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GPs go forth

PHE publishes updated guidance on use of PPE

New updated guidance from Public Health England (PHE) stops short of recommending GPs use PPE for all patient contacts, although it suggests this may be necessary depending on 'local risk assessment'.

The new guidance says primary care professionals should use PPE when coming within two metres of a possible or confirmed case of coronavirus (Covid-19).

This should include a fluid-resistant (Type IIR) surgical mask; plastic apron; eye protection; and gloves, PHE said.

The document says: 'For primary care, ambulatory care and other non-emergency outpatient settings (including hospital outpatient clinics) plastic aprons, FRSMs, eye protection and gloves should be used for any direct care of possible and confirmed cases.'

But, recognising the 'pandemic evolution' of the virus spread, the guidance adds: 'Such PPE may be indicated for work in such settings regardless of case status, subject to local risk assessment.'

PHE reiterates advice for health professionals to establish, remotely via phone or other remote triage, or from a distance of two metres, whether a patient may be symptomatic.

But it adds: 'Where the potential risk to health and social care workers cannot be established prior to face-to-face assessment or delivery of care (within two metres), the recommendation is for health and social care workers in any setting to have access to and where required wear aprons, FRSMs, eye protection and gloves.'

PHE has also updated guidance to say that some PPE, namely facemasks and eye protectors, do not need to be exchanged inbetween each patient contact, but can be used for a full session.

It says: 'While generally considered good practice, there is no evidence to show that discarding disposable respirators, facemasks or eye protection in between each patient reduces the risk of infection transmission to the health and social care worker or the patient.'

The guidance suggests that 'indeed, frequent handling of this equipment to discard and replace it could theoretically increase risk of exposure in high demand environments, for example by leading to increasing face touching during removal'.

'The rationale for recommending sessional use in certain circumstances is therefore to reduce risk of inadvertent indirect transmission, as well as to facilitate delivery of efficient clinical care.'

It recommends that reception staff should keep two metres from patients, but where this is not practical, they should wear a fluid-resistant facemask.

RCGP chair Professor Martin Marshall commented: 'This new guidance provides much of the clarity the college has called for and it is appreciated that PHE and NHS England have been receptive to our concerns.

'It should provide GPs and their teams with much-needed reassurance around how and when to use protective equipment when they are seeing patients face to face in the best interests of their patients, their teams and themselves.'

But commenting on GP concerns with supply of PPE, he added: 'We understand that initial stocks of PPE have been getting to GP practices, we now need to ensure that this supply is sustained throughout the pandemic, that practices start receiving new equipment recommended in the guidance such as eye protection soon, and that effective mechanisms are in place for practices to request emergency supplies, should they need them.'

BMA chair of council Dr Chaand Nagpaul said: 'Although PHE has produced updated guidance, what fundamentally matters is that doctors and healthcare workers get the adequate and appropriate supplies of PPE on the frontline. Without these supplies there is continued unacceptable danger to the health and lives of healthcare workers and their patients.'

The BMA has warned that without adequate protection, GPs and hospital doctors 'will die' from Covid-19.

Dr Nagpaul said: 'It is four days since the minister Robert Jenrick gave the assurance that no frontline staff should be working without the right protective equipment. Yet this week the BMA has received concerns from doctors in over 30 hospital trusts about inadequate PPE supplies and GPs across England who are yet to receive eye protection.'



Related images

  • facemask PPE coronavirus - getty RF

Readers' comments (11)

  • This is exceptionally dangerous guidance and should be binned immediately. COVID-19 kills.

    Most of the governments claims are based on politics and rationing because they messed up their planning despite adequate warnings from the WHO and affected countries. A few weeks ago they let Cheltenham Festival go ahead and now people are sick. The government allowed people onto crowded tube trains whilst the police followed people around the Derbyshire dales with drones. This sort of policy only makes sense in the minds of Boris and Dominic Cummings (who are infected).

    COVID-19 quickly contaminates indoor areas. It's spread is not well understood but appears to occur via the oropharynx and eyes, particularly where there is close and sustained contact, whatever the context.

    In the civilised world where corronavirus is under control and not infecting healthcare staff, a proper gown, respirator, eye protection, hair covering and long gloves are regularly used.


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  • PHE advice as always late, pointless and worth ignoring. In the real world, we have been following standard infection control and prevention measures for many weeks and obtaining PPE as recommended by WHO independently without waiting for hopeless inadequate provision from NHS supply chains.

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  • 'While generally considered good practice, there is no evidence to show that discarding disposable respirators, facemasks or eye protection in between each patient reduces the risk of infection transmission to the health and social care worker or the patient.' What about us spreading it from one patient to the next...…..?
    Clearly not an issue

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  • Nice to see that PHE are saying that they think a paper bag and crossing my fingers will work. I think I'll stick to the WHO advice, from those who've actually dealt with pandemics in living memory.

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  • Michael-where are you getting your PPE from? Have been failing repeatedly to get 2R or FFP3 masks for weeks whatever the price. Last successful purchase was 31st Jan!

    We were told to order from regional Logistics cell - who have told us that there was a "misunderstanding". Nothing til April 7th

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  • Baaaaaaa. Chop.

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  • The PHE may be crap but hey we will give you clap instead.

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  • No PPE No see

    The BMA needs encourage actions, not words!

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  • Totally contradicts the WHO advice. How convenient that we are told to re use PPE - just when it happens to be in obvious short supply.Trust this?

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  • The only people who believe the PHE guidance are managers and clinician-managers who insist that staff who do not comply with these guidelines (by asking for better protection) can either take no-pay leave or go work somewhere else. I have heard this from our Deputy Medical Director (himself a Respiratory physician). Some of these people will see COVID as a final hurrah; once the pandemic is over, they will move on to higher policy-making roles and look back on their time 'managing coronavirus' as a success.

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