DAUK in the BMJ: “Give NHS staff working with patients higher grade masks”

fit testing PPE

NHS staff who work directly with patients should have routine access to face masks that offer high protection because covid-19 infections threaten to overwhelm services, doctors’ leaders have said.

Three national organisations said that filtering facepiece respirators (FFP3s) should be made fully available because of the increased transmissibility of the omicron variant. The BMA, the Hospital Consultants and Specialists Association, and the Doctors’ Association UK, concerned at rising hospital admissions and rates of staff sickness, cite growing evidence that airborne transmission of SARS-CoV-2 is a major driver of infection.

They want better protection for all healthcare staff who work with or around patients who have covid-19, saying that the current guidance on FFP3 use and the NHS’s reliance on usual surgical masks leave staff at increased risk of infection.

Jenny Vaughan, who chairs the Doctors’ Association UK, said that staff were deeply concerned that the NHS could be overwhelmed by high numbers of patients needing beds in wards and critical care. “Our frontline workers must be protected,” she said.

Research published earlier this year showed that FFP3 masks for healthcare workers on covid-19 wards reduced hospital acquired SARS-CoV-2 infections.

The NHS is required to follow UK national guidance on infection and prevention control, which was updated by the UK Health Security Agency on 21 December. This says that an FFP3 respirator (or equivalent) must be used by staff when they care for patients with a suspected or confirmed infection that is spread wholly by the airborne route, and when performing aerosol generating procedures on a patient with a suspected or confirmed infection spread wholly or partly by the droplet or airborne route.

FFP3 masks can be used more widely when transmission risk remains unacceptably high, after local risk assessments that should include “evaluation of ventilation in the area, operational capacity, and local prevalence of infection/new SARS-CoV-2 variants of concern.”

But doctors’ leaders said the guidance did not do enough to minimise the risks to all staff who may be exposed to the virus, nor did it guarantee an adequate supply of FFP3 masks.

In an open letter to the UK Health Security Agency, published last week, the Doctors’ Association UK said the distinction between normal patient care and “aerosol generating procedures” was “artificial” and that the latest guidance would confuse NHS trusts over how to fulfil their health and safety responsibilities.

The letter said, “We now know that breathing is sufficient to generate airborne coronavirus capable of infecting others who are breathing the same air. With omicron rates doubling roughly every two days we must treat every patient we see as being a potential carrier of covid. We believe it is necessary to provide FFP3 masks for all staff working indoors where exhaled air from patients is circulating.”

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