PHW Advisory Note - Use of Personal Protective Equipment (PPE) in Social Care Settings (Care Homes and Domiciliary Care)

Scope and Purpose

The UK COVID-19 Infection Prevention and Control (IP&C) guidance has been developed jointly by  the Devolved Administrations (Public Health Wales on behalf of Wales) and  Public Health England (PHE), NHS England & NHS Improvement.

The Royal College of Nursing, other Royal Colleges and professional societies were also consulted.

The guidance is regularly reviewed and updated and should be checked to ensure that most up to date guidance is being followed.

Guidance on infection prevention and control for COVID-19. Sustained community transmission is occurring across the UK.

This resource provides guidance on the use of personal protective equipment (PPE) for care workers working in social care settings during this current period of sustained COVID-19 transmission in the community across the UK.

Implementing IP&C and PPE guidance within care homes and in domiciliary care

Guide to donning and doffing standard PPE

Colleagues working in domiciliary care will also find the above document helpful and should apply the same principles to their working environments.

See tables of recommended PPE for use in various scenarios in appendix 1.

General Advice in implementing PPE guidance in Social Care Settings

It is key that across Wales we ensure that PPE is used correctly and appropriately so that health and social care workers are protected. It is very important that in using the PPE specified and provided, that all social care staff have had the appropriate training to put it on (donning) and take it off safely (doffing) to ensure they do not inadvertently contaminate themselves on removal of PPE or when going between service user or resident.

Video on how to don and doff PPE in care home setting available here.

Outside of the clinical/care giving areas it is important that social distancing, hand hygiene (before moving out into communal areas) and  respiratory etiquette are used as the key measures for reducing transmission of the virus. Social care staff report immediately to their line manager before attending work with any symptoms suggestive of COVID-19. It is good practice to ask staff as they start their shift if they are well and have any symptoms.

Standard infection prevention and control precautions (SICP) must be applied in combination with the Fluid Resistant Surgical Mask (FRSM) and eye protection to protect the carer from the infection risk.

Careful attention to hand hygiene is required before contact with the service user, during doffing and after disposal of PPE. PPE can be contaminated in use and pose a risk to others if not removed and disposed of correctly.

Guide to donning and doffing standard PPE

It is also important to apply the rules on social distancing of 2m wherever possible. This could be in a person’s own home or in nursing and residential settings if no direct care is being given e.g. chatting or discussing their care.

Staff also need to maintain social distancing (remain at least 2 meters apart) between themselves, during their shift, handovers and during their breaks. If staff are travelling to work together they should adhere to advice on social distancing in the workplace

Coronavirus (COVID-19): employers and businesses guidance

Phone triage should be used whenever possible to ascertain if any of those in their own home are known or suspected to have COVID-19 and service users should be encouraged to notify any risks to their provider.

Social Care workers must be alert to any symptoms of infection during their visits or in their daily assessment within a residential or care home as the elderly may not present with typical symptoms of cough, and/or high temperature, and/or loss of, or change in, their normal sense of smell or taste – anosmia,  but may be displaying behaviour or other signs that they are unwell (especially in dementia patients).

PPE Practical Examples

The UK is currently experiencing sustained community transmission of COVID-19, therefore at present PPE is recommended for use by all social care workers when providing direct care (within 2 metres) to residents / service users.

If caring for residents or services users with possible or confirmed COVID-19, the required PPE is the same (FRSM, eye protection, gloves and apron) as per table 1 in appendix 1, with the following additional considerations:

  • Sessional use of masks / eye protection can still be considered, but should be for a “session” of work within an area with several positive patients if you have them – If you are only managing one positive case in an area, PPE should be removed in total when the resident / service user’s room is left.
  • If you have several cases / possible cases of COVID-19 infection within your home consideration should be given to cohorting affected residents and assigning staff to COVID-19 cohort areas or non-cohort areas as far as possible per shift.
  • Isolation precautions for the resident / service user – the resident / service user should remain in their own room, ideally with en-suite toilet / bathroom or a designated toilet / bathroom. Meals should be taken in their room and they should not leave the room for socialising and should not have visitors unless there are exceptional circumstances. Enhanced cleaning of their room / bathroom is recommended.

For all other resident / service user care, therefore, in addition to standard infection prevention and control precautions: PPE is recommended for use by all social care workers when providing direct care (within 2 metres) as follows:


Social Care workers in residential and nursing homes

Will be required to wear disposable single use gloves and aprons, the FRSM and eye protection can be sessional use e.g. providing ongoing care for a group of residents, medication round. The eye protection is used if there is likely to be splashes for example the resident is spluttering/coughing directly into the face of the carer. Hand hygiene as described above.


Social Care workers visiting people in their own home

Will be required to wear disposable single use gloves and aprons and the FRSM. The eye protection is used if there is likely to be splashes for example spluttering/coughing directly into the face of the carer. Staff must remove all PPE before leaving the house. Hand hygiene as described above.


Social Care workers visiting people at high risk (those under shielding guidance) in their own home

Will be required to wear disposable single use gloves and aprons and  FRSM . The aim here is to protect the highly vulnerable person from the staff as the vulnerable person is at high risk of serious illness if infected. If no direct care is given  a surgical mask must be worn (not FRSM) if within 2m.


Social Care workers visiting children in their own home

Will be required to wear disposable single use gloves, aprons and FRSM. The eye protection is used if there is likely to be splashes for example spluttering/coughing directly into the face of the carer. Staff must remove all PPE before leaving the house. Hand hygiene as described above

Eye Protection can be reused if it not marked as single use. This can be cleaned with the routine disinfectant wipes or solution used in the social care settings.


Guidance Tables for Social Care

Best Practice: how to hand rub

Best Practice: how to hand wash

Appendix

When providing personal care which requires you to be in direct contact with the resident(s) (e.g. touching):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When performing a task requiring you to be within 2 metres of resident(s), but no direct contact with resident(s) (i.e. no touching)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When working in communal areas with residents- no direct contact with resident(s) though potentially within 2 metres of resident(s)