Medicines and Healthcare products Regulatory Agency (MHRA) as medical devices. Both are appropriate as protective solutions in managing the COVID-19 pandemic, depending on circumstances.
Effective and appropriate use of PPE is only part of the actions to take in reducing the transmission of COVID-19. The prevention and control of COVID-19 requires the inclusion of other measures including enhanced cleaning, ventilation, social distancing and hand hygiene.
This guidance should be read in conjunction with admission and care of residents in a care home during COVID-19, visiting arrangements in care homes, and reducing risk in adult social care.
PPE must be used correctly and is only effective when combined with:
You must perform hand hygiene immediately before every episode of care and after any activity or contact that potentially results in your hands becoming contaminated. This includes after the removal of PPE, equipment decontamination and waste handling. Follow your organisation’s policies and procedures on monitoring residents who are symptomatic or confirmed with COVID-19, permitted jewellery and hand maintenance (for example, keeping nails short, using moisturiser to keep skin on hands intact).
You should follow advice for the general public when outside of work (that is, before work duties commence and after work duties end). This includes following guidance on wearing face coverings (not medical grade masks) when in enclosed spaces, such as public transport and supermarkets.
For more information see the guidance on how to stop the spread of coronavirus (COVID-19).
Determining the PPE to use
You need to take precautions to protect your own health and to prevent passing on infection to people you care for. We recommend you use PPE regardless of whether the person you are caring for has any symptoms. The type of PPE required will depend on the tasks you are carrying out and if the social distancing rules can be maintained.
Risk assessment involves assessing the likelihood of encountering a person with COVID-19, considering the ways that infection might be passed on and how to prevent this, including through use of PPE.
The PPE you will use depends upon the risk assessment taken. The risk assessment should be based on the following 2 questions:
- Are you likely to be within 2 metres of a resident and carrying out direct personal care or domestic duties?
- Are you more than 2 metres from a resident undertaking domestic duties and not delivering personal care?
The risk assessment is an organisational responsibility but should involve individual care workers. This will determine when and for which residents or duties items such as eye protection and Type IIR masks should be worn, for example when providing personal care for residents who are known to have respiratory symptoms or a known positive coronavirus test result within 10 days (14 days if medically advised).
You should discuss situations where you are unsure about with your manager. If after raising a concern you believe you are being asked to work in a way that is not safe, you should seek support, including from your union if you are a member, and consider whether making a disclosure to the Care Quality Commission (CQC) is appropriate. There is further guidance available on raising a concern with the CQC.
Exemptions on wearing face coverings in public are covered by regulations that do not apply to care settings. Where people may have difficulty wearing masks as required by this guidance, this should be discussed between you and your employer. If a mutually agreeable position cannot be reached to comply with the guidance, employees can refer to the Advisory, Conciliation and Arbitration Service (ACAS) for resolution, who can be contacted through their website.
It is not recommended to use homemade face coverings or cloth masks for staff delivering health and care activities.
There may be circumstances where following this guidance presents challenges in caring for the resident, for example, where lip-reading or facial recognition is especially important for care.
Supported individuals who are clinically extremely vulnerable
Residents who are clinically extremely vulnerable or at higher risk from COVID-19 may need additional precautions, for example avoiding contaminating surfaces that might be touched by the resident. If you have any concerns about whether your residents should belong to this group, then you should discuss this with your manager.
When delivering care to a resident who is clinically extremely vulnerable, please follow the sections on providing close personal care in direct contact with the resident(s) and carrying out domestic cleaning duties. The primary purpose of wearing PPE in this scenario is to protect the vulnerable individual.
Supported individuals with learning disabilities, mental health problems, autism and dementia
There may be challenges in following PPE recommendations and providing care particularly for people with learning disabilities, mental health problems, autism and dementia. For example, face masks may cause distress which can result in behaviour that may cause harm to the resident or others.
A comprehensive risk assessment should be undertaken for each resident identifying the specific risks for them. It is important that in doing this you do not alter the PPE items in any way as this could reduce their effectiveness in protecting staff or the people you are providing care for.
See guidance for care staff supporting adults with learning disabilities and autistic adults for more information.
Supported individuals who have previously tested positive for COVID-19 or have been vaccinated
The same PPE recommendations apply for personal care regardless of whether they have tested positive or not for COVID-19 or if they have had the vaccine.
The COVID-19 vaccination…