PPE requirements for GPs working in Covid ‘hot zones’ need to be reviewed with the consideration of recommending higher-grade face masks, scientists studying aerosol transmission have told Pulse.
Dr James Dodd, a consultant senior lecturer in respiratory medicine at the University of Bristol, who led recent research on aerosol transmission by Covid-positive patients, said this applies to any healthcare setting where patients are likely to cough.
Dr Dodd was the lead researcher on a study, carried out by the University of Bristol and North Bristol NHS Trust, which found that coughing generated at least 10 times more infectious aerosol emissions than breathing or speaking.
The study, which is not yet peer-reviewed, said: ‘PPE guidance should be updated to ensure medical staff are protected with appropriate PPE in situations when patients with suspected or proven Covid-19 are likely to cough.’
Although the study focused on a hospital environment, Dr Dodd told Pulse the principles ‘absolutely’ also apply to general practice.
Under current PPE guidance, some intensive care unit treatments – such as continuous positive airway pressure (CPAP) – are considered high-risk ‘aerosol generating procedures’ and warrant the use of the highest level of protection for staff, including FFP3 masks.
However, the Bristol study found that the use of CPAP, with a mask and filter on, ‘produced less aerosols than breathing, speaking and coughing’.
Hence, the researchers said their study ‘strongly supports’ the re-evaluation of guidance listing CPAP as a high-risk aerosol generating procedure, adding that current recommendations for critical care staff but not other health workers to wear FFP3 masks to mitigate the risk of Covid is ‘misplaced’.
Particularly regarding ‘hot zones’, where GPs see patients with confirmed or suspected Covid-19, Dr Dodd told Pulse: ‘PPE should be reviewed in that setting and the ventilation should be looked at as well.’
Dr Dodd said: ‘If you are looking after somebody who is coughing with SARS-CoV-2 in a room that is poorly ventilated – there will be aerosolised viral particles in that room – and we would say that therefore, we should be looking at strategies to reduce the risk to anybody in that environment.’
He added that the current guidance appears to have it ‘the wrong way around’ by requiring higher-grade PPE for aerosol generating procedures – and not in these environments.
Fresh Air NHS – a group of frontline healthcare workers and supporters – has also started a campaign urging the UK and devolved Governments to ensure measures to update PPE guidance. Its open letter, which currently has almost 1,500 signatures, said it is essential that healthcare workers have their PPE upgraded to protect against airborne transmission.
Dr Eilir Hughes, a GP in Wales and a leader of the Fresh Air NHS campaign, said he is aware of a number of GPs who are seeing suspected Covid patients while wearing an FFP3 mask, and that GPs generally have a degree of freedom around PPE.
However, he said the fact that the guidance does not reflect this as a requirement is an issue.
Dr Alison Johnston, a GP in South Cumbria, told Pulse: ‘Personally, I don’t feel safe in a flimsy apron and a surgical mask, particularly when seeing patients in the hot clinic. I know some colleagues across the country have been very ill with Covid even though they are healthy, and colleagues have sadly died. I do feel happier to have been vaccinated to keep me safer.’
She added that she would feel safer with an FFP3 mask, and that the problem with buying one from the open market is the lack of fit testing.
A spokesperson for the Department of Health and Social Care told Pulse: ‘The safety of NHS and social care staff has always been our top priority and we continue to work tirelessly to deliver PPE to those people who protect us all on the frontline.
‘In response to the new Covid-19 variants that have emerged in recent weeks, the UK Infection Prevention Control Cell conducted a comprehensive review of evidence and concluded that the current guidance and PPE recommendations remain appropriate.
‘New and emerging evidence is continually monitored, including on the latest variants, and reviewed by Government in conjunction with our world-leading scientists.’
Dr Chaand Nagpaul, BMA council chair, said: ‘The BMA has repeatedly called for high-quality PPE to protect healthcare workers from infection and illness throughout this pandemic. More recently, there is evidence that the virus can be spread by aerosol transmission in general settings. Current surgical masks are insufficient to prevent aerosol spread, which is why the BMA is calling for greater provision of enhanced FFP2/FFP3 masks.
‘We know that staff are still getting sick and having to take time off work to isolate and recover, depriving the NHS and its patients of their expertise at a time when all efforts are being put into defeating Covid-19. That is why it is vital that healthcare staff have widespread access to the very best PPE, since we cannot protect our patients if our medical workforce is not protected first.’