Webinar: PPE Guidance for homecare providers with Claire Sutton of National Care Forum

At Birdie, we’re dedicated to helping home care providers to deliver the best care - to help us reach our goal of improving the lives of 1 million older adults by 2023. Never before has our mission been so important. And that’s why, in light of COVID-19, we’ve been running regular webinar sessions, to help care providers to access the information they need to deal with the challenges that lie ahead. 

During our last webinar with Hasbury Home Care Services, we noticed that much of the Q&A was around PPE. Notably, how to get hold of it and how to use it.

Now, while we at Birdie don’t, unfortunately, have the powers to send you all PPE for your staff and we may not have all the answers, we’re actively pushing for solutions. Our newest joiner Malte, who was former head of strategy and intelligence at the CQC, is leading the COVID response on our side and we’re actively lobbying for help for our care agencies and encouraging national organisations to centralise data collection. There’s still a lot of uncertainty around PPE, and there is no quick fix, but by talking about it more and sharing ideas we can all hopefully move forward and find solutions, together.

The guidelines can be confusing, and there’s a lot of misinformation out there - that’s why we invited Claire to talk with us about the correct uses of PPE in a care setting. Read on for a full write up of the interview, or watch the video here.

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First, get to know our guest speaker, Claire Sutton:

Claire Sutton is one of the digital transformation leads at the National Care Forum. She’s also a registered nurse and has worked in social care as well as working in technology, which is how she came to be working at NCF. The National Care Forum are the membership organisation for not-for-profit adult social care providers and they’re also part of the Care Provider Alliance which is a wider group of membership bodies that represent lots of different aspects of social care - including UKHCA which many of you will know and may be members of. 

“If care providers are struggling to get hold of PPE, where should they go? Or who should they be talking to?”

The recommendation is to try and source your PPE through your normal providers. The issue is that within home care and care home settings, you may not have been ordering in a lot of PPE before, and some of the PPE that you’re being asked to use is not something you’d necessarily be ordering.

The official hotline and contact point is below - and even if you were previously not an NHS supply chain customer, you can get in contact through the methods below:

• PPE Hotline (NHS Supply Chain customers)
• @: supplydistributionservice@nhsbsa.nhs.uk
• P: 0800 915 9964 

The latest guidance sent on 2 April included some more channels and routes to try, however, we’re aware that often home care providers are being ‘sent round in circles’ when trying to get hold of PPE while supply chains are rerouted to the NHS. 

UKHCA provided this guidance:

There’s still a problem with inadequate supplies of face masks and other basic PPE. We’re aware that the four suppliers listed in the letter from DHSC yesterday are either not answering calls/emails or are not taking on new customers.
We’re going through the offers we have received for PPE, with help from our partners, Marr Procurement Limited and Brosch Direct. This includes offers from members of the British Healthcare Trades Association (BHTA) who have a Code of Conduct. We will share with United Kingdom Homecare Association Ltd (UKHCA) members in due course. Just to manage expectations, PPE is in generally short supply at present and quick fixes at scale are challenging.

We know that this is a massive challenge. And one we can’t solve on a webinar. But we at Birdie and the National Care Forum are working with organisations to create centralised data around this. 

“Can you explain the types of PPE available? And what care providers will receive, if they haven’t already?” 

Initial deliveries should have been 300 fluid repellent masks. The government used their pandemic stockpile to send these to regulated care providers.

The guidance changed as of 1 April. The changes were specifically about the types of PPE available and when to use these. 

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The main changes (as outlined on gov.uk) are:

• enhanced PPE recommendations for a wide range of health and social care contexts
• inclusion of individual and organisational risk assessment at local level to inform PPE use
• recommendation of single sessional (extended) use of some PPE items
• re-usable PPE can be used. Advice on suitable decontamination arrangements should be obtained from the manufacturer, supplier or local infection control
• guidance for when case status is unknown and SARS-CoV-2 is circulating at high levels
• recommendation on patient use of facemasks

The full table can be found here. (Table 2)

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We discussed what this means during the webinar, and the main points are as follows:

In home care the guidance is a little more straightforward...

Sessional use and single use: 

• In home care, a session would constitute a visit. Carers know that each new client visit to a new home counts as a new ‘session’, which therefore means a new set of PPE is needed.
• In home care, it’s a little more complex as the guidance isn’t clear whether a visit to a client’s room constitutes a new session, or whether the same PPE can be worn throughout an entire shift, for example. 
• NCF are working on clarifying this guidance and we’ll update you with more information when we have it.

Aerosol generating procedures:

An aerosol generating procedure would require a full filtering mask or an FFP mask.

The following procedures are currently considered to be potentially infectious AGPs for COVID-19: (full source: gov.uk)

• 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 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
• 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)
• For patients with possible or confirmed COVID-19, any of these potentially infectious AGPs should only be carried out when essential. Where possible, these procedures should be carried out in a single room with the doors shut. Only those healthcare staff who are needed to undertake the procedure should be present.

One thing that isn’t an aerosol generating procedure is the use of a nebuliser. 

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For home care providers, these new rules mean that PPE is required for many more visits than previously required. If you do not have the right level of PPE it’s important to raise this with your local commissioners and providers. 

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“Is there any guidance about using non-official PPE? Things like 3D printed face masks etc”

The main point is that these have not been signed off by Public Health England. 

They don’t have a Kitemark or a CE mark, which means that a product has been declared as safe and meets EU standards and regulations. 
Some nations have authorized things like 3D face masks as being safe, however the NHS has not. 

It could be more dangerous to use things that aren’t certified as safe, so whilst there is an argument for ‘something being better than nothing’ home care providers should use caution when exploring these options. 

“Once a care provider has received PPE, what’s the first step? Should they make client assessments? Or should they train their staff in usage?” 

The government advice is that, if a client, or anyone in their household is displaying COVID-19 symptoms, a care provider should be wearing PPE, in the form of gloves and a fluid repellent surgical face mask. You must also wear PPE if you are visiting a person who is in the ‘shielding’ group of people. You should just use a basic, straightforward surgical mask in this instance. 

The group of people who fall into the ‘shielding’ group will have been contacted, and if any of your clients have been contacted by the government to tell them to remain in isolation for 12 weeks, you should update client care plans accordingly and ensure that every member of staff is aware of the precautions needed. 

With regards to training:

• Email resources to your staff
• Review care plans constantly
• Ensure you’re training staff on how to look after their own health 

"We've heard some stories of care staff feeling the need to reuse PPE, as they don't have enough... is there a danger in this?"

• Single use means you cannot remove PPE and put it back on again
• If you are using PPE in a single session, you can use it throughout your full session of care, however you should not take it off and put it back on again

"What’s the safest way to dispose of PPE?”

Once your session is over the steps to take are:

• If you have access to clinical waste bags (yellow or orange) PPE should be removed safely and put into these bags
• The bags SHOULD NOT be placed in general waste until 72 hours has passed
• COVID-19 can survive on hard surfaces for 72 hours, so you should separate PPE waste and only dispose of it with other waste once 72 hours have passed
• If you do not have access to a yellow or orange bag, you can use a normal bag, just be sure to keep it separate
• Tip: Add a post it note to your PPE waste bags with the date and time written on the bag, so you know when it is safe to dispose

Guidance for removing PPE safely can be found here.

“What other guidance is there for minimising risk of transmission?”

Handwashing:

If your hands are visibly soiled, use soap and water to wash them.

It’s just as important to dry your hands after using soap and water (you must have something to properly dry your hands with). In some cases, you may not want to use a client’s towel to dry your hands so if possible care providers should try to equip their staff with paper towels to dry their hands with. 

Good practices around handwashing and hand hygiene:

• No rings/painted nails/watches as germs can collect there
• The virus can live on these hard surfaces for 72 hours

“How should care providers clean their devices to reduce any risk of transmission?”

Devices should be treated as a hard surface (where germs can harbour for 72 hours, so should be cleaned when you leave an individual’s property. Things you can use:

• Antibacterial wipes
• Sprays
  

If your phone has a case, germs can harbour here, so do ensure that you’re cleaning inside the case if possible, at least once a day. 

“What are your thoughts on care providers needing to use the same level of PPE as say… the ICU nurses we see in the news?”

Those who are on the television are usually the ones who are working in incredibly high risk areas. 

It’s not glamorous to show the average GP surgery or home care visit. The people that we are seeing on TV with full hazmat suits and respiratory masks are working in the highest risk COVID-19 wards.

In home care, if you are visiting a client who has no symptoms, a mask may even become a barrier between you and your client. It could cause panic for your client. In care, much of a relationship between a carer and client is built around person-centred, human care, and it’s very important to consider the effect of wearing PPE around a client who is fully well and is displaying no symptoms. It’s a challenging time for a client to grasp, and could be further exacerbated by the use of PPE when it isn’t required. 

In a vast majority of cases, you will not need to be wearing PPE. If you are supporting a confirmed, or a suspected case of COVID-19 you should be wearing a fluid repellent surgical mask. If a person, or anyone in their household has symptoms, you’ll need to wear the fluid repellent mask. If a person is in the vulnerable group, you’ll need to wear a standard surgical mask. If none of these apply, there is no need for any type of face mask. 
If your client has dementia or any other condition which may make it difficult to explain the situation, there is some guidance from  Royal College of Speech & Language Therapists website here. 

“What are your other tips and useful advice for care staff during the crisis?”

NHSmail

If you haven’t heard of NHSmail, it’s “a secure email service approved by the Department of Health and Social Care for sharing patient identifiable and sensitive information.” It allows any organisation that’s commissioned to deliver publicly funded health and social care to share patient identifiable and sensitive information with the highest, government approved, levels of security. It’s ideal for care providers as it allows safe transfer of information between office staff and external bodies like GPs and others involved in care. Previously, NHS Mail required lots of steps and application forms, but in light of COVID-19, these have been relaxed, so there’s never been a better time to sign up. 

Why get an NHS email address?

• Pass secure sensitive information directly with your health and social care partners
• Facilitate conversations through a secure and encrypted mail account

You can find more information at this link.

Other useful links:

• gov.uk PPE guidance
• PPE Supply Channel
• nationalcareforum.org.uk (for daily updates following the bulletin)
• Aphasia Friendly Resources: Create your own accessible information using images provided
• PrAACtical Resources: Dealing with the Covid-19 Pandemic for people with Augmentative and alternative communication (ACC) 
• Speaking space: Coronavirus and staying safe - Makaton version  
• UK Personal Protection Equipment (PPE) guidance for patients during Coronavirus
• UK Coronavirus poster set
• UK easy-read social story: Coronavirus - Washing my hands 

Q&A:

“If a domiciliary carer is at a person’s house for a 12 hour shift, should they wear an apron and gloves all day, or just when a carer comes for a double-up visit?”

• If that client has confirmed or suspected COVID-19, then yes, you will need to wear PPE all day, regardless of whether another carer is visiting
• If the person has no symptoms (and no one in their household does either) then no PPE is required above your usual level
• If you are undertaking a 12 hour shift, it is likely you’ll take a break, so remember that if you do go outside, or have some lunch, or remove your PPE, a fresh set should be put on when you resume your duties
• We are still looking into this situation within a care home, as the guidance on what and what isn’t a ‘session’ is unclear

“If a service user is requesting you put a mask on, what do you do?”

• In this case, we are assuming the client does not have any symptoms
• At the moment, the guidance suggests that there isn’t any benefit to members of the public wearing face masks. 
• The guidance means you should not be wearing a mask in this situation
• We do not have enough PPE to be using it in situations where it is not required
• It may be a difficult conversation that you’ll need to have with the client and their family, however, PPE must only be used when there is a definite need, due to shortages
• Here is some guidance on how to communicate with clients from the Royal College of Speech & Language Therapists website

Follow Claire/National Care Forum

• Facebook: National-Care-Forum
• LinkedIn: National-Care-Forum
• Twitter: @NCFCareForum / @ClaireLSutton

Follow Birdie

• Facebook: birdiecare
• LinkedIn: /birdiecare
• Twitter: @birdiecare

If you have any questions, or you’d like to feedback on our webinar, you can email support@birdie.care.