Coronavirus: Has the NHS got enough PPE?

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Unions have been concerned that some care workers do not have proper protective equipment

Personal protective equipment (PPE) – masks, gloves and other clothing to stop the spread of coronavirus – saves lives.

NHS staff in hospitals and the community need it to be able to do their jobs safely.

The government says it’s working “around the clock” to provide protective equipment, but there have been concerns that supplies of items like gowns are not reaching staff.

NHS staff were advised by the Department of Health and Social Care to consider reusing some PPE ahead of expected shortages this weekend.

What is PPE and who should wear it?

Anyone who comes into close contact with patients who may or do have coronavirus should wear some form of protection. That includes staff working in care homes, prisons and other community settings as well as in GP surgeries or hospitals.

The type of PPE required depends on the level of risk.

Guidelines recommend that anyone working within 2m (6ft) of a confirmed or suspected Covid-19 patient should wear an apron, gloves, a surgical mask and eye protection.

Clinicians carrying out tasks that could generate airborne droplets of saliva loaded with the virus should use an even higher standard of protection, including disposable gowns, filtering respirators and face-shielding visors.

For example, that would include intensive care doctors getting a patient ready to go on a ventilator to support their breathing.

What about ambulance staff and pharmacists?

The ambulance driver does not need to wear any PPE, but the rest of the crew should wear the appropriate amount depending on the likely level of exposure and risk they face.

Pharmacy staff who cannot keep 2m away from possible patients should wear a surgical mask.

How much kit has the government sent out?

By the weekend of 18 and 19 April, one billion items of PPE will have been shipped in the UK – according to Health Secretary, Matt Hancock.

The government has not yet given a breakdown of those items, but on 10 April, when it said it had provided 761 million pieces of PPE, it gave the following details:

  • Deliveries to hospitals, hospices, care homes, home care providers, GPs, pharmacists and dentists
  • 158 million masks (surgical masks and more highly protective FFP3 masks, but it is unclear how many of each type)
  • 135 million aprons
  • one million gowns
  • 360 million pairs of gloves

The 761 million figure also included body bags, pulse oximeters, swabs, clinical waste containers, cleaning equipment and detergent to NHS Trusts.

Is this enough?

This is the vital question that is difficult to answer.

There are around 1.58 million NHS staff across the UK in hospitals and the community. All of them will require varying amounts of PPE depending on the type of work they are doing.

What can be reused?

Some bits of kit can only be used once per patient, while others can be used for whole sessions, such as during a ward round visit to many patients.

All PPE worn during the highest risk situations – where there will be lots of splatter from infectious droplets – should be single use, unless they can be decontaminated.

Gowns, aprons, gloves and surgical masks should usually be disposed of after a single use or session.

However, when there are shortages, guidelines now say NHS staff can reuse some kit where it is safe to do so, even if it is labelled as single use by the manufacturer.

The Health and Safety Executive says it recognises “some compromise” is needed when there are extreme shortages of kit and that these “exceptional circumstances” do not reflect its standard approach.

For example, some gowns could be washed by the hospital laundry and reused, it says.

It is easy to see how a member of staff would need to use lots of PPE when following the guidelines.

NHS Providers, whose members include health trusts, says coveralls are being used as alternatives to gowns – with some fire and police services, local authorities and vets donating their stocks.

On 17 April, the deputy chief executive of NHS Providers, Saffron Cordery, said: “The supply of clinical gowns is now critical and it’s clear some trusts will run out of fluid repellent gowns this weekend.”

Can supply meet demand?

The government acknowledges it will require a “Herculean logistical effort” to get the right PPE to those who need it.

Global demand for this equipment is at unprecedented levels and several countries have placed export bans on the sale of PPE.

Ministers have recruited UK companies, like Burberry, to turn over production lines and start making PPE.

Deliveries of kit will now happen every day, rather than every few days, says the government.

There is a hotline that NHS and social care workers can call to request PPE.

What do NHS staff say?

The British Medical Association, which represents doctors in the UK, criticised the advice that some single-use PPE could be reused.

“If it’s being proposed that staff reuse equipment, this must be demonstrably driven by science and the best evidence – rather than availability – and it absolutely cannot compromise the protection of healthcare workers,” said Dr Rob Harwood, chair of its consultants committee.

A BMA survey published on 18 April found that 50% of doctors working in high-risk areas reported shortages of long-sleeved disposable gowns and goggles.

Also, 64% of GPs said they had shortages of eye protection.

The Royal College of Nursing says its members can refuse to treat patients as a “last resort” if adequate PPE has not been provided.

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