Coronavirus (COVID-19) - Personal Protective Equipment (PPE) guidance and Frequently Asked Questions

Information from Director of Public Health - the correct use of Personal Protective Equipment during COVID-19 epidemic

In order to minimise the risk of transmission of COVID-19 infection it is essential that Personal Protective Equipment (PPE) is used correctly.

We are being advised that there is a lot of confusion about the correct use of Personal Protective Equipment (PPE). We are also being told that staff in community care settings have on some occasions been advised by health professionals that the PPE they have been issued with is not compliant with the current guidance.

The information below clarifies the correct type of PPE to be used and when it should be used. 

For all Health and Care Services

A risk assessed approach must be taken by the health or social care worker prior to each visit with a service user - This is a dynamic approach and must take place either by phone prior to entering the premises or at 2 metres social distance on entering to determine if any individual in the premises has possible or confirmed symptoms or is in the extremely vulnerable category

In all cases - Where the health or social care worker is delivering close personal care (within 2 metres) appropriate PPE should be donned prior to.

How to work safely in care homes

All reusable PPE needs to be decontaminated after use with a client.  Staff need to establish if their PPE (for example - goggles) are reusable.

Sessional use is:

A single session of work is a period of time where the care provider is undertaking duties in a specific setting or environment, it is not a full shift and masks should not be taken off then reused.

  • This means for example if a member of staff is providing personal care to a number of residents, bathing, applying medication etc, they will continue to change aprons and gloves between each resident but can continue to use the face mask ensuring they don't touch their face as the mask needs changed if this occurs.  This is also the same for eye wear if it has been risk assessed that it is required
  • Staff need to continue to hydrate so if they have a drink and remove the mask or raise it to get air that is the end of that session and the mask needs to be disposed of as clinical waste and a new mask applied, this is the same if staff leave a unit to go to the toilet or have a break
  • The session ends when the care provider leaves the care setting, e.g. completing a specific set of tasks or moving from one unit to another within the care home
  • Masks should also be changed if staff are caring for a symptomatic resident then move to care for an asymptomatic resident

Please note:
PPE should not be subject to continued use if damaged, soiled, uncomfortable or damp.  

The use of visors does not replace the use of masks only eye goggles, masks still need to be worn.

Recommended PPE to be used by healthcare workers delivering or assisting with an aerosol generating procedure 

This includes Intensive Care Units or the hot (contaminated) zone of an Emergency Department

  • Long sleeved gown
  • Respirator
  • Eye protection
  • Gloves

The national guidance states hand hygiene should be extended to washing up to the elbow when forearms are exposed.

The supplies of PPE to the care sector is fundamental for the good care of individuals with suspected symptoms of coronavirus Covid-19.

The Department of Health and Social Care has been clear that no wholesaler has been asked to prioritise NHS provision over the care sector nor should they be doing so.

A Cumbria County Council led PPE Working Group is in place to identify, monitor and prioritise provision of PPE to our teams involved in the delivery of Health and Social Care services. Allocation priorities includes residential care, community mental health teams, social workers (adults and children's), domiciliary care workers and other teams working in community facing roles. Included in this are commissioned independent providers. Senior managers in all services are organising PPE stock based on the requirements of their teams. 

Supply

If you are in the independent sector looking for help with the supply of PPE, please call 0800 783 1967 where an emergency short term response can be considered. An online request form is also available.

Please continue to use your usual PPE suppliers as a first option, the National Supply Disruption Response via the 24/7 helpline 0800 915 9964 or by email at supplydisruptionservice@nhsbsa.nhs.uk may also be able to pick up emergency needs.

It is important that all staff providing home care telephone the service user before each visit to enquire if they have any symptoms of COVID-19. This will enable the staff member to risk assess with their line manager and make sure the correct PPE is available.

Homecare

Entering the property

In a property where a person has a confirmed or suspected diagnosis of Covid-19 and PPE has been placed into the property, staff should enter the property before putting their PPE on. The plastic box should be stored 2 meters away from the person, ideally in a separate room. 

  • Hands and forearms should be washed.
  • PPE should then be put on following the guidance issued, including a mask and goggles / shields if required.

Leaving the property

  • PPE should be removed in line with the guidance issued
  • Hands and forearms should be washed
  • The call should be finished, call records written.
  • Before leaving the property, as a last step, a squirt of hand sanitiser can be placed into one hand, the lid placed back onto the plastic storage box and the property exited.
  • The hand sanitiser in you placed into hand can be rubbed in on the way back to your car.

Residential staff

All PPE should be left outside the room of the service user being isolated so staff can put on their PPE before entering the room.  In the case where residents can not be isolated, PPE should be stored in a safe place for staff to put on before delivering care.

Providers will be expected to continue to care for people who are self-isolating or diagnosed with COVID-19; at home or in the residential care setting - unless hospital care is required due to serious illness or treatment that can only be provided in a hospital setting. 

The correct sequence for putting on your PPE is:

  • Perform hand hygiene
  • Apron
  • Fluid repellent surgical facemask
  • Eye wear if required
  • Gloves

PPE must be removed in an order that minimises the potential for cross contamination, before leaving the service users room. The correct procedure for the removal of PPE is outlined below:

  • Gloves
  • Apron
  • Eye wear if used
  • Wash hands (Hand hygiene)
  • Fluid repellent surgical facemask
  • Wash hands (Hand Hygiene) performed following the removal of all PPE

There is a useful diagram on page 8 of the Cumbria County Council Infection Control, Personal Protective Equipment Policy (PDF 216KB) which shows the correct procedure.

Homecare

If service user is being shielded or following the use of usual PPE - this should be disposed of in a separate waste bag and placed in the rubbish bin within the property.

If a service user has symptoms or a positive diagnosis then the waste should all be placed into a yellow bag, if possible, if not a separate bag and kept safely for 3 days. After 3 days this should be sealed and stored within the property. A second waste bag should be started. At 7 days, the first sealed bag should be placed outside in the general waste and the second bag should be sealed. This should be kept in the property for 3 days before being placed into the dustbin.

Residential Care

Clinical waste should be treated as category B waste and once bags are 2 thirds full they should be closed, labeled with the date closed and kept for 72 hours before putting out for collection.

Staff should only use issued fluid repellent surgical facemasks EN14683 Type 11R with CE marking.

Shielding

When dealing with service users who have received a letter from their GP and are shielding, staff can use a surgical facemask Type 11 at all times which can be disposed of in domestic waste.

Fluid Repellent Surgical Masks

Face masks should not be routinely worn while staff are providing care for service users with no symptoms of COVID-19. There is no benefit to wearing a mask in these cases and no good evidence that this practice will reduce transmission rates. Therefore the use of face masks should be limited to where staff are providing care for service users with either possible or confirmed COVID-19 infection.

On Thursday 4 June, it was announced that from Monday 15 June, it would be mandatory (a legal requirement) for the public to use face coverings on public transport.

On Friday 5 June, it was announced that from the same date, all staff in hospitals in England will be provided with surgical masks which they will be expected to wear from 15 June and all visitors and outpatients must wear face coverings at all times when visiting hospital sites.

Useful information:

Isn't a face covering just a mask?

No. It is important to understand that a face covering is different from a mask. The public are being asked NOT to wear masks because this would place demand on stocks of PPE surgical masks (that are still needed by people working in the health and social care sector) and masks needed by people to protect them from industrial hazards through their work (dust, chemicals etc).  A face covering is defined as a cloth/fabric covering that can be home-made or purchased. Please do not buy surgical or industrial grade masks (this disrupts the supply chain and can cause the cost to increase for others, such as care homes).

Why are people being asked to wear a face covering specifically on Public Transport?

People are still being advised to avoid public transport where they can, but if they do use public transport, it will be a legal requirement to wear a face covering from the 15th June on buses, ferries, trains and planes (individuals can be fined if they don't wear a face covering when they should). When necessary to use public transport, people may be more likely to be in enclosed spaces for longer periods of time where we know there is a greater risk of the spread of the virus and social (physical) distancing is likely to be difficult to follow consistently. This differs from enclosed spaces like shops for example, where people can more easily go outside if social (physical)  distancing is not possible and where shop owners can place limits on the number of customers allowed inside at any one time. The Scientific Advisory Group for Emergencies (SAGE) has set out that using face coverings on public transport can provide some small additional protection to fellow passengers and can help people to avoid unknowingly spreading the virus if they are suffering from coronavirus, but not showing symptoms.

Why are people being asked to wear a face covering specifically when visiting hospitals/attending outpatient appointments?

Again, it can be difficult to maintain social (physical) distancing in busy areas, such as hospitals, where there are lots of people who are particularly vulnerable if they catch COVID-19. Many outpatient appointments require hospital staff to get very close to the patient, therefore this would be an additional measure to protect our frontline health and care workforce.

Are there certain groups of people who should not wear a face covering?

We are awaiting more detail from the Government on this one, but we do know that young children (face coverings pose a suffocation risk for children under the age of two), some people with disabilities and others with breathing problems are not required to wear a face covering. If in doubt speak to your GP, other health practitioner or health visitor for advice.

How do I make and wear a face covering?

Guidance on how to wear and make a face covering.

There is also information on the World Health Organisation website.

I've seen lots of people in public in Cumbria wearing face coverings, but they are not covering their noses. It is really important that the face covering covers both your mouth and nose. Also, do not wear the face covering around your neck or on top of your head when not in use. 

People should wash their hands or use hand sanitiser before putting their face covering on and after taking it off and it is important that people don't touch their face covering when wearing it, where possible, to avoid hand to face covering transmission of the virus. Carry a bag (such as a sandwich/food bag) to keep your face covering in when it is not it use. Wash your face covering regularly and do not share it with other people. 

Appreciate that on long journeys on public transport, people will need to eat and drink. Minimise the time spent not wearing your face covering and follow the good practice advice given above in this section regarding hand hygiene and handling of your face covering.

If I'm going to buy a face covering, is there anything to be aware of?

I would not recommend you buy surgical or industrial grade masks, look for cloth/fabric face coverings. In particular be cautious of masks from commercial websites/sellers that have valves attached. This is a type of N95 mask that have a one-way valve allowing exhaled air to pass through a small round or square filter disc attached to the front. The exhaled air may not be filtered and therefore it can undermine the job of a face covering in protecting those around you. 

Anything else?

Here are a few other tips if you're not used to wearing face coverings:

  1. remember to breathe! You may subconsciously change how you breathe when your nose and mouth are covered so try to breathe normally
  2. wearing a face covering can make you feel warmer, so wear layers in case you get hot on public transport or in hospital settings (which we know can be hot anyway)
  3. Experiment with wearing your face covering at home before having to wear it for any period of time when on public transport or whilst attending/visiting hospital - that way you can adjust it and find out how to wear it most comfortably before being in a situation where you can't touch it.