The objective of this guideline for staff is to:
- Maximise the protection for our staff working with suspected or confirmed COVID-19 patients
- Enable our staff to feel confident in performing their duties
- Maximise the efficiency and effectiveness of our PPE usage
Use of eye protection
Eye protection is recommended when working with outpatients or inpatients in green wards who are suspected of having Covid-19.
We require all patient-facing staff working with Covid-19 contacts, on amber or red wards (for example, ED), to wear eye protection (i.e. goggles or visors), to minimise the risk of cross-infection.
Please be aware that prescription spectacles alone do not provide adequate protection.
Staff working in outpatients should continue to risk assess the need for use of eye protection according to existing guidance.
Eye protection should be used on a sessional basis rather than for individual patients. It can be cleaned using a Clinell wipe after use, e.g. during breaks, with appropriate hand hygiene before and afterwards.
Visors should be labelled with your name and placed in an agreed area when not being used, e.g. hung from hooks or placed on a dressing trolley/flat, cleanable surface in the donning area.
Visors should be discarded in clinical waste bins:
• If visibly soiled
• When you finish a clinical shift or move to a new clinical area
Tuesday 01 September 2020 – updated PHE infection prevention & control guidance
Public Health England (PHE) has recently published updated COVID-19 infection prevention & control guidance. Notably this includes a de-escalation in some aspects of the PPE required for healthcare workers managing patients who have tested COVID-negative whilst maintaining the current PPE strategy for those patients who are confirmed as COVID-positive or whose COVID status is unknown.
Divisional leaders have been informed of the new guidance and have been asked to cascade to their teams for implementation. The full guidance can be found here.
In response to the COVID-19 outbreak, the following protocol is now in place for the use of PPE when working with COVID-19 positive or suspected patients. The protocol also provides recommendations for best working practice during this response.
The proposal is outlined in the following scenarios:
- Scenario 0: Green areas
- Entrance poster: PPE_Scenario_STOP_0_PosterNo19v1_Nov20_Ref_MS146306
- Scenario 0+: Outpatient and all green inpatient areas with a suspected Covid-19 patient
- Entrance poster: PPE_Scenario_STOP_0+_PosterNo20v2_Dec20_Ref_MS146376
- Donning poster: PPE_Scenario_0+_donning_PosterNo21v2_Dec20_Ref_MS146376
- Doffing poster: PPE_Scenario_0+_doffing_PosterNo22v2_Dec20_Ref_MS146376
- Scenario 1: Amber areas and wards closed to admissions
- Entrance poster: PPE_Scenario_STOP_1_PosterNo23v2_Dec20_Ref_MS146376
- Donning poster: PPE_Scenario_1_donning_PosterNo24v2_Dec20_Ref_MS146376
- Doffing poster: PPE_Scenario_1_doffing_PosterNo25v2_Dec20_Ref_MS146376
- Scenario 1+: Red wards and areas where AGPs are performed on negative Covid-19 patients
- Entrance poster: PPE_Scenario_STOP_1+_PosterNo26v2_Jan21_Ref_MS146376
- Donning poster: PPE_Scenario_1+_donning_PosterNo27v1_Nov20_Ref_MS146306_
- Doffing poster: PPE_Scenario_1+_doffing_PosterNo28v1_Nov20_Ref_MS146306_
- Scenario 2: Cohorted areas where aerosol-generating procedures (AGP) are carried out frequently with suspected or confirmed Covid-19 patients
- Entrance poster: PPE_Scenario_STOP_2_PosterNo29v1_Nov20_Ref_MS146306
- Donning poster: PPE_Scenario_2_donning_PosterNo30v1_Nov20_Ref_MS146306_
- Doffing poster: PPE_Scenario_2_doffing_PosterNo31v1_Nov20_Ref_MS146306_
- Scenario 3: Operating theatres and other areas where procedures are performed with suspected or confirmed Covid-19 patients.
Please read these scenarios carefully. Training in the donning and doffing of these procedures will be provided. Scrubs will be made available for those working in scenario 1.
Introduction of FFP3 masks into Covid-19 red areas (from 22 December 2020)
Staff working on red wards with Covid-19 positive patients are currently wearing fluid resistant surgical masks (FRSM) and visors, unless an aerosol generating procedure (AGP) is being undertaken – in which case FFP3 masks are worn. This is in keeping with current Public Health England (PHE) guidance.
However, due to increased numbers of staff testing positive for Covid-19 on red wards and to further protect staff who have prolonged exposure to large numbers of Covid-19 positive patients, we have taken the decision as a Trust to require the use of FFP3 masks instead of FRSM for all tasks involving patient contact on these red wards (currently D10, C6 and EAU5). This is defined as scenario 1+ PPE.
PHE still consider FRSM to be an appropriate level of PPE, so amber areas and areas where patients are awaiting swab results should continue to wear FRSM (scenarios 0+ or 1).
The effects of this change in PPE will be monitored closely and any further changes will be notified to staff immediately.
In order to facilitate this change, staff on these red wards will who are not currently fit tested to an available FFP3 mask or are not hood-trained will need to book to be fit tested. Please email MaskFitTesting@addenbrookes.nhs.uk as soon as possible to arrange an appointment.
Additional recommendations for working practice
- Staff working in critical care areas to take breaks every four hours in order to:
- Maximise the efficiency of our PPE usage as over the course of a 12-hour shift this will only incur the need for three changes of PPE
- Fit-testing and fit checking
- We have secured access to 600 reusable half-mask respirators which can be used in place of disposable FFP3 masks.
- We have taken the decision to restart our fit testing programme for bother reusable respirators and FFP3 masks, in addition to the continued and essential process of fit checking
- Please see films here showing how to fit check FFP3 masks with and without a valve.
- Cohorting of suspected or confirmed COVID-19 patients in order to:
- Avoid positive and suspected patients being placed on wards with asymptomatic patients;
- Improve the efficiency of our PPE usage.
- ( a risk assessment will be undertaken to assess the risk of cohorting suspected patients with confirmed positives)
- In view of a robust supply of eye protection, face visors are for single or sessional use only and should not be cleaned or reused.
If reusable goggles are used based on personal preference or specific clinical scenario, decontamination should be performed using thorough cleaning with a Clinell wipe for one minute after use.
- Use of visors with FFP3 masks
- In line with national guidance, when using FFP3 masks with valves staff should use visors, which are full face, rather than goggles.
- At present, the Trust has sufficient supplies of PPE. Staff who need to wear PPE in line with Trust guidance should use Trust-supplied PPE for their own safety. We are aware of reports of some members of staff purchasing their own items of PPE. While we understand the concerns that lie behind this, the Trust does not support the use of such equipment given the potential risks to staff and patients from use of equipment which has not been sourced through verified supply routes and subject to appropriate checks. Please only use PPE which is supplied by the Trust. The Trust cannot accept liability for any harm caused through use of self-supplied items of PPE.
- Information on the use of masks by staff and patients is available on the masks page of the staff portal.