Infection control

COVID-19 health, safety and wellbeing

Employees may well be concerned about the risk of infection. These clear, simple communications reinforce the key steps everyone should be taking and should be regularly and consistently communicated.

  • You should follow PHE’s guidance to stay at home and only leave the house for one of four reasons:
    - travelling to and from work, but only where this absolutely cannot be done from home
    - shopping for basic necessities such as food and medicine, which must be as infrequent as possible
    - any medical need, or to provide care or to help a vulnerable person
    - one form of exercise a day, for example a run, walk, or cycle – alone or with members of your household.
  • If you have symptoms of COVID-19 infection, however mild, stay at home and do not leave your house for seven days from when your symptoms started. Follow PHE’s advice on self-isolation. Do not go to a GP, pharmacy or hospital. You do not need to contact NHS 111 to tell them you’re staying at home.
  • If you live with others and you are the first in the household to have symptoms of COVID-19, then you must stay at home for seven days, but all other household members who remain well must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill.
  • It is likely that people living within a household will infect each other or be infected already. Staying at home for 14 days will greatly reduce the overall amount of infection the household could pass on to others in the community
  • Wash your hands more often than usual, for 20 seconds, using soap and hot water, particularly after coughing, sneezing and blowing your nose, or after being in public areas where other people are doing so. Use hand sanitiser and moisturiser if that is all you have access to.
  • To reduce the spread of germs when you cough or sneeze, cover your mouth and nose with a tissue and throw the tissue away immediately. If you don’t have a tissue, cough or sneeze into your elbow (not your hands). Then wash your hands or use a hand-sanitising gel.
  • Clean and disinfect regularly touched objects and surfaces using your regular cleaning products to reduce the risk of passing the infection on to other people.

Employers should ensure they are actively keeping informed of the latest guidance and advice issued by the government, Public Health England and the Department of Health and Social Care alongside advice from local infection prevention and control specialists.

See the Gov.uk website for guidance on COVID-19 infection prevention and control and read the stay at home guidance for further information.

Contents of this section

NHS staff - COVID-19 testing

NHS staff - hotel accommodation

Personal protective equipment (PPE) for staff

Heat stress and PPE

Update on supply of PPE 

Advice on requiring staff to shave off facial hair and fitting PPE 

NHS staff - COVID-19 testing

To maximise the numbers of NHS staff who are able to stay well and at work, COVID-19 testing is now being rolled out.

In a letter dated 24 April, the Department of Health and Social Care shared details with employers on COVID-19 testing for essential workers. From now on, employers can register and refer self-isolating staff through an employer referral portal. The first step is to request access to the portal by emailing: portalservicedesk@dhsc.gov.uk

Staff can also directly book tests for themselves and their household through a new online booking service. This will make the process of getting an appointment quicker and easier, while reducing the burden on employers. 

Employers can access the full letter and resources, including posters and digital banners, to help promote the online booking service to staff from the Coronavirus Campaign Resource Centre.  More information on how to access testing through the online booking service and who is eligible can be found in the full guidance

In a letter from Pauline Philip and Sarah Jane Marsh on 12 April 2020, NHS trusts have been asked to increase testing of staff and the people they live with who have symptoms of COVID-19. Testing should take place within three days of symptoms appearing. If a staff member tests negative, they should return to work. If an individual living in the same household as an NHS staff member tests negative then the NHS worker can return to work without themselves being tested.

Staff members who test positive should follow government guidance to self-isolate. Organisations should follow the Health and Safety Executive (HSE) RIDDOR guidance where a staff member tests positive which includes details of when you should make a COVID-19 report under RIDDOR. There is a useful flowchart on the sickness absence web page that sets out the process and requirements.

In a letter dated 1 April, NHS England and NHS Improved asked NHS trusts which host labs capable of Covid-19 testing to ensure they are utilising the maximum testing capacity, and where possible sharing this testing facility with neighbouring acute trusts, ambulance trusts, community, mental health, primary care and social services. 

In a letter dated 29 March, NHS England and NHS Improvement asked that staff members who work in priority areas including those in critical care, emergency departments and ambulance services, should be tested first. Organisations should also prioritise testing for staff members from priority areas who are not at work due to household self-isolation measures. 

NHS staff – hotel accommodation

To ensure that staff are supported, and as promised in the letter from Sir Simon Stevens and Amanda Pritchard on 17 March, all staff affected by PHE’s 14-day household isolation policy should, on an entirely voluntary basis, be offered the alternative option of staying in NHS-funded hotel accommodation while they continue to work. 

NHS England and NHS Improvement have now published guidance and a single process for NHS staff to secure accommodation locally. NHS organisations can request access to the central hotel booking system and make bookings online on behalf of their staff. 

Employers are encouraged to refer staff and colleagues to this guidance and process, which will be updated over the coming weeks.  

Personal protective equipment (PPE) for staff

PPE is used to protect the user against health or safety risks at work. PPE is used as a last resort when there are risks that cannot be adequately controlled in other ways. Employers have duties concerning the provision and use of PPE at work and must comply with the requirements of the relevant regulations. You should liaise with your internal local lead for PPE regarding the regulations and local procedures and refer to the PHE guidance on infection prevention and control.

Recent updates to the national PPE guidance include:

  • Recommendations for PPE use in a wide range of different health and social care settings.
  • Use of risk assessments to inform PPE use, including giving staff the choice to use PPE where they feel they are at risk.
  • A recommendation for patients to wear a fluid-resistant (Type IIR) surgical face mask (FRSM) if this can be tolerated and would not compromise clinical care.
  • An agreement from the Health and Safety Executive that coveralls can be used as an alternative to surgical gowns in some circumstances.

The regulations require that PPE is:

  • properly assessed before use to make sure it is fit for purpose
  • maintained and stored properly
  • provided with instructions on how to use it safely
  • used correctly by employees.

Organisations should review PPE equipment to ensure adequate supplies are available, fit testing and training for use has been undertaken, and staff who are caring for patients are fully up to date with infection prevention measures, including the donning and doffing of PPE.

The Health Safety Executive state where respiratory protective equipment (RPE) is used, it must be able to provide adequate protection for individual wearers. Fit testing will ensure that the equipment selected is suitable for the wearer.

The HSE's guidance on respiratory protective equipment (RPE) fit testing provides information on fit test methods, information on what can be achieved from a fit test; and the core information to be included in a fit test report.

NHS England has produced guidance on helping prevent facial skin damage beneath personal protective equipment which is useful for supporting your staff who wear PPE.

Organisations will have a clear process in place to enable staff to raise any concerns about PPE. Staff should be encouraged to continue to use established incident reporting procedures (for example Datix) alongside occupational exposures being reported to the HSE via RIDDORto enable the required action to be taken to ensure the safety and wellbeing of the workforce and patients.

HSE’s Workplace health, safety and welfare guidance say adequate space should be provided to store workers’ own clothing and special clothing and changing facilities should also be provided for workers who change into special work clothing. 

Some NHS trusts have provided material bags and installed portable shower facilities so staff can shower after they finish a shift and before they travel home.  The uniform is then put into a material bag and placed in the washing machine at home to prevent the spread.  This has helped relieve anxieties of staff who feared they were transferring germs from the workplace to home.

 

Heat stress and PPE

Heat stress can be a real risk threat to NHS staff that wear PPE in their role.  It is important that employers need to know what to do to protect staff from heat stress in the workplace. 

Heat stress occurs when the body’s means of controlling its internal temperature starts to fail.  Heat stress can affect individuals in different ways, and some people are more susceptible to it than others.  

HSE's guidance, Heat stress in the workplace, includes information about the risks to the body from overheating, gives practical guidance on how to avoid it and what you need to consider when carrying out risk assessments with your staff.

 

Update on supply of PPE

Employers should ensure they have adequate supplies of PPE and keep up to date with the latest advice on the supply of PPE from NHS England and NHS Improvement. The most recent letter from Professor Stephen Powis, Yvonne Doyle and Carrie MacEwan outlines the steps NHS England and NHS Improvement are taking to improve the PPE supply chain. 

Organisations can report supply issues by contacting the 24/7 NHS Supply Disruption Line on 0800 915 9964 or supplydisruptionservice@nhsbsa.nhs.uk.

Advice on requiring staff to shave off facial hair and fitting PPE

NHS organisations are facing an emerging issue with PPE, specifically face masks. In order to be effective, FFP3 type face masks have to form a seal to the face. Face masks can often not be used correctly which is why fitting/fit testing is required to ensure they are being used effectively.

Beards, stubble and facial hair cause a common problem when using PPE face masks, as this can prevent the mask being able to seal to the face and passing the fit test. Employers should talk with relevant staff and may want to engage with local faith groups when agreeing their approach to this issue. As the outbreak continues, there is a significant increase in the numbers of staff who need to wear the mask, and those who need to be trained and ready to wear them.

There are alternatives to masks that can be provided where required, which are hoods or helmets. These are more expensive than face masks and would require a couple of hours’ training, which may mean it is not a feasible solution depending on the circumstances and numbers of staff involved.

In the first instance, employers should explain their concerns to those staff required to use PPE and the risks associated with having facial hair and ask staff if they would be willing to be clean shaven to eliminate any risks. It may be helpful to include staff side in these conversations. Any concerns employees have should be discussed with their manager, getting further support from occupational health if required to fully understand any concerns and personal circumstances that may need to be taken into account. There are many reasons why an individual may not want to follow this request, which would need to be explored. Where required, alternative solutions should be explored to ensure staff are being supported as much as is reasonably possible. This might include other forms of PPE if available or working in areas of less risk.

Where a voluntary approach is not accepted, employers will need to consider the implications of requesting staff be clean shaven and whether this is proportionate. For example, it may be appropriate to redeploy clinical staff to non-clinical area. You may want to consider the following:

  • The request could indirectly discriminate some employees by applying a provision, criterion or practice (PCP) that may disadvantage those of certain religions and/or faiths when compared to others.
  • An assessment should be made as to which areas this applies (for example, emergency departments and COVID-19 treatment centres) and the numbers of those potentially affected by the requirement to shave.
  • If the number is low, can alternative hooded/helmet PPE be provided and is the cost and training proportionate?
  • Is there a legitimate business need to insist that employees be clean shaven (prevention of the spread of virus/public health priorities) and is the requirement a proportionate means of achieving the aim? Where this is the case, a local approach should be agreed and implemented consistently, in line with risk assessments.

These are exceptional circumstances as the UK tries to contain the virus and employers do their best to protect the health, safety and wellbeing of staff and patients. 

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