Welcome to a special COVID-19 edition of NHS Hot Topics. In this edition, we dissect an issue that affects the NHS in the current COVID-19 pandemic. This week we are looking at Personal Protective Equipment – PPE.
What is PPE?
Personal Protective Equipment (PPE) protects the user against health or safety risks at work. Healthcare workers use PPE, but usage is not limited to this setting. Other examples of workers who regularly use PPE are construction workers and chefs. Healthcare professionals regularly use PPE such as gloves, masks and aprons, where appropriate.
What PPE is required for NHS staff in the COVID-19 pandemic?
The WHO guidance for healthcare staff providing direct care for COVID-19 patients consists of:
- medical mask
- gown
- gloves
- eye protection (goggles or face shield)
For aerosol-generating procedures performed on COVID-19 patients, an N95 respirator or FFP2 standard is recommended instead of a medical mask, and an apron is also recommended. An example of an aerosol-generating procedure is intubating a patient.
A surgical mask does not protect against smaller airborne particles and the loose-fitting has potential for leakage. An N95 respirator filters out at least 95% of airborne particles and has a much tighter fitting, therefore providing more protection.
The guidance on necessary PPE depends on proximity to COVID-19 patients and the circumstance.
The UK guidance echoes that of the WHO, going beyond in recommending FFP3 respirators in high-risk situations, which filter out 99% of airborne particles compared to the 94% protection rate offered by the FFP2.
In higher risk acute inpatient care areas, such as intensive care and emergency department resuscitation areas, long-sleeved disposable fluid repellent gowns or disposable fluid repellent coveralls, FFP3 respirators, eye protection, and gloves must be worn.
Why does PPE matter?
PPE is needed when treating coronavirus patients because SARS-CoV-2, the virus that causes COVID-19, is an airborne virus. This means it can be spread by droplets from an infected person-produced when that person sneezes or coughs. Staff in social care also currently require PPE.
Without the correct PPE, treating COVID-19 patients poses an unacceptable danger to both staff and patients, says the chair of the council at the BMA.
Usage of PPE depends on the situation and type of PPE. PPE used in the highest risk situations should be single use only (or ‘sessional’), as should gloves, gowns, aprons and surgical masks.
Goggles and face shields can be reused if they are decontaminated. In some scenarios, PPE can be used for ‘extended’ sessions such as a whole ward round.
What is the current issue with PPE?
Recently there has been a lack of PPE in some healthcare settings in the UK. Despite the government saying there is enough PPE to go around, the British Medical Association says supplies are dangerously low in some parts of the country, notably London and Yorkshire. Pictures have emerged of healthcare workers making their own PPE out of bin bags and other materials.
The BMA council chairman, Dr. Chaand Nagpaul, says that some doctors are facing a decision whether to carry on without adequate PPE.
In some areas of England, some pieces of PPE are no longer available forcing doctors into impossible situations, says the BMA.
A survey carried out by the BMA showed more than half of doctors working in high-risk environments had either shortages or no adequate supply of face masks. It is unclear whether lack of PPE is related to any of the deaths of healthcare workers in the UK so far.
The Royal College of Surgeons of England has said that doctors should not risk their own health if they do not have the right equipment to stay safe. The Royal College of Nursing has said that if adequate PPE is not provided, their members can refuse to treat patients as a last resort.
Why is there an issue with PPE?
This issue is not unique to the UK. In WHO guidance published in mid-March, it was stated that the global stockpile of PPE is insufficient for medical masks and respirators, and the supply of gowns and goggles are soon expected to also be insufficient.
The surge in global demand driven by the increase in COVID-19 cases, panic buying, and stockpiling has further increased the insufficiency and PPE production can only increase so much.
There are 1.58 million staff working for the NHS around the UK. With a huge surge in COVID-19 cases, most will likely at some point be in contact with COVID-19 patients.
This produces a huge requirement for PPE above what the NHS would usually need. There have been supply and distribution issues that have and are being addressed by the UK government.
There has been increased demand which has diminished several companies’ stockpiles of PPE. Despite many manufacturers ramping up production and other companies converting their usual processes to making PPE, there is still a need for more.
Prior to the pandemic, China made about half of the world’s facemasks. Other countries that usually export face masks are using their supply for their own country’s crisis and many, such as Germany, are banning most PPE exports. This is another factor contributing to the supply problem.
Another challenge the UK government faces is distribution: getting the PPE to where it is needed. This requires a huge logistical effort with the army now helping to distribute supplies to where they are needed.
What is being done to resolve the issue?
So far, the UK government has provided more than 761 million pieces of personal protective equipment. This includes 158 million face masks, 135 million aprons, 1 million gowns and 360 million pairs of gloves. There is still more to be done.
Business Secretary Alok Sharma says that despite plans, more needs to be done to get PPE out to the front lines.
On Friday 10th April the Health Secretary Matt Hancock unveiled a new PPE plan, consisting of 3 core strands. The first is guidance: being clear who needs PPE and when they need it.
The second strand is delivery – the ‘herculean’ logistical effort to distribute PPE supplies.
The third strand is all about supply – buying more PPE and appealing to British companies to help create PPE on a huge scale.
With efforts to convert companies in areas such as fashion to PPE manufacturers, it is hoped that supply of PPE can be increased. Burberry and Rolls-Royce have already switched to manufacturing PPE in their facilities.
There is now also a dedicated hotline that NHS and healthcare workers can call to request PPE. Deliveries of PPE will also be increased to daily rather than every few days. A nationwide delivery system has been set up with the help of the army.
A combination of increasing supply of PPE and having an effective distribution system is key for ensuring all frontline workers have adequate PPE. This is a vital part of equipping the NHS to deal with COVID-19 and an issue everyone involved hopes is solved soon.
Questions to think about: What are some of the ways shortages of PPE are being combated worldwide?
Words by Safiya Zaloum
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