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PROTECT THE NHS

What is PPE and who needs to wear protective equipment in the UK?


FOREIGN Secretary Dominic Raab stressed that the government is working to provide NHS heroes with suitable personal protective equipment as they battle on the frontline against coronavirus.  

This came after an investigation has been launched into the death of an NHS doctor who died from the virus after repeatedly pleading for better protection.

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 An Italian medic putting on his PPE
An Italian medic putting on his PPECredit: Getty Images - Getty

What is the latest in the PPE shortage?

Mr Raab said the UK is continuing to source PPE from abroad.

In the last 10 days, more than 5 million masks have been secured from China and three flights of gowns have arrived from Turkey.

This comes as an investigation has been launched into the death of Dr Peter Tun, 62, who died at Royal Berkshire Hospital on April 13 after testing positive for Covid-19.

He had pleaded with bosses for PPE but his request was rejected due to a shortage - he died two weeks later.

A spokesperson for the trust said: “We can confirm a serious incident investigation has been launched.

"It involves senior managers and clinicians who are working closely with Dr Tun’s family to look at their concerns and answer their questions. Whilst this is ongoing, we are unable to say any more.”

Dr Tun sent emails to his hospital managers pleading for PPE, but was told because it was in short supply his neuro-rehabilitation ward ranked lower than others that also needed it, The Guardian previously reported.

And the doctor was told his team could not have surgical masks, since there were no suspected or confirmed cases of Covid-19 in his ward, despite the fact two members of his team were self-isolating.

Dr Tun's emails revealed in full

From: Tun Peter

Sent: 23 March 2020 15:16

Subject: RE: PPE for Caversham Ward Neurorehab Medical Team

Dear _________

According to the President of the Royal College of Physicians guideline advice, we are not supposed to touch or do CPR in a suspected or confirmed COVID-19 patients unless appropriate minimal PPE (like basic surgical masks, none available on Caversham ward).

Two doctors in our department are already self-isolating for 14 days currently. One [member of our] team has regular duty … with suspected COVID-19 patients, and she is coming to our office daily.

We do not know for sure whether a patient needing CPR (could be anywhere in the hospital), could have been exposed to COVID-19 patients in RBH [Royal Berkshire Hospital] since admission, because RBH policy does not test PCR for COVID-19 for all patients with “Fever, Cough and Breathlessness”, unless they fit a certain criteria to be agreed by the microbiologist and chest physician.

If we are not prepared in advance before the ward becomes “HOT” [has confirmed cases], it will be too little and too late.

Yours sincerely,

Peter

To: Tun Peter

Sent: 23 March 2020 15:26

Subject: RE: PPE for Caversham Ward Neurorehab Medical Team

Dear Peter

The advice that you have quoted is the same that we are following for suspected or confirmed patients. Many people are currently off self-isolating for 14 days however as we have no directive from the government at this point about testing of staff we will not know if these are COVID or not, they may just have a cough or a temp for other reasons.

I am unable to order masks for Caversham without any suspected or confirmed cases on the ward. These supplies are not widely available and need to be used sensibly for those staff most at risk (ie those looking after suspected or confirmed cases). I will be able to get supplies immediately if and when you need them.

This is the Trust position at the moment and I do not have any powers to influence this

Apologies

Emails seen by The Guardian

What is PPE?

Personal Protective Equipment (PPE) varies, but it is the extra layers used to keep the wearer safe from pathogens, chemicals and most importantly right now, coronavirus.

It is the battle armour of the NHS medic.

The main goal of PPE is to stop pathogen-loaded airbourne particles, like saliva or blood, transferring from patient to medic, like an extreme sneeze guard.

PPE stops those particles getting into the wearer's body through vulnerable points like their mouths, lungs and eyes.

Under normal circumstances, PPE is worn by specialists like surgeons, forensics teams and pathologists who come within two metres of unknown substances.

The World Health Organisation describes it as "garments placed to protect the health care workers or any other persons to get infected.
"These usually consist of standard precautions: gloves, mask, gown."

In the case of blood or airborne high infections like coronavirus, PPE will include face protection, goggles and a mask or face shield, gloves, gown or coverall, head cover and rubber boots.

There is fierce debate over what counts as a proper gown as new NHS advice says "disposable fluid-repellent coveralls or long-sleeved gowns" are no longer mandatory for all procedures involving coronavirus patients, saying only that they must be used when a disposable apron provides "inadequate" cover.

The advice was issued without consulting medical bodies according to the Royal College of Surgeons of England who said they were "deeply disturbed" by the change and slammed it as an "unacceptable" risk to the health of staff.

 A nurse wearing required protective equipment, including a mask, gloves and a visor
A nurse wearing required protective equipment, including a mask, gloves and a visorCredit: Mirrorpix

What is the NHS standard for PPE at the moment?

Every country's standards vary when it comes to PPE and most of it is single use.

The standard PPE kit in the UK is a surgical gown, alcohol hand rub, surgical gloves, a visor, goggles, and a fit-tested FFP3 respirator.

Due to the PPE global shortage a lot of medics have had to improvise, but here's the breakdown of what should be worn.

Mask/respirator

A well-fitted mask that covers both the nose and mouth. It should not be used for more than one shift and should be "Filtering Face Piece Class 3" or better.

Lesser masks, like N95 and surgical masks, should be worn with a full face shield if no FFP3 masks are available.

Eye protection: Face shield, goggles and/or visor

Eye protection stops particles getting into your eyes and therefore should be fitted and airtight if possible.

A lot of medics are using a visor too. This is a bit of plastic that acts like a salad bar sneeze guard.

The visors are easy and cheap to produce, which is why our 3D printer hobbyists have started making them.

Fluid repellant gowns or coveralls

This is the iconic hazmat suit, or a fluid repellant overall that you see in forensic dramas, designed to stop pathogens touching the wearer's skin.

For this reason the more skin they cover the better, but the rules on this have been recently altered by the government, causing outrage in the medical community.

There has been fierce debate over what counts as "adequate" cover lately due to the global shortages, with some US doctors forced to wear bin bags, and many UK medics resorting to simple aprons.

 Paramedics and staff at the Royal Liverpool University Hospital wearing various items of PPE
Paramedics and staff at the Royal Liverpool University Hospital wearing various items of PPECredit: The Press Association

Disposable gloves

Single-use gloves, like the ones your dentist uses, must be worn when providing direct patient care and must be disposed of immediately afterwards.

Hands have to be washed thoroughly first and they are pulled over the gown sleeves.

Join our George Cross campaign for NHS staff

We are urging Sun readers to sign a petition calling for our NHS staff to be awarded the George Cross.

We are backing a proposal by Lord Ashcroft to honour our health heroes with the gallantry gong given for acts of bravery that did not take place in battle.

A No10 spokesman said: “The NHS is doing a fantastic job and the nation will want to find a way to say thank you when we have defeated this virus.”

SAS hero Andy McNab added: “The award of a George Cross would show an emotional appreciation.”

We are asking our readers to please sign the petition below.

 

What are NHS medics wearing as PPE?

A lot of UK medics have been forced to improvise by the international shortages of supplies.

For the most part there are supplies, but most of the equipment is single use, so hospitals are at constant risk of running out and often only have days worth.

This is not a normal situation and our medics are wearing anything they can get so that they can treat their patients, frequently putting their own safety at risk.

There has been a consistent shortage of supplies since the UK was hit by the virus, with reports of bureaucratic bottlenecks making things worse.

Five thousand doctors signed a letter saying they feel like "lambs to the slaughter" and "cannon fodder" due to the shortage.

 This image shows how nurses are wearing bin bags to cover themselves while treating Covid-19 patients at a North West London hospital
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This image shows how nurses are wearing bin bags to cover themselves while treating Covid-19 patients at a North West London hospital

How can you help hospitals and medics that are struggling to get hold of PPE?

In spite of the government doing its best to get supplies to our NHS heroes, there are a lot of cases where medics, care facilities and hospitals are forced to buy their own PPE due to the international shortage.

All hands are on deck in our hospitals and nursing homes, but a lack of PPE means that they are putting themselves and many of their patients at risk.

Without proper PPE our doctors and nurses are literally dying in the line of duty.

Hospitals are going as far as to get schools to make PPE masks and even getting medical masks from sex shops.

You can help by donating to causes like Masks for Heroes, a team of doctors who are buying in more PPE for British hospitals and can get it airdropped within the week.

DONATE TO THEM HERE

Should I be wearing a face mask during coronavirus lockdown?

The general advice given across the world is people don't buy up the stock of medical-grade masks as there is a global shortage and medics need it more than the average Joe.

World Health Organisation official guidance says people need only to wear masks if they have Covid-19 symptoms or are caring for someone who does.

University of East Anglia researchers found "there is enough evidence to support vulnerable people using them for short periods when in temporary higher risk situations – such as on public transport, visiting shops or in healthcare settings".

The best thing to stop the spread is to social distance as much as possible.

Chinese medical worker shows how to put on COVID-19 protective suit
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