PPE, Infection Prevention and Control

THIS SECTION CONTAINS PRE SESSION ACTIVITIES WHICH SHOULD BE COMPLETED PRIOR TO THE FACE TO FACE SESSION

What you need to do:

We have collated a range of resources to help you understand essential infection prevention and control principles, to protect yourself and others during your Placement.

Prior to the face to face session:

1. Please take some time to update yourself on current guidance and engage with Sections 1 - 3 below before viewing the web-tutorial.

2. View the web-tutorial.

3. Complete Section 4 as pre sessional work prior to the face to face session

During the face to face sessions we will be:

• Discussing how to protect yourself and ensure you are safe

• Strategies for identifying risk and communicating concerns

• Practice the sequence of donning and doffing as part of other sessions. Please note: equipment may vary across different Placement areas and what is used in the face to face session may vary from this.

After the face to face session:

• Please review Section 5 and complete the remaining activities to check your understanding of the section content

• Familiarise yourself with the additional links and resources provided

Recent information published by Public Health England tells us that that COVID-19 viruses are likely to be present in all body secretions and excretions except sweat, so it is important to treat these as potentially infectious. At present there is still relatively little known about COVID-19 transmission and research is required to determine whether it is spread by individuals before they become symptomatic or when they are asymptomatic.

In healthcare settings there are things that we can do to reduce the risk of transmission of COVID-19.

These include:

• Follow NHS advice on self-isolation and social distancing

• Hand hygiene

• Encouraging staff, patients and visitors to follow respiratory and cough hygiene advice

• Use of PPE (see detailed information in the section on practising the correct donning and doffing techniques for PPE)

• Environmental and equipment decontamination

• Managing infected waste as per placement area policy

• Managing infected linen as per placement area policy

• Following your placement area policy for uniform and infection control. You may be asked to wear scrubs instead of your SHU uniform and these should be left to be cleaned at your placement if possible. Infection Control and Uniform policy may vary so it is important that you contact the Placement to ask what you should wear.

For example, if a patient has a tracheostomy and you will be close to them whilst an open suction procedure of their airway takes place this is classed as an aerosol generating procedure, but if you are involved in altering the position of a patient to prevent skin pressure this would usually be a non-aerosol generating procedure. PPE must be available for you in every clinical area where there may be patients with COVID 19. Putting PPE on is known as donning and taking it off is doffing.

Please note that the information below is taken from national guidance and it is advised that you also check the Placement area guidelines.

Donning and doffing procedures can be categorised into (taken from up to date Public Health England’s full guidance on PPE)

1. Aerosol generating procedures (AGP)

These include:

• intubation, extubation and related procedures, for example manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)

• tracheotomy or tracheostomy procedures (insertion or open suctioning or removal)

• bronchoscopy and upper Ear Nose and Throat (ENT) airway procedures that involve suctioning

• upper gastro-intestinal endoscopy where there is open suctioning of the upper respiratory tract

• surgery and post mortem procedures involving high-speed devices

• some dental procedures (for example, high-speed drilling)

• Non-Invasive Ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)

• High Frequency Oscillatory Ventilation (HFOV)

• induction of sputum (cough)

• High Flow Nasal Oxygen (HFNO)

2. Non-aerosol generating procedures

If you are required to wear a FFP3 mask you will need a fit test to ensure that you have the correctly sized mask. This will need to be done in advance by a specially trained professional.

For full guidance please see Public Health England guidance.

Single use vs sessional use

Single use items include disposable gloves and aprons which must be disposed of between interventions with a patient and between different patients.

Sessional use items of PPE can be used between different patients. For example, if you are working in a bay of patients who are all positive for COVID-19, you can use the same surgical face mask or visor between patients. This does not need to be changed until you leave the room or bay area.

For full guidance on single and sessional items of PPE in the acute setting please click here for Public Health England guidance. It is important you do this an items that may be for sessional use in a ward area (such as a fluid-repellent surgical gown) may be for single use in an area where there are AGPs. Please check the PPE items for the clinical area that you will be working in.

Click here for Public Health England guidance on PPE for community, primary care and outpatient settings.

Recent updates in PPE guidance

Face Masks

The Government has recently recommended that all hospital Trusts in England ensure that all clinical and non-clinical staff, as well as any visitors or patients outside of ward areas, wear a face mask or face covering when entering a hospital building. In a care setting you will be required to wear a fluid resistant surgical face mask which helps to prevent the transmission of droplets from person to person. You will be asked to socially distance by 2 metres at break times when getting changed (when face masks are not worn).

Eye protection

Please note that you may be advised to wear a visor or goggles if you are having prolonged contact with any patient, such as carrying out personal cares. This is regardless of whether the patient is suspected of having COVID-19 or not. The guidelines for this may vary between Trusts so please check your local guidance.

“Health and social care workers should consider the need for contact and droplet precautions based on the nature of care or task being undertaken. Risk assessment on the use of eye protection, for example, should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the care episode. Sessional use of FRSMs and eye protection is indicated if there is perceived to be close or prolonged interaction with patients in a context of sustained community COVID-19 transmission.” Taken from Public Health England’s full guidance on PPE.

NMC statment on PPE shortages

National PPE shortages have made headline news in recent months. If you require further information about this please see the NMC's statement on PPE.

This section will focus on essential preventative measures you need to follow as students placed in areas that may have patients with COVID 19. Please have a good look at the information within this section in preparation for the face to face session.

This will be a potentially dangerous environment and so you must fully protect yourself and avoid any likely cross contamination. When caring for your patients you need to wear the right Personal Protective Equipment (PPE) taking account of the sort of procedures you might be doing or witnessing. For example if a patient has a tracheostomy and you will be close to them whilst an open suction procedure of their airway takes place this is classed as an aerosol generating procedure, but if you are involved in altering the position of a patient to prevent skin pressure this would usually be a non-aerosol generating procedure. PPE must be available for you in every area where there may be patients with COVID 19; putting this on is donning and taking it off is doffing.

Please note that the information below is taken from national guidance and it is advised that you also check your placement area guidelines.

Donning and doffing procedures can be categorised into (taken from up to date Public Health England’s full guidance on PPE )

1. Aerosol generating procedures (AGP)

These include:

• intubation, extubation and related procedures, for example manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)

• tracheotomy or tracheostomy procedures (insertion or open suctioning or removal)

• bronchoscopy and upper Ear Nose and Throat (ENT) airway procedures that involve suctioning

• upper gastro-intestinal endoscopy where there is open suctioning of the upper respiratory tract

• surgery and post mortem procedures involving high-speed devices

• some dental procedures (for example, high-speed drilling)

• non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)

• High Frequency Oscillatory Ventilation (HFOV)

• induction of sputum (cough)

• high flow nasal oxygen (HFNO)

2. Non-aerosol generating procedures

Except for sweat, all body secretions and excretions are thought to be infectious for COVID-19. It is therefore essential to follow local and national guidance for the correct sampling, labelling and packaging of all potentially infectious samples in healthcare settings. Taking samples from a patient known or suspected to have COVID-19 presents an infection risk to anyone handling the sample. Below you will find a video detailing how to process and send a sample for testing in a Public Health England Laboratory. Some Trusts may offer in-house testing for samples and it is important to ensure that all potentially infectious samples are labelled as per the placement area policy.

Sampling from patients with confirmed or suspected COVID-19

The principles are relevant to all samples taken from a patient with suspected or confirmed COVID-19 but local policy may differ. It is generally recommended that you:

• Take printed labels and bags with you to the patient’s room or bay so that these can be stuck to the sample without having to remove the sample from the patient’s room or bay, as this will increase the risk of infection spread. If the placement area policy requires you to write on the sample do this before you enter the room or bring a pen with you that will be left in the room.

• Ensure that lids are tightly in place on the sample.

• Decontaminate the sample pot or bottle once the sample has been taken away from the patient, but still in the patient’s room. If you have another member of staff with you, they can do this.

• Change your gloves.

• Place the sample in a zip-lock bag and seal.

• Once you have left the room immediately place the sample and bag within a second bag.

• Ensure that forms or stickers are with the sample as per local policy. It is often advised that these are outside the second bag.

• Make sure all details are completed, patient details are correct and that there is a contact number for patients to receive their results if they are not inpatients.

Testing for COVID-19

There are 3 ways in which samples can be obtained for COVID-19 testing. (Full guidance can be accessed here from the Public Health England website).

1. Upper respiratory tract sampling: preferably both a throat and nose swab combined but a nose swab is acceptable if it is not possible to obtain a throat swab. A nasophayngeal aspirate can also be tested.

2. Lower respiratory tract sampling: sputum.

3. Tracheostomy or laryngectomy stoma site swabbing.

**Ensure that you wear appropriate PPE, including the required face mask and visor or goggles, when sampling for COVID-19 testing.**