The UK government has continually updated its guidance on the reuse of PPE if settings are finding that they are suffering shortages of specific pieces of equipment. Take a look at the latest advice and understand how each piece of personal protective equipment (PPE) should be used.
Alignment with other world-leading health bodies
The Centers for Disease Control (CDC) and World Health Organization (WHO) have their own guidance on how to utilise PPE when it is in short supply. The government has chosen to align its advice with these organisations.
The Health and Safety Executive (HSE) has made it clear that the reuse of certain items of PPE is safe and should occur if there is a shortage. While the Covid-19 pandemic has forced governments across the globe to assess their use of PPE, it has also become evident that there is a global shortage. Some PPE is designated for single use. However, the HSE has also made it clear that there needs to be a little bit of compromise when it comes to potentially reusing this equipment.
The safety of healthcare workers is crucial, so any guidance outlined will never compromise the health and safety of NHS and care home workers. The HSE puts the onus on local health trusts to ensure that an action plan is present to ensure that all PPE that is reused is safe and adheres to relevant legislative guidance.
It is vital that all healthcare workers are adequately protected from the risk of Covid-19. When there is an inadequate supply of PPE, UK government guidelines on how to reuse PPE should be enforced sensibly and effectively.
These principles should already be standard:
- Face-to-face contacts within a healthcare setting should be kept to a minimum.
- Transmission between patients should be kept to a minimum. Actions should be in place to prevent cross-transmission.
- FFP2 respirators can be used as an alternative to Type IIR surgical face masks in lower risk settings.
- All surgical masks need to be face fit tested to ensure that the PPE is adequate protection. Alternative ties and ear fastenings can be utilised to ensure a tighter or more effective fit.
- If a mask is required in an area when aerosol generating procedures are being carried out, a face fit test is less crucial.
- All healthcare settings must carry out risk assessments when embedding any form of legislative change. This is crucial for the implementation of a reuse policy for surgical masks, gowns, aprons, visors, goggles and gloves.
- UK government guidelines on how to reuse PPE is not a standard approach and is a response to a worldwide shortage of personal protective equipment. Gold star standard policy would be to adhere to single use guidance at all times. However, in unprecedented times, unprecedented measures will need to be put in place to maximise the safety of every healthcare worker.
Fluid repellant surgical masks and disposable respirators can all retain airborne germs and contaminants. These masks and respirators should be single use as much as possible because of this risk.
One healthcare worker should utilise their own mask. The sharing of this equipment is not recommended to limit the spread of the coronavirus. UK government guidelines on how to reuse this equipment includes:
- Replacing the mask if it becomes damaged, dirty, contaminated or moist.
- A shift of longer than six hours can result in extensive use in a hot and humid environment.
- Hand hygiene is hugely critical if the mask is touched.
- If taking a break, moving around the hospital or heading outside for a break, the surgical mask should be removed and disposed of.
Reusing surgical masks
If surgical masks are in short supply, reuse may become necessary.
- If the mask is damaged or soiled, and contamination is possible, reuse is never recommended.
- Tie on face masks should not be reused because they are more likely to be touched when removed. Elastic ear hooked masks can be reused.
- Hands should be sterile before removing any surgical mask.
- Carefully folded masks should be stored in a clean sealable box.
- All masks that are being reused must be reused by the same individual and never shared among colleagues.
- Non-standard PPE, like homemade cloth face coverings, cannot be used within healthcare settings as they are not considered effective.
Where aerosol generating procedures are being performed, fluid repellant gowns are crucial pieces of PPE. Alternatives can be considered if gowns are not available.
- The fluid repellant gown type should be kept back for surgical procedures and the aerosol generating procedures. Other procedures can utilise a different type of gown.
- A disposable plastic apron can be worn over the fluid repellant gown.
- Washable or reusable gowns can be used underneath a disposable plastic apron. These would need to be washed after every shift within the hospital laundry, so capacity may need to be increased.
UK government guidelines on how to reuse gowns mainly involve those lower risk clinical areas. Higher risk clinical areas should be where fluid repellant gowns are designated.
If a gown becomes torn, damaged, soiled or contaminated, it must be disposed of immediately. Hand hygiene remains paramount when removing the gown, both before, and after. To ensure that gowns can be worn for longer in a shift, there should be an action plan and procedure in place to make this safe.
- Once a gown is worn, it should remain worn until their next break or when their shift ends. A disposable plastic apron should be replaced every time a new patient is treated.
- All high-risk areas should be clearly labelled and signposted to ensure the fluid repellant gowns are only worn in these areas.
- Gowns should only be removed if going outside, moving to a new ward or at the end of a shift.
Gowns should be reserved for those high-risk areas. If other areas require gown usage, alternatives should be sought to the fluid repellent options. Disposable plastic aprons alongside forearm washing can be an option. Lab coats and long sleeved gowns that are washable can be reused when laundered effectively.
Goggles can be reused as they can be cleaned effectively in between shifts. If the integrity of the polycarbonate material that the goggles are made from is damaged, they must be disposed of. However, if they remain effective at providing barrier protection for the eyes, they can be reused. Healthcare workers should label their own goggles to ensure that they do not inadvertently spread potential contaminants.
Visors are a larger covering that protects the facial area, and can be worn over goggles for added protection. They can also be used as an alternative to goggles in times of PPE shortage. UK government guidelines on how to reuse visors only includes those items that are labelled for reuse. Single use options should never be reused.
Many goggles and visors will deteriorate over time. Shifts are often long, hot and busy meaning that all healthcare workers need to be alert to their PPE becoming degraded. If this occurs, disposal is the only option for the goggles or visor.
Goggles and visors, when cleaned, should be done so with hot water and detergent, and left to dry. Any anti-misting element on the goggles or visors will need to be reapplied.
Gloves are crucial protection in high-risk areas. They are always single-use and cannot be reused. The UK government guidelines on how to reuse gloves are not present as they should be disposed of after each use and when moving in between patients.
UK government guidelines on how to reuse PPE should only be considered if there is a shortage of PPE items. Aprons, gowns, fluid repellant masks, goggles, visors and gloves are all crucial parts of PPE to protect healthcare workers across the globe, not just in the UK. With a global shortage, compromise is needed to ensure that every healthcare worker gets the protection they need on every shift.
Reuse needs to be managed at a local level via Trusts. Healthcare settings are so varied that the HSE can provide guidance, but this should then be personalised to each healthcare setting in the country. Relevant risk assessment and policies should be honed and carried out to ensure PPE usage is managed in a safe and effective way.
Some PPE will always be of personal use. This means that visors, goggles and medical masks should never be washed and shared. They remain individual. Only reusable gowns can be washed and reutilised by others.
All healthcare workers need to remain hydrated at all times to combat fatigue when wearing PPE. Shifts can be long and draining, so it's important that all healthcare workers can recognise the signs of exhaustion. The health and safety of doctors, nurses, ports, cleaners and healthcare assistants is vital to the effective running of the medical provision of the UK.
Further updates will be given as guidance changes or adapts to further coronavirus developments.