Infection control

COVID-19 health, safety and wellbeing

Employees may well be concerned about the risk of infection. 

Staff should not attend work if they have symptoms of COVID-19, or if they live with someone who has symptoms. Employers should ensure their staff are kept informed of the latest infection control guidance and adhere to hand washing and PPE protocols. 

Employers should actively keep 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

Staff with symptoms of COVID-19

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 

Uniform and workwear

Staff with symptoms of Covid-19

If a member of staff develops symptoms of COVID-19, they should: 
  • follow the stay at home guidance
  • while at home (off-duty), they should not attend work and notify their line manager immediately
  • while at work, they should put on a surgical face mask immediately, inform their line manager and return home
  • arrange, through their organisation, to have a test.

NHS staff - COVID-19 testing

NHS England and NHS Improvement has asked NHS trusts to ensure they are utilising the maximum testing capacity and, where possible, share this testing facility with neighbouring acute trusts, ambulance trusts, community, mental health, primary care and social services. They also 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. 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.

In a letter dated 24 April, the Department of Health and Social Care shared details with employers on COVID-19 testing for essential workers. To supplement the capacity for NHS testing, employers can register and refer staff for tests 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 the online booking service

Employers can access the 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

Positive test results

Staff members who test positive should follow government guidance to self-isolate. Where a member of staff tests positive, organisations should consider the need to make a RIDDOR report, supported by this decision-making flow chart and following the Health and Safety Executive (HSE) RIDDOR guidance.

As the RIDDOR guidance was published prior to the pandemic, the HSE has produced further guidance on RIDDOR reporting of COVID-19, which will help to determine if you need to make a report and provides some principles to use when assessing the information available and making your judgement. 

Symptomatic staff who test positive or who have an inconclusive test result, can return to work:

  • no earlier than ten days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
  • if a cough or loss/change of smell (anosmia) or taste is the only persistent symptom after ten days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases).

NHS Test and Trace

In line with the Test and Trace guidance, staff should inform their line manager and self-isolate for 14 days, if they have been notified that they have been in contact with either:

  • a person who has a confirmed case of COVID-19 in the community (outside the health or social care setting or their place of work)
  • a co-worker who they had contact with while not wearing PPE.

Staff exposures in the workplace

In line with government advice, a risk assessment should be undertaken in conjunction with local infection prevention and control policy to assess whether a staff member has had breach of PPE whilst providing care to a patient with confirmed or suspected COVID-19. If the risk assessment concludes there has been a significant breach or close contact without PPE, the staff member should self-isolate for 14 days. More information about the considerations employers should take in account when undertaking risk assessment of staff and examples that are unlikely to be considered breaches of PPE can be found in the full government guidance.  

This advice should be followed regardless of the results of any SARS-CoV-2 antibody testing. 

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:

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. 

Uniform and workwear

NHS England and NHS Improvement have published revised guidance for employers on uniform and workwear for NHS staff to support the drive for a more inclusive and culturally responsive NHS. It addresses the interaction between infection control requirements relating to uniform and workwear and the public sector Equality Duty, with specific consideration given to the needs of faith groups. 

Employers can also access a range of resources including good practice examples, blogs and infographics. These can be used in conjunction with the guidance to support employers in developing policies on appropriate dress codes that respect the needs of faith groups whilst maintaining safe infection control standards. 

 

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