Joint statement from UK anaesthetic and intensive care bodies in response to updated PPE guidance

Our organisations have to consider whether recently updated guidance represents an erosion of PPE standards

19 April 2020

On 17 April 2020, Public Health England (PHE) set out updated guidance for PPE use and reuse by UK healthcare professionals.

PHE stated that the guidance is aligned with publications by the World Health Organization (WHO) on PPE use during “severe shortages” and the USA’s Center for Disease Control and Prevention (CDC) on “crisis capacity strategies”. This tacit acceptance by the UK Government that PPE supplies are becoming inadequate is of considerable concern to the four organisations we lead and to our members, who form a key part of the NHS’s frontline medical workforce in combatting the COVID-19 crisis.

The Faculty of Intensive Care Medicine, the Intensive Care Society, the Association of Anaesthetists and the Royal College of Anaesthetists have supported PPE guidance documents published by PHE before 17 April 2020, but the newly updated guidance contains significant differences that include:

fluid-resistant surgical masks and disposable respirators (FFP3/FFP2/N95) can be reused if they are neither damaged nor soiled, and if they are folded such that the outer surface is held inward and against itself, and stored in a sealable bag

in the absence of fluid-resistant, disposable gowns or coveralls, reusable items such as washable laboratory coats or long-sleeved patient gowns can be used.

Although these recommendations appear in the documents published by the WHO and CDC, we are not aware of evidence that supports the view that they provide the wearer of the PPE with equivalent protection to recommendations previously published by PHE. We therefore have to consider whether these updated recommendations represent an erosion of PPE standards. Although many had anticipated this eventuality, this confirmation by a Government agency of critical shortages of PPE means that those who deliver care to NHS patients may have to make difficult decisions that balance the health of patients with that of healthcare professionals.

Intensivists and anaesthetists should of course act in compliance with guidance set out by the UK’s General Medical Council (GMC). The guidance stresses that doctors should report shortages to their employers and make every effort both to remediate shortages and use effective alternatives if possible. It also stresses that decisions on whether or not to provide care must be made by an individual faced with a particular set of circumstances. We think that clinicians should carefully evaluate the risks before taking a decision about whether to provide care, and should discuss a decision not to provide care with a colleague.

Our organisations will continue to support the efforts of NHS England, PHE and their devolved equivalents, and assist them in attempts to provide safe and practicable guidance. However, our first responsibilities are to NHS patients and to our members who care for them. If shortages continue or worsen, our members will face increasingly difficult decisions. This will involve balancing the safety of patients against their personal safety and that of other staff, those they return home to after work and patients they may treat in the future.

Our four organisations will support those of their members who, having done their best to work with their employers and colleagues to provide safe and effective care to patients, decide against exposing themselves to significant risks of COVID-19 infection when PPE is clearly inadequate. If members find themselves in this position, we would strongly recommend that you comply with GMC guidance by making “a clear a contemporaneous record of your decisions in the event that a concern is raised”.

The skilled and selfless work of all our members are central to the current battle against COVID-19. The conduct of our members is a matter of great pride for the four organisations and us personally, and we offer you our heartfelt thanks. In the meantime, we will continue to work on your behalf to resolve this unsatisfactory situation.

Dr Alison Pittard

Dean, Faculty of Intensive Care Medicine

Dr Ganesh Suntharalingam

President, Intensive Care Society

Dr Kathleen Ferguson

President, Association of Anaesthetists

Professor Ravi Mahajan

President, Royal College of Anaesthetists

ENDS