Sustained Transmission

COVID-19 is circulating highly in the community (as confirmed by Public Health England (PHE) on 12 April 2020), and the likelihood that any service user receiving care having coronavirus infection is raised.

Therefore as detailed in Table 4 of the COVID-19 infection prevention and control national guidance, PPE, for ALL DIRECT CARE patient encounters, within 2 metres, should be worn for clients with or without symptoms of COVID-19. This guidance should be read in conjunction with the ‘How to work safely in care homes‘ guidance (also relevant for those providing residential supported living). Simply put… DIRECT CARE includes providing personal care, hoisting, assisting in the toilet, tooth brushing, assisting with eating etc. NON-DIRECT CARE means generally assisting someone to stand up (when not hoisting), walk, participate in activities, medication rounds, meal rounds etc.

If you are providing DIRECT CARE you will be within 2 meters of an individual so you will need Gloves, Apron, Fluid Resistant Mask
If you are working within 2 metres of an individual but NOT providing direct care, you will only need a mask (see Table 1 for which type)
If you are working outside of 2 meters of an individual, you do not require PPE
.

Note for:

1. Specific Residential Guidance

In Residential settings if uniforms are worn: It would make sense to try to ask staff to change into uniform when they arrive at work and change out of it when they leave as this will keep contamination down to a minimum.

2. Specific Homecare Guidance

Masks In Homecare:

Guidance recommends you use face masks continuously until you need to remove it (e.g. to drink, eat, take a break from duties, or to travel on public transport), both to reduce risk to you and to make it easier for you to conduct your usual work without unnecessary disruption. You may wear the same face mask between different homecare visits, if it is safe to do so whilst travelling.

This includes travelling between households on foot or by car or by public transport, so long as you do not need to take the mask off, or lower it from your face. You should not touch your face mask. You can wear the same face mask between clients whether or not they have symptoms of COVID-19.

When you take a break or otherwise need to, you should remove your face mask and eye protection and replace it with a new face mask for your next duty period. You must ensure your eye protection it is appropriately cleaned when you remove it/ before next use. There may be circumstances that you would need to remove and replace your face mask or eye protection before your break or you otherwise feel you need to” This has now added to p8 of the Hertfordshire Public Health Guidance.

Aprons and Gloves In Homecare: These are single use and should be worn if staff are going to within 2 metres of the person and providing Direct Care. They should be changed each time they enter the persons house (please ensure staff do not wear aprons and gloves for travel and only put on when they enter the person’s house.

The Government Homecare Guidance is clear and has some interesting case studies which may help – you can find these here

The document explains in summary:

	PPE					Additional items
Scenario – For Sustained Transmission Period Staff providing	Disposable gloves	Disposable plastic apron	Surgical mask	Fluid repellent* surgical mask (FRSM)	Eye protection (single use if available)⁴	Disposable bags (for any waste)	Hand hygiene
Direct care to WELL (NON-symptomatic) service users
Direct care^1a to well service users	✓ single use⁶	✓ single use⁶	x	✓ sessional use⁷	✓ risk assess⁵ or sessional⁷ use	✓	✓
Direct care^1a to very vulnerable² service users or visiting households with very vulnerable² service users	✓ single use⁶	✓ single use⁶	x	✓ sessional use⁷	✓ risk assess⁵ or sessional⁷ use	✓	✓
Direct care to SYMPTOMATIC³ service users
Direct care^1a to symptomatic³ service users or direct care^1a to any member of the household where any member of the household is symptomatic³	✓ single use⁶	✓ single use⁶	x	✓ single⁶ or sessional⁷ use	✓ risk assess⁵ or sessional⁷ use	✓	✓
Performing aerosol generating procedures on any service user	✓ single use⁶	✓ single use fluid repellent overall gown⁶		✓ single use filtering face piece respirator⁶	✓ single use⁶	✓	✓
NON direct care^1b to all service users (symptomatic or non-symptomatic)
Working in an area (home/room) with all service users (symptomatic or non-symptomatic) and 2 metres maintained	x	x	x	x	x	x	x
Working in an area (home/room) with all service users (symptomatic or non-symptomatic) and unable to maintain >2 metres e.g. assisting someone to stand up (when not hoisting), walk, participate in activities, medication rounds, meal rounds etc	x	x	x	✓ sessional⁷ use	✓ risk assess⁵ or sessional⁷ use	✓	✓
Working in the same room as all service users (symptomatic or non-symptomatic) and unable to maintain >2 metres e.g. communal rooms, reception. For Homecare e.g. assisting with Medication, delivering meals etc	x	x	✓ sessional⁷ use	x	x	x	✓
Cleaning areas where symptomatic³service users (symptomatic or non-symptomatic) have been	✓	✓	x	x (risk assess⁵ for body fluids)	x (risk assess⁵ for body fluids)	✓	✓

» Read the full guidance here * Type-IIR or EN14683 tested & CE marked