Government guidance continues to put staff and patients at risk from the airborne nature of Covid-19

Today, Fresh Air NHS, Patient Safety Learning and the Safer Healthcare and Biosafety Network are calling for urgent change to the UK government’s guidelines on Personal Protective Equipment (PPE), which are failing to adequately protect healthcare workers against the airborne nature of the Covid-19 virus.   Safety needs to be prioritised, not undermined, and all staff caring for Covid-19 patients should be provided with airborne PPE (i.e. FFP3 respirators) to protect them from the airborne nature of the virus, not just staff on the intensive care unit (ICU).

Dr David Tomlinson, a member of Fresh Air NHS, said: “The response from medical and political leaders to repeated pleas from the healthcare sector for better protection has been inadequate, unsafe, and unlawful.   It appears that the authors of infection prevention and control (IPC) guidance are accepting greater staff infection risk because they do not want to admit that they were wrong in removing airborne protection for non-ICU healthcare workers in March 2020, with the consequent financial exposure from the likely many cases of preventable death and/or disability resulting from workplace-acquired Covid-19.

“Instead, IPC guidance authors continue to emphasise the need for ‘local risk assessment’; a move clearly intended to shift legal responsibility for PPE decision making onto individual NHS Trusts. However, their guidance remains without a scientifically valid risk assessment method, since airborne transmission risk is restricted to a small group of so-called ‘aerosol generating procedures’ (AGPs) – a concept now recognised to be invalid, since a single cough has been shown to produce ~500 times greater aerosols than intubation, historically believed to be one of the highest risk AGPs.

“Healthcare organisations including the British Medical Association and Royal College of Nursing representing hundreds of thousands of members, and Fresh Air NHS, have all been repeatedly calling for better ventilation and airborne PPE for all Covid-19 facing HCWs.   Our serious safety concerns are being ignored; it feels like we were screaming into a vacuum. No one is listening. No one is taking responsibility.”

In March 2020, UK PPE guidance for Covid-19 facing HCWs was downgraded, from requiring airborne protection for all staff, to only those in areas where AGPs were commonly performed – mainly  the ICU.  To-date, approximately 1,500 UK health and care workers have died from Covid-19, with non-ICU HCWs experiencing far greater risk of infection than their better protected ICU colleagues. It is estimated that a further 122,000 health service workers who contracted Covid-19 are struggling with prolonged symptoms, often referred to as Long Covid.

Helen Hughes, Chief Executive of Patient Safety Learning, said: “Providing enhanced PPE to everyone working in non-ICU Covid-19 wards would offer much-needed reassurance that our leaders are committed to protecting both patients and staff from avoidable infection and the associated consequences.

“The lack of recognition of the airborne nature of Covid-19 transmission from the UK government puts at risk the safety of healthcare staff, their loved ones and patients. There needs to be an urgent review of the PPE guidance to ensure that it is lawful, evidence-based, reflective of the airborne nature of the Covid-19 virus, and that safety is prioritised.”

On Tuesday 29 June 2021, research released as a preprint by a team from Cambridge University Hospitals NHS Foundation Trust, demonstrated that the quality of face masks makes a huge difference to the risk of SARS-CoV-2 infection at work.  Following a local policy change from surgical masks to FFP3, the previously noted 47-fold greater risk of SARS-CoV-2 infection amongst HCWs on Covid-19 ‘red’ versus ‘green’ wards, was completely eliminated.

Frontline healthcare staff have undoubtedly been disproportionately affected by Covid-19 infections. It has also become clear that a significant number of in-patients who had Covid-19, acquired the virus whilst in hospital. Failure to account for the known peak infectious viral shedding  early during Covid-19, ineffective standards for hospital ventilation and most importantly, inadequate guidance and provision of PPE, created a ‘perfect storm’ for greater infection risk amongst non-ICU HCWs.

Tragically, only 15 NHS Trusts currently provide FFP3 respirators to non-ICU HCWs: the rest remain exposed to SARS-CoV-2 variants demonstrating important vaccine escape and associated with greater Covid-19 disease severity. The continued failure of IPC guidance authors to change guidance maintains an NHS PPE postcode lottery, and represents an abdication of their responsibility to protect HCWs and their families. As we enter a third wave of infections, for the NHS to recover and care not only for those with Covid-19 but also the millions awaiting treatment, it is essential that we have a healthy workforce. The way to achieve this is to immediately change Covid-19 IPC guidance and require airborne PPE for all Covid-19 patient care, bringing with it an end to workplace-acquired Covid-19. 

Notes to Editors

Fresh Air NHS

Fresh Air NHS is a group of frontline healthcare workers campaigning for better protection for healthcare workers against COVID-19. Fresh Air NHS is specifically working to improve recognition of the dangers of and essential mitigations against, airborne viral transmission. The group produced an open letter to the Prime Minister, First Ministers of Wales, Scotland and Northern Ireland, Secretary of State for Health and Social Care, Minister for Health and Social Services, Wales, Scotland and Northern Ireland in January 2021, signed by ~1,600 scientists and concerned individuals.

The open letter  highlights the vulnerabilities of healthcare workers and stresses the particular risk in healthcare settings where current guidance does not call for the use of respiratory-protective PPE. The letter calls for immediate changes, including an increase of ventilation in all settings, immediate access to FFP3 masks for all staff working with confirmed or suspected Covid-19 patients, and a review of national PPE guidance.

The letter can be found at: http://bit.ly/3jod6pg

Patient Safety Learning

Patient Safety Learning is a charity and independent voice for improving patient safety.  We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. We believe patient safety is not just another priority; it is a core purpose of health and social care. Patient safety should not be negotiable.

the hub is Patient Safety Learning’s platform for patient safety. It offers a powerful combination of tools, resources, stories, ideas, case studies and good practice to anyone who wants to make care safer for patients. This recently featured a blog discussed the patient and staff safety concerns related to existing PPE guidance which can be found here: https://www.pslhub.org/learn/coronavirus-covid19/273_blogs/ppe-guidance-continues-to-put-staff-and-patients-at-risk-by-dr-david-tomlinson-r4707/

Safer Healthcare and Biosafety Network

The Safer Healthcare and Biosafety Network is an independent forum which has been in existence for more than 20 years and focused on improving healthcare worker and patient safety and caring for those who care for us.  It is made up of clinicians, professional associations, trades unions and employers, manufacturers and government agencies with the shared objective to prevent occupationally acquired diseases and improve occupational health and safety in healthcare. In recent years the Network has expanded its agenda to drive awareness and promote a greater range of safer practices and new technology and the role they can play in improving healthcare worker and patient safety standards. The Network has recently launched a campaign called Safety for All which is calling for improvements in, and between, patient and healthcare worker safety to prevent safety incidents and deliver better outcomes for all.