COVID-19 is a highly infectious respiratory disease caused by the SARS-CoV2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. COVID-19 may cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease.
To reduce the risk of transmission for our employees and the people we work with face-to-face, social distancing is advised where practicable.
Risk assessment
We continually monitor UK government guidance about COVID-19 in making risk assessments about safe working practices for employees. While the UK government has now lifted general restrictions in England, some basic precautions should still be followed by all employees to help stop the spread of COVID-19, and there are some settings in which additional measures are still needed.
Specifically, personal protective equipment (PPE) should be worn in some care settings and services when there is a risk of transmission and social distancing is not possible, for example when undertaking personal care. Individuals must also ensure they remain good standard infection control precautions, including being bare below the elbow, and practice hand hygiene.
For the management of individuals with confirmed or suspected COVID-19 individuals should refer to the relevant UK Health Security Agency guidance and specialist infection control advice.
For more information, see the infection prevention and control: resource for adult social care.
Before undertaking any procedure, employees should refer to the risk assessment produced with your manager for the work you are undertaking or client you are working with. This details the risks of exposure to blood and body fluids, and the possible entry routes for this infection.
The risk assessment will detail what PPE is required to control these risks and employees will be expected to wear PPE as detailed in the risk assessments that protects adequately against the risks associated with the procedure.
Suitable PPE will be issued where required.
Basic precautions
Physical distancing, ventilation and good hand hygiene are basic precautions which should be exercised by all employees to help stop the spread of COVID-19.
Physical distancing
Physical distancing is the most effective method of reducing transmission between staff, visitors, and clients.
Ventilation
Ventilation is the process of introducing fresh air into indoor spaces while removing stale air. Letting fresh air into indoor spaces can help prevent the spread of respiratory infections.
Hand hygiene
Effective hand hygiene is also one of the most effective ways to protect yourself from the transmission of illnesses including COVID-19.
The following products are suitable to use for hand hygiene:
- liquid hand soap: to wash hands before and after every task
- alcohol hand gel (60%): to be used in the absence of soap and water
- bottled water: in the absence of access to running water at the person's home
- paper towels: to clean and dry hands after washing
Employees caring for clients should follow these ‘5 moments for hand hygiene’ at the point of care:
- Before service contact:
When? Clean your hands before touching a service user when approaching them.
Why? To protect the service user against harmful germs carried on your hands.
- Before a clean or antiseptic procedure:
When? Clean your hands immediately before any clean or aseptic procedure.
Why? To protect the service user against harmful germs, including the service user's own, from entering their body.
- After bodily fluid exposure risk:
When? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).
Why? To protect yourself and the health and social care environment from harmful service user germs.
- After service user contact:
When? Clean your hands after touching a service user and their immediate surroundings; when leaving the service user's side.
Why? To protect yourself and the health and social care environment from harmful service user germs.
- After contact with service user surroundings:
When? Clean your hands after touching any object or furniture in the service user's immediate surroundings when leaving - even if the service user has not been touched.
Why? To protect yourself and the health and social care environment from harmful service user germs.
Other examples of when hand hygiene should be performed by employees not undertaking direct personal care:
- on arrival at work, between each task and before you go home
- whenever hands are visibly dirty
- before putting on and after removal of personal protective equipment or domestic gloves (wearing gloves should not be a substitute for handwashing)
- after coughing, sneezing or blowing your nose
- after using the toilet
- before and after having a coffee, cup of tea or meal break
There are general principles you should follow to help prevent the spread of COVID-19 including:
- wash your hands more often - with soap and water for at least 20 seconds or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and after you eat or handle food
- avoid touching your eyes, nose, and mouth with unwashed hands
- avoid close contact with people who have symptoms
- cover your cough or sneeze with a tissue, then throw the tissue in a bin
- clean and disinfect frequently touched objects and surfaces in the home
When hand washing, it is important to wash them effectively to avoid commonly missed areas.
Watch the NHS video about good handwashing technique.
Personal protective equipment (PPE)
PPE is equipment a person wears to protect themselves from risks to their health or safety, including exposure to infectious agents.
The level of PPE required depends on suspected or known infectious agents, the severity of the illness caused, the transmission route of the infectious agent, and the procedure or task being undertaken.
Quality standards and use-by dates
PPE must meet current UK quality standards and be used within the use-by date printed on the packaging or item. PPE which has passed the use-by date must not be used and be disposed of safely according to local procedures.
Requirements for our employees during COVID-19
Information about what PPE employees should be wearing relevant to the work they are undertaking can be found in our COVID-19 PPE quick guide.
Adult social care managers should read this information in conjunction with our infection prevention and control policy.
Types of personal protective equipment
The different types of PPE used for COVID-19 are detailed as follows.
Gloves
Gloves are single use only, if contact with blood and/or body fluids, non-intact skin or mucous membranes is anticipated or there is a risk of suspected or known infection such as COVID- 19, disposable gloves should be worn that are appropriate for the task.
Gloves must comply with European Standard EN 455 Medical Gloves for single use (Parts 1 to 4) and be UKCA/CE marked for single use. The Medical Devices Agency recommends that only powder-free gloves are purchased due to latex allergy or sensitivity. In homes where employees perform aseptic techniques, such as urinary catheterisation, sterile gloves must be available for such procedures.
Hands must be washed or, where unavailable, alcohol hand rub of at least 60% alcohol should be applied immediately before putting on and after removing each pair of gloves.
Gloves provided will be nitrile material unless otherwise discussed on an individual basis with managers. Nitrile gloves are a synthetic alternative to latex gloves. They are suitable to be worn when in contact with blood and blood-stained body fluids and if a resident or member of employees is latex sensitive. For this reason, Nitrile gloves are the organisation's first choice.
Gloves should be:
- changed if a perforation or puncture is suspected
- disposed of after each procedure or care activity
- changed between different procedures on the same resident
- appropriate for use, fit for purpose and well-fitting
The reuse of gloves is not recommended for the following reasons:
- glove integrity can be damaged if in contact with substances such as isopropanol, ethanol, oils and disinfectants
- many gloves will develop micro-punctures very quickly and will no longer perform their barrier function
- there is a risk of transmission of infection
- washing of gloved hands or using an alcohol hand rub on gloves is considered unsafe practice
Aprons and gowns
Disposable aprons are impermeable to bacteria and body fluids and protect the areas of maximum potential contamination on the front of the body.
A disposable apron or gown is single use. It should be worn whenever body fluids or another source of contamination is likely to soil the front of the uniform or clothing, especially when:
- undertaking an aseptic technique
- decontaminating equipment or the environment
- undertaking a procedure on a resident with a known or suspected infection
- care or domestic duty likely to involve bodily fluids
Fluid-resistant gowns must be worn:
- when a disposable plastic apron provides inadequate cover of staff uniform or clothes for the procedure or task being performed
- when performing AGPs on patients with a suspected or confirmed respiratory infection
- when there is a risk of extensive splashing of blood or other body fluids for example during AGPs
A disposable apron or gown should be removed and disposed of after each task. Never wear an apron for a dirty task and then move onto a clean task without changing it. Hand washing should be performed after removing the apron.
Aprons and gowns are single use as per Standard Infection Control Precautions (SICPs), with disposal and hand hygiene after each patient contact.
Aprons or gowns are not required for tasks such as delivering meals or medication to a client where there is no personal care involved and therefore the risk of contamination to clothing is extremely low, social distancing and good hand hygiene principles should be observed and time spent in the area should be kept to a minimum.
Facial protection
Care workers and visitors to care homes do not routinely need to wear a face mask at all times in care settings or when providing care in people’s own homes. However there remain a number of circumstances where it is recommended that care workers and visitors to care settings wear masks to minimise the risk of transmission of COVID-19.
These are:
- if the person being cared for is known or suspected to have COVID-19 (recommended Type IIR fluid-repellent surgical mask)
- if the member of staff is a household or overnight contact of someone who has had a positive test result for COVID-19
- if the care setting is in an outbreak
If a care recipient is particularly vulnerable to severe outcomes from COVID-19 (for example, potentially eligible for COVID-19 therapeutics) mask wearing may be considered on an individual basis in accordance with their preferences.
Mask wearing may also be considered when an event or gathering is assessed as having a particularly high risk of transmission.
If a care recipient would prefer care workers or visitors to wear a mask while providing them with care then this should be supported. In addition, the personal preferences of care workers and visitors to wear a mask in care settings will be supported.
Eye and face protection should not be impeded by accessories, such as false eyelashes or facial piercings.
When wearing facial protection employees are at increased risk of fatigue and dehydration. Managers should ensure employees are able to take regular breaks.
Eye protection: including cleaning of visors
A full-face visor will protect the eyes and also offers additional protection against respiratory droplets or splashing to the wearer, with the surgical mask acting as a second layer of protection.
The use of goggles instead of a full-face visor is not recommended. This is because goggles do not provide a shield in front of the surgical mask and certain designs may also allow droplets to enter the eye at the sides.
Employees should wear a full-face visor in addition to a fluid repellent surgical masks (Type IIR) mask where there is a risk of blood, body fluids, secretions or excretions splashing on to the face.
Eye protection used during an Aerosol Generating Procedure (AGP) must be disposed of immediately after the intervention. Hand washing should be performed following removal of visors.
Surgical masks
Surgical masks, where required, provide protection for both the care worker and the client by protecting the mouth and nose from respiratory secretions and other body fluids, secretions or excretions. Fluid repellent surgical masks (Type IIR) provide additional protection against splashing.
Face masks can be used for a single session, that is for a maximum of 4 hours, unless the worker is providing personal care or cleaning the room of someone with suspected or confirmed COVID-19 or is carrying out an AGP.
Within residential and day care settings a mask should be worn for the duration of a session (i.e. worn for a period until a break is taken or it is the end of the shift). If a mask becomes heavily contaminated it should be replaced immediately rather than waiting until the end of the session. For activities undertaken within a domestic premises the mask must be discarded after each client.
Surgical masks should:
- cover both the nose and mouth and not be allowed to dangle around the neck after use
- not be touched once put on
- be changed when they become soiled, damaged, uncomfortable or when taking a break in undertaking care activities
- not be worn for more than 4 hours without a break (removal)
To ensure the effectiveness of PPE and reduce the risk of contamination it is important PPE is put on and taken off correctly and where possible be observed by another employee
Hand hygiene must be performed after disposal
FFP3 respirator
A FFP3 respirator (known as respiratory protective equipment (RPE)) which provides a high protection factor will only be required in rare circumstances identified on the risk assessment.
This will normally only be when carrying out aerosol generating procedures (AGP) on a patient with possible or confirmed COVID-19. Care settings and carers need to alert managers to clients where AGP’s are performed or when someone is being discharged.
RPE used by us for AGPs must meet the FFP3 standard.
The fit of RPE is critically important. Every user required to wear RPE should have a fit test by a fit test trained health professional and be trained in the use of the respirator. Discuss with your line manager and the public health protection team (email: health.protection@derbyshire.gov.uk) where this is required.
A face fit test should be carried out before wearing RPE for the first time. An inadequate fit can reduce the protection provided by the RPE. A fit test should be repeated whenever there is a change to the RPE type, size, model or material, or whenever there is a change to the circumstances of the wearer that could alter the fit of the RPE, for example:
- weight loss or gain
- substantial dental work
- any facial changes (scars, moles, effects of ageing etc) around the face seal area
- facial piercings
- introduction or change in other head-worn personal protective equipment (PPE)
There is no stipulated frequency for retesting, and you don't need to retest if there are no changes in these circumstances. However, a seal check should be carried out each time the RPE is worn. If there are changes in circumstances arrange with your line manager to be fit tested for the close fitting RPE you use.
Managers can arrange FFP3 fit-test and training sessions for employees by contacting the health, safety and wellbeing team, email: ffp3fit.test@derbyshire.gov.uk.
The full list of AGPs is published by the government. In summary, the list of procedures which are currently classed as AGPs in relation to COVID-19 are:
- awake bronchoscopy (including awake tracheal intubation)
- awake ear, nose, and throat (ENT) airway procedures that involve respiratory suctioning
- awake upper gastro-intestinal endoscopy
- dental procedures (using high-speed or high-frequency devices, for example ultrasonic scalers or high speed drills)
- induction of sputum
- respiratory tract suctioning
- tracheostomy procedures (insertion or removal)
Note: 'awake' includes conscious sedation (excluding people who are anaesthetised with secured airway).
Certain other procedures or equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk for COVID-19. In care settings, procedures commonly undertaken which are not classified as AGPs include:
- non-invasive ventilation (NIV)
- bi-level positive airway pressure ventilation (BiPAP) and continuous positive airway pressure ventilation (CPAP)
- high flow nasal oxygen (HFNO)
- oral or pharyngeal suctioning (suctioning to clear mucus or saliva from the mouth)
- administration of humidified oxygen
- administration of entonox or medication via nebulisation
Using PPE
When using PPE it is important that it is worn and fitted correctly. Following the simple steps below will ensure that PPE is put on (donned) and taken off (doffed) in the correct sequence.
The steps below are where all PPE is worn, including FFP3 respirators. Refer to your task risk assessment for the appropriate PPE for the task.
Putting on PPE
- Before putting on PPE, perform hand hygiene by washing hands or using alcohol hand rub. Ensure you are hydrated and are not wearing any jewellery, bracelets, watches or stoned rings.
- Put on your disposable apron or gown and ensure it is securely fastened around the back.
- Put on your mask (Type IIR/FFP3) and make sure it is securely fitted at the crown and nape of neck. Once it covers the nose, make sure it is extended to cover your mouth and chin. For FFP3 RPE perform a fit check to ensure it is sealed to the face.
- Put on your eye protection if there is a risk of splashing.
- Put on disposable gloves.
- You are now ready to enter the patient area.
When wearing facial protection, care workers are at increased risk of fatigue and dehydration. Managers should ensure employees are able to take regular breaks.
Taking off PPE
- Remove gloves, grasp the outside of the cuff of the glove and peel off, holding the glove in the gloved hand, insert the finger underneath and peel off the second glove.
- Perform hand hygiene using alcohol hand gel or rub, or soap and water.
- Snap or unfasten apron or gown ties at the neck and allow to fall forward.
- Snap waist ties and fold apron or gown in on itself, not handling the outside as it is contaminated.
- Once outside the patient room. Remove eye protection.
- Perform hand hygiene using alcohol hand gel or rub, or soap and water.
- Remove mask.
- Wash your hands with soap and water.
Illustrated guides
The UK Health Security Agency has illustrated guides which show how to put on and take off PPE correctly:
The UK Health Security Agency illustrated guides may not be suitable for users of assistive technology, email: publications@phe.gov.uk to ask for the accessible format you need.
A Public Health England and NHS England video about putting on and removing PPE for non-aerosol generating procedures (AGPs) is also available to watch.
Disposal of PPE
All PPE should be disposed of as soon as the activity or session is completed according to local policy.
Waste management
In addition to standard precautions the following should be observed:
- in a care home, waste generated when supporting a person with confirmed COVID-19 should enter the hazardous waste stream
- waste visibly contaminated with respiratory secretions (sputum, mucus) from a person suspected or confirmed to have COVID-19 should be disposed of into foot-operated lidded bins which should be lined with a disposable waste bag
- if there is not access to a hazardous waste stream, such as waste generated in people's own homes, this should be sealed in a bin liner before disposal into the usual waste stream
Always perform hand hygiene appropriately after disposing of PPE.