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Healthcare workers


Find out the latest changes in governmental PPE advice.


Contents

The IOSH Health and Social Care Group provides a range of services to IOSH members including webinars, as well as producing guidance and sharing good practice.



Status of Covid-19

As of 19 March 2020, Covid-19 was declassified as a High Consequence Infectious Disease (HCID) in the UK. In the UK cases of Covid-19 are no longer managed by HCID treatment centres only. All health workers who have contact with a confirmed or potential coronavirus case should ensure they follow the national advised guidance in dealing with Covid-19.

Covid-19 continues to be an infectious disease of significant public concern and of global proportions. It was declared a pandemic by the WHO on 11 March 2020 due to its global spread and impact. The pandemic is at different levels of severity in various regions of the world, which makes it necessary to refer to local and national guidelines when managing the disease.

For health workers, the risk of contracting Covid-19 from their community contacts is increased by the risk of transmission of the virus in their working environments.


Advice for workers in the Health Care sector

During this pandemic, those working in health care, in both the public and private sectors have found themselves on the frontline, working to keep up with the health demands of Covid-19 related cases, while managing existing patient needs.

Health workers, including those with direct patient contact (eg doctors, nurses, physiotherapists) and indirect patient contact (eg porters, cleaning staff, administrators) are at risk of infection from the coronavirus. In addition, they are also at risk from the psychosocial hazards associated with the longer working hours, psychological stress, fear of contracting Covid-19, fear of passing the infection to their families and of violence.

Health workers are most at risk in environments where precautionary, preventative and controlling measures are not well established to manage virus transmission and the psychosocial risks. Staff are also susceptible when caring for patients who are infectious but have not yet been diagnosed with Covid-19. There is significant literature reporting on the lack of suitable protective equipment for those providing direct patient care, the long hours staff are required to work, as well as the increased levels of stress and anxiety due to the unrelenting workloads.

Below is guidance for individuals at risk on minimising the risks to themselves, those within their wider working environments and the family they return home to after a shift. It must be noted that due to the evolving nature of the pandemic, controls will need to be reviewed on a frequent basis through the risk assessment process to address current local circumstances.

  • Allied health professionals
  • Ambulance service teams
  • Dental teams
  • Doctors
  • Health informatics
  • Healthcare science workers
  • Management
  • Medical Associate professions
  • Midwifery
  • Nursing
  • Pharmacy
  • Psychologists
  • Public Health workers
  • Wider Healthcare team

 


Changes in General and Administrative Measures

  • Appoint a designated leader on the prevention, control and preparedness effort. This is a way of ensuring clarity and consistency. 
  • Staff should be encouraged not to come to work if they are feeling unwell, have symptoms consistent with Covid-19 or have contact with a person who has tested positive and/or is             self-isolating. PCR testing can be conducted to determine if there is Covid-19 infection. 
  • Encourage and facilitate the use of lateral flow testing as a means of early detection of infection, especially in asymptomatic people.  
  • A Covid-19 risk assessment needs to be conducted and the outcome reported to all staff. The risk assessment should be easily accessible for reference purposes. Note that it may be necessary to complete an individual health risk assessment for a health care worker eg a worker who has existing health concerns.  
  • Create a Covid secure environment where workers can have some down time.  
  • All staff in a health care facility – not only health workers themselves – should be involved in ongoing training sessions. 
  • Ensure communication around hand and respiratory hygiene is made clear to staff, patients and visitors. Use additional posters as prompts.  
  • Visitors should be kept to an absolute minimum with records of all visits being kept to help with contact tracing. 
  • Equally, records of all staff providing care for Covid-19 cases should be maintained. 
  • All staff should be offered vaccination as a priority and informed waivers should be secured from those who refuse vaccination 
  • Ensure access to mental health and counselling services to manage the psychological impacts of working in these high-risk environments.

It is vital that bank, agency and locum staff follow the same deployment advice as permanent staff.


Triaging and Assessment

Triage of patients should be undertaken by telephone or online where possible and risk assessments, aimed at establishing a patient’s medical and travel history, undertaken immediately upon presentation at a health care facility. Screening for current symptoms and possible contact with a person suffering from Covid-19 is an important starting point and should be completed by the first person with whom the patient comes into contact. Record the outcomes of this screening.   

Before engagement with patients, it is important that all staff who have patient contact are kept abreast of the latest epidemiologic situation in their locality (regionally and nationally), as well as made aware of patient symptoms, precautionary measures, preventative measures and any other relevant risk related information. 

Surgical masks should be used by all patients showing any respiratory symptoms and face coverings should be used by all other patients and their care givers. 


PPE and Staff Uniform Clothing

PPE 

The correct PPE (eg respirators, masks, gloves, aprons, face shields) should be put on (donning) and removed (doffing) in a manner that minimises the potential for self-contamination and cross contamination. Health workers should be provided with additional training on the correct use of PPE in a pandemic situation.  

Standard disposable PPE (gloves, goggles, gowns and FFP2/3 respirators) should be used as a minimum to protect against droplet and airborne transmission of the virus. 

The recommended order for donning and doffing of PPE can be viewed in the videos.

Donning 

  • Gather correct PPE (ensure size is correct)

  • Sanitize hands

  • Put on gown/apron

  • Put on respirator

  • Put on face shield / goggles

  • Put on gloves

     

  • Now enter patient space

Doffing

  • Remove gloves

     

  • Remove gown/apron

     

  • Leave patient space

     

  • Sanitize hands

     

  • Remove face shield/goggles

  • Remove respirator

  • Sanitise hands

 

PPE Shortages

Where there are shortages, supplies should be prioritised for Aerosol Generating Procedures (AGP).   

The WHO recommends ‘the following temporary measures’ could be considered independently or in combination, depending on the local situation: 

  1. PPE extended use (using for longer periods of time than normal according to standards);
  2. Reprocessing followed by reuse (after cleaning or decontamination/sterilization) of either reusable or disposable PPE;
  3. Considering alternative items compared with the standards recommended by WHO.

For more information on PPE shortages, visit the WHO website.

Staff uniforms/clothes 

The appropriate use of PPE will protect staff uniforms from contamination in most circumstances. Health care facilities should provide changing rooms/areas where staff can change into uniforms on arrival at work and store their street clothes away from risk of contamination. 

Organisations may consider the use of theatre scrubs for staff who do not usually wear a uniform, but who are likely to come into close contact with patients eg non-medical staff. 

Health care laundry services should be used to launder staff uniforms. If there is no laundry facility available, uniforms should be transported home in a disposable plastic bag. This bag should be disposed of into the household waste stream. 

Uniforms should be laundered: 

  • separately from household linen
  • in a load not more than half the machine capacity
  • at the maximumtemperaturethe fabric can tolerate, then ironed or tumbled-dried. 

It is best practice to change into and out of uniforms at work and not wear them when travelling, although this is based on public perception rather than evidence of any infection risk. This does not apply to community health workers who are required to travel between patients in the same uniform. 


Risk levels based on tasks

Assigning a dedicated team of staff to care for patients in isolation/cohort rooms/areas is an additional infection control measure. This should be implemented whenever there are sufficient levels of staff available (so as not to have a negative impact on the care of non-affected patients). 

Staff who have had confirmed Covid-19 and recovered should continue to follow the infection control precautions, including use of PPE.  

The WHO has provided risk assessment insights for health workers based on their proximity to the patient, patient care and activities performed.  

Lower risk

Workers who are not required to make contact with people known or suspected of being infected with SARS-CoV-2 (eg tele-interviewing of infected patients or those suspected of being infected).   

Use face coverings in common areas.  

Medium risk 

Workers have close frequent contact with patients, visitors and co-workers but no contact with people known or suspected of being infected with SARS-CoV-2. They should wear medical masks and other PPE such as gloves, aprons and face shields based on risk of tasks.  

High risk 

Workers have high potential for close contact with those known or suspected of being infected with SARS-CoV-2 or contact with possibly contaminated objects and surfaces (fomites). Use of medical mask, gowns, gloves and eye protection are advocated with the use of standard universal precautions.  

Very high risk  

Working with Covid-19 patients where there is risk of exposure to aerosols containing SARS-CoV-2, in settings where aerosol-generating procedures are regularly performed and while working with patients indoors. The use of respirator (N95, FFP2 or FFP3), gown, gloves, eye protection and apron are advised. 


Domestic / cleaning staff performing environmental decontamination 

Any domestic or cleaning staff performing environmental decontamination should: 

  • Be allocated to specific area(s) and not be moved between Covid-19 and non-Covid-19 care areas. 
  • Be trained in which PPE to use and the correct methods of wearing (donning), removing (doffing) and disposing of PPE. 
  • Keep the care environment clean and clutter free. 
  • Remove all non-essential items including toys, books and magazines from reception and waiting areas, consulting and treatment rooms, emergency departments, day rooms and lounges. 

Cleaning of communal areas 

If a suspected Covid-19 case spent time in a communal area – for example, a waiting area or toilet facilities – then these areas should be cleaned with detergent and disinfectant (as above) as soon as practicably possible, unless there has been a blood or body fluid spill, which should be dealt with immediately. Once cleaning and disinfection have been completed, the area can be put back into use.


Additional resources 

For the latest changes in advice and guidance on national infection control for Covid-19 in health care settings please visit: COVID-19: Guidance for maintaining services within health and care settings - Infection prevention and control recommendations.

Advice for first responders (as defined by the Civil Contingencies Act) and others who as part of their normal activities may have close contact with persons who may have Covid-19. Guidance was updated 18 mar 2021

PHE COVID-19: personal protective equipment use for non-aerosol generating procedures includes guidance and video clips.

Covid-19: Occupational health and safety for health workers: guidance notes from the WHO to ensure protection of health workers.