PPE guidance updated (including changes for flu vac)

PPE guidance updated (including changes for flu vac)

August 24, 2020

The national COVID-19 infection prevention and control recommendations issued by the UK public health bodies were updated at the end of last week; this includes further changes to the recommendations on use of personal protective equipment (PPE), which will impact on community pharmacy service provision, including the flu vaccination Advanced service.

The guidance

Public Health England (PHE) and the other UK public health bodies, alongside the NHS, published the following guidance on Friday 21st August 2020:

COVID-19: Guidance for the remobilisation of services within health and care settings – Infection prevention and control recommendations

This supersedes the previous guidance issued on 18th June 2020 and separate advice on the use of PPE when administering vaccines, issued by PHE and NHS England and NHS Improvement (NHSE&I).

The infection prevention and control (IPC) principles in the guidance apply to all health and care settings, including acute, mental health and learning disabilities, primary care (including community pharmacies) and care homes.

The guidance says patients’ treatment, care and support is to be managed in three COVID-19 pathways:

High risk: There is no change in recommendations for IPC or for the use of PPE by staff when managing patients who have, or are likely to have, COVID-19.

Medium risk: This includes patients who have no symptoms of COVID-19 but do not have a COVID-19 SARS- CoV-2 PCR test result. Most patients visiting pharmacies will fall within this pathway.

Low risk: Patients with no symptoms and a negative COVID-19 SARS- CoV-2 PCR test who have self-isolated prior to admission to hospital.

In the guidance, sessional use of single use PPE items has been minimised and only applies to extended use of facemasks for healthcare workers.

The use of face masks (for staff) or face coverings is recommended (where face coverings are not legally required) in addition to social distancing and hand hygiene for staff, patients and visitors in both clinical and non-clinical areas to further reduce the risk of transmission.

Physical distancing of 2 metres is considered standard practice in all health and care settings.

Impact on use of PPE in pharmacies

The guidance does not change the previous recommendations for community pharmacy staff use of face masks as described below:

Interaction Circumstances PPE
Pharmacy staff interactions with patients Staff are working in an area with possible or confirmed cases and are unable to maintain 2 metres social distance from the patients. Sessional use of a Type IIR face mask (Fluid Resistant Surgical Mask). One session could be a half day period of time, with a new mask being used after a break from work.
Staff working in the pharmacy, e.g.  in the dispensary, with other colleagues The pharmacy is not COVID-19 secure, because staff cannot maintain a social distance from one another at all times.

A Type I or Type II face mask should be worn to prevent the spread of infection from the wearer.

If Type IIR face masks are more readily available, and there are no supply issues for their use as PPE, then these can be used as an alternative to Type I or Type II masks.

It does, however, change some of the guidance on wider use of PPE when providing direct care to patients. Previously, where direct care of potentially infected patients was provided, the general recommendation was for use of Type IIR masks, disposable gloves, disposable aprons and eye protection.

In the revised guidance, gloves and aprons are recommended when there is (anticipated) exposure to blood/body fluids or non-intact skin.

The guidance states that in some clinical settings, such as vaccination/injection clinics, where contact with individuals is minimal, the need for single use PPE items for each encounter, for example, gloves and aprons is not necessary. Staff administering vaccinations/injections must apply hand hygiene between patients and wear a sessional Type IIR mask.

The previous guidance on PPE to be used when vaccinating patients was use of a Type IIR mask and eye protection on a sessional basis and use of disposable gloves and aprons on a single use, changed between each patient.

Funding for PPE

PSNC is continuing to discuss with the Department of Health and Social Care and NHSE&I the way in which pharmacy contractors will be reimbursed for the cost of PPE purchased for use during the pandemic, including the PPE used when providing the flu vaccination Advanced service.

As soon as further information on this topic is available, we will share it with contractors.

 



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