Personal thoughts on PPE during Coronavirus
I have received numerous requests and had many conversations
with individuals and organisations about the use of PPE. It is hugely
encouraging as a H&S professional to hear enthusiastic debate about such things
as PPE being discussed in the wider media and community, however too often
people will jump at the possibility of using or issuing PPE as the first option
to control a risk, this is wrong. Let me explain why.
There is understandably some confusion about what PPE is and
where and when it is to be used and a lack of clear understanding on what we
should consider before issuing it. This is in no way a surprise or a criticism
of those looking at the issue, there are not many community groups, parish councils
or charity’s who have heard of, let alone considered, RPE FFP3
respirators.
The starting point for identifying any suitable control
measures is through a good assessment of the risk, being completed in a
structured approach and usually being documented and regularly reviewed.
Bearing in mind the minimal understanding we have of the virus and the rapidly
changing information coming forwards it is imperative that any risk assessment
must be reviewed and updated regularly to keep abreast of any such changes.
Risk Based approach; When thinking about your risk
assessment, remember:
- the hazard
is anything that may cause harm; these can be hazards to physical
health such as chemicals, electricity, working from ladders, an open
drawer or to mental health – if, for example the common causes of
work-related mental ill health e.g. demands, control and support for
individuals are not properly managed in the workplace.
- Clearly
the Hazard under consideration here
is C-19
- the risk
is the chance, high or low, that somebody could be harmed by these and
other hazards, together with an indication of how serious the harm could
be
- Clearly
the current Risk is High in
relation to contracting C-19 from face to face contact with others who may
be carrying the virus either knowingly or unknowingly and the potential
consequence.
Having identified the hazard and ascertained the starting level
of risk we would now need to consider how we manage that risk level down to its
lowest practicable level in the environment we are considering. We can look at
each end of the spectrum here, we could do nothing and leave the whole process
down to chance and in the end hope to achieve herd immunity from C-19 or we
could isolate every member of society in their homes for 6 months, or longer,
to remove the chance of transmission completely. Neither of these are ‘reasonably
practicable’ approaches so we must consider the controls we can put in place to
reduce the risk to as low as reasonably possible. To do this we should be looking
at the controls we might have to hand to protect us, our friends, family,
staff, volunteers etc. Remember the hazard C-19, may only be one of the
associated hazards to the activity your are assessing e.g. deliveries in your
community during the pandemic may involve other hazards such as driving,
traffic, slips trips and falls etc.
To control the risks, you should consider:
- Removing
the process or activity altogether or change it for a less hazardous
process such as removing or reducing social contact to as low as is
possible or exchanging cash payments to phone or contactless payments as
an example.
- Stop
staff, visitors, customers etc accessing the hazardous activity, in this
case contact with others. If it is not possible to remove all social
contact e.g. in the case of supermarket employees, how can you reduce it
to its absolute minimum, in the scenario here you could think about floor
markings to enforce the 2m rule, changing processes to remove the need to
break the 2m rule i.e. when one person holds a piece of equipment to allow
another to access it, could you secure it mechanically removing the second
person from the process. If you have situations where people usually come
into close contact, such as small areas or rooms, can you limit the number
of people entering at one time or place static protective screens in situ.
Could you reduce contact by varying shift patterns, split in to two
separate teams working at different times as an example.
- Provide
employees, volunteers, customers etc with Personal Protective Equipment
(PPE). But remember; PPE should
only be used as a last resort when all other controls have been exhausted
through the application of the hierarchy of controls.
- Ensure
you have adequate first-aid and welfare facilities available including
soap, water and individual/single use towels.
- Communicate
with those at risk and consider their opinions and experience on control
measures.
Personal Protective
Equipment
When considering the correct PPE for the task and activity
being undertaken there are a number of considerations we need to be thinking
about. In some cases issuing PPE may actually create greater risks for the
person we are trying to protect, so it is critically important that we
understand what that piece of PPE is designed and capable of protecting us/them
from and to consider what unintended consequences we might be bringing into the
equation.
If we think about the known transmission routes of C-19 such
as airborne particles or aerosols, being inhaled directly or hand to mouth/face
transmission from contact with contaminated surfaces to mouth, nose and eyes we
can see how putting things such as face masks or respiratory protective
equipment (RPE) on and off our faces when the risk of aerosol transmission is
very low, may well increase the risk to the face mask user simply by increasing
the likelihood of hand to face contact. Front line staff, in most cases, are
being issued with RPE with a face fit protection level 3 (FFP3), this is one
the highest standards with FFP1/2 being lower protection. Again if we were to
issue the FFP1 RPE the level of protection would be far below the standard
required and may increase contamination risks rather than lower them. The risk
maybe made greater through a misplaced belief that they are safer and therefore
reduce personal social distancing because they have a face mask, albeit an
ineffective one.
Face visors are a similar consideration, the updated UK Gov
advice on the use of face visors suggest they should be used where aerosol
generating procedures (AGP’s) are being conducted such as CPR where forced
exhaled air from a patients lungs may produce large aerosols or bodily fluid
that could make contact with the face of frontline staff. However if we
consider someone working in a busy food takeaway scenario, where by definition
most people are not likely to be symptomatic because the majority are following
UK Gov advice and placing themselves and their families in isolation when they
become symptomatic, they are unlikely to be exposed to AGP’s. Therefore we
should consider the potential ‘increased risk’ in issuing face visors in this
scenario if we were to issue it without making the decision on a clear risk
based assessment. As an example, the risk maybe made greater in this scenario
through staff sharing the visors or placing them on contaminated surfaces
before use.
Other considerations to bear in mind when thinking about PPE
are quality, are they CE Marked, could they cause a greater risk if the PPE is
substandard or defective i.e. poorly made goggles that shatter on impact. The
maintenance, storage and cleaning of PPE are also important considerations,
what processes should be in place to ensure that facially worn PPE is not
passed from one user to another either inadvertently or without a suitable and
effective decontamination process in place.
Personal Protective Equipment is essential in protecting the
health of those at risk but the process in deciding what to use or not to use
is not as straight forward as some people I have been speaking with during this
awful pandemic believe it is. I hope that this gives an insight into some of
the considerations you could be thinking about and discussing with those at
risk.
This is not specific guidance on the use of PPE and you
should ensure that your risk assessment takes into account all reasonably
foreseeable risks and hazards inherent in the activity you are assessing. The
information here is only my personal opinion as a H&S professional and is
not intended to be specific guidance in preventing any risk from contacting the
C-19 virus or any other type of harm. The comment here is solely intended to
provide some context around the decision making you might want to consider in
preventing the spread of C-19 if you are being asked about providing or using
PPE as a control measure.
The best advice is to stay home, wash your hands for at
least 20 seconds with soap and water regularly and maintain social distancing
where ever possible.
Stay safe.
Hugo
Sources;
NOTE;
References or information may change and the reader should check for any
updates during this rapidly changing pandemic before making any safety critical
decisions. 13/04/2020.
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