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
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:
|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 care1a to well service users||✓ single use6||✓ single use6||x||✓ sessional use7||✓ risk assess5 or sessional7 use||✓||✓|
|Direct care1a 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 care1a to symptomatic3 service users or direct care1a 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 care1b 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 symptomatic3 service 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