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BMA: Update PPE guidance to recommend ‘wider use’ of FFP3 respirators in general practice

by Awil Mohamoud
13 January 2021

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PPE guidance should be updated to recommend that healthcare staff wear FFP3 respirators in high-risk settings like general practice, the BMA has said. 

In a letter sent to Public Health England (PHE) today (13 January) the BMA called for an ‘urgent review’ of PPE guidance amid a faster spreading variant of coronavirus and a worry that ‘inadequate’ PPE is placing many at serious risk while at work.

It added that there are ‘growing concerns about the role of aerosol transmission of Covid-19 in healthcare settings’ and called for PHE to support the wider use of respiratory protective equipment (RPE) – such as FFP3 – beyond aerosol generating procedures. 

The BMA said: ‘During the first wave, PHE guidance on PPE use was being driven by supply, or lack of it. Now that we have been assured that supply is no longer an issue, we believe guidance should be updated to take a more precautionary approach to better protect those working on the frontline.’

The letter also cited updated World Health Organisation (WHO) advice, which states that respirators may be used by health workers more widely if availability and costs allow.

According to the BMA, some trusts are ‘leading the way’ by protecting their staff with a higher level of RPE in ‘amber’ as well as ‘red’ settings, with the union calling for similar steps in general practice, including hot hubs – ‘where there is also a high risk of transmission’.

Dr Chaand Nagpaul, BMA council chair, said: ‘If healthcare workers fall ill from being infected and are unable to work, it will be devastating for the health service at this time of critical pressures, and it will compound the pressures besieging hospitals and GP practices.’

The BMA also wrote to the Department of Health and Social Care (DHSC) to highlight ‘persistent concerns’ about ill-fitting PPE – which it said is mainly an issue for female staff who are ‘often failing the ‘fit test’ or being left with sores and ulcers after long shifts’.

‘Protect workers now’

The GMB union also wrote a letter to Matt Hancock, health secretary, yesterday (12 January) calling for guidance to be ‘increased’ to give all health and social care workers access to level three PPE ‘should they need it’. 

The letter said: ‘We have repeatedly been assured that there are sufficient levels of PPE and we are calling on Government to use the supplies we have to protect the workers now. This could be a temporary measure until workers have received their vaccines and we understand more about whether the vaccines also stop transmission of the virus.’

The GMB added that it is ‘deeply concerning’ that the number of health and care workers contracting Covid is increasing, and that ‘there can be no doubt’ that they are at increased risk due to the new variant. 

The letter referenced advice from SAGE, which states: ‘A better level of mitigation could be achieved through specifying higher performance face coverings and masks, and this should particularly be considered in settings where people are more vulnerable to the consequences of the disease and/or are more likely to be infectious.’

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.

‘Current guidance should be followed’

In a statement to Management in Practice, PHE said that while the PPE guidance is published on its website, it is written with NHS leaders and agreed by all four chief medical officers, in consultation with the medical and nursing royal colleges.

Dr Yvonne Doyle, PHE medical director, said: ‘NHS staff are under immense pressures and their safety has always been our highest priority. The NHS Infection Prevention Control group has reviewed the latest evidence and has advised that PPE should continue to be worn as laid out in the current IPC guidance, with FFP3 masks required for staff undertaking clinical aerosol generating procedures. This is supported by WHO.

‘Emerging evidence and data on variant strains and transmission will be continually monitored and reviewed.’

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