THE Government’s COVID-19 UK wide infection control guidelines for protecting patients and NHS staff are “flawed and need replacing”, a report commissioned by the Royal College of Nursing says.
The report, written by independent experts, analysed a literature review which underpins those guidelines.
It found that this review met just four of the 18 criteria the experts deemed essential for a review of its kind.
Crucially, it concluded the review failed to consider a key way the virus is transmitted – airborne infection – about which growing evidence has emerged during the pandemic.
For these reasons, the experts concluded the review provided only a “superficial account” of the available COVID-19 evidence. It added that the Government’s guidelines based on the review were in turn “fundamentally flawed and need replacing”.
In their report, the authors Professor Dinah Gould, an Honorary Professor of Nursing at London’s City University, and Dr Edward Purssell, also from City University, said: “UK IPC guidelines to prevent the spread of Covid-19 in health care settings and the rapid reviews of the literature on which it was based still identify droplet spread and hands as the major route, based on early advice from the World Health Organization (WHO).
“Updated evidence indicates that aerosol spread is much more significant and the original advice from the WHO has been superseded. The UK guidelines are still based on this outdated evidence, however. They urgently need thorough revision and replacing.”
The UK government’s guidelines omit detail on the importance of ventilation and say that higher-grade personal protective equipment must only be provided in certain high risk settings like intensive care but that it is up to individual health trusts to decide whether or not to provide them more widely to other staff.
This has caused huge concern among nursing staff, especially with the emergence of highly-infectious new COVID-19 variants
Some feel given the lack of action on ventilation in UK hospitals that the standard PPE, which includes the basic surgical masks currently advised even for close contact, are inadequate and that the Government’s failure to provide higher-grade PPE – known as FFP3 – to all NHS staff is putting lives at risk.
That includes nursing staff working in the community, who are treating COVID-19 patients in their own homes.
Airborne transmission – where tiny droplets of saliva from people talking, calling out or coughing can remain suspended in the air – can be a particular problem in poorly-ventilated rooms, research suggests. The Government has even issued guidance on the importance of ventilation in indoor spaces but is failing to act on hospitals.
One community nurse who works at a trust in England said: “I’m at my wits’ end. I’ve had Covid-19 before and really don’t want to get it again.
“I’ve got FFP3 face masks but my trust won’t let me wear them. They say either wear the standard surgical mask or you can’t work. I don’t want to leave nursing – I love my job – but I don’t want to catch COVID-19 either.”
Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing, said: “This nurse is raising the alarm on behalf of countless others. We have been battling this pandemic for more than a year now. 'Following the science’ is a hollow boast when we have evidence showing the flaws.
“The report and its findings must launch an official review and not be swept under the carpet as an inconvenience.
“Health care workers need to know everything possible is being done to keep them protected. It is inadequate to say they have masks if they aren’t fit for purpose. Staff are scared for themselves and their families and left any longer it’ll turn to anger.”
The RCN has repeatedly tried to engage the Government on this issue, including by writing to the Prime Minister Boris Johnson.
It is calling for all NHS staff to be given the higher-grade PPE pending the outcome of a review. The experts’ report lends more weight to that argument, it argues.
The 18 criteria Prof Gould and Dr Purssell considered in their analysis is based on the World Health Organisation’s advice and included whether or not they was a clear explanation of how the literature chosen for review was selected; stakeholder involvement; whether it was multi-disciplinary; and whether engineering, maths and physics experts were involved for their insight on airflow.
They said that there were around 200,000 articles relating to COVID-19 which could have been part of the review, but which weren’t. The review was first done by Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland in March last year.
The ARHAI Scotland review has been updated throughout the pandemic – the 11th iteration was last month (February) – but it has focussed throughout on the two principal ways of passing on the virus identified at the start of the pandemic, the experts said.
Figures compiled by the RCN show that by the end of January at least 988 UK health and social care workers had died in the pandemic, with the number now likely to be far higher. This does not include deaths in Northern Ireland, where no data was available (see notes to editors).
It is highly likely that some of these staff will have caught COVID-19 at work.
Ends
A copy of the report is available here.
