Covid-19 how to work safely in care homes (Government update)

Public Health England (PHE) has released new personal protective equipment (PPE) recommendations and guidance for workers in care homes and nursing home settings.

How to work safely

UNISON St Helens would start with a ‘Thank You’ for the continued care and support you are providing for our most vulnerable residents.  These are challenging times for everyone but for you on the frontline whilst you may appear to have been forgotten by the ’decision makers’ UNISON has been shouting loud that you are all Heroes in our communities.  WELL DONE TO EACH AND EVERY ONE OF YOU!

Many of you have found time to complete our online Survey and from the responses received from across your workplaces you share some similar concerns.  The following information is intended to provide some of the answers. If you have raised particular serious concerns happening in your workplace these will be dealt with individually and quickly to make change happen.

If you have not looked at the Survey yet, please take time to tell us, good or bad, what’s happening in your workplace.

Keep Safe and stay in touch.
Mike Swift  &  Neil Woods


Q. Is PPE required in my care home when none of our residents have symptoms of COVID-19?

As there is sustained transmission of COVID-19 we
recommend use of PPE in general, however, in
circumstances where no resident has symptoms of
fever or cough and where no staff member or visitor has experienced these symptoms in the preceding 14 days, then PPE may not be required.

Your organisation will inform you if this applies and will perform daily risk assessments.

Q. Why is PPE needed for all care, not just when caring for residents with symptoms?

Where COVID-19 is circulating in the community at high rates, and symptoms can differ from
person to person (being relatively mild in some but severe in others) it is not always obvious who might be infectious. Elderly residents often have minimal symptoms of respiratory infection. We know that about one third of people can carry COVID-19 without having symptoms.

You and fellow care workers need to take precautions to both protect your own health and prevent transmission to the vulnerable people you are in contact with and care for during your work.

Q. Why are you recommending continuous use of face masks and eye protection until my break?

There is no evidence to suggest that replacing masks and eye protection between each resident would reduce risk of infection to you. Instead there may in fact be more risk to you by repeatedly changing your face mask/eye protection as this may involve touching your face unnecessarily.

We recommend you use face masks and eye protection continuously until you leave for a break both to reduce risk of transmission and also to make it easier for you to conduct your routine work without unnecessary disruption. When you take a break, you should remove your face mask and eye protection, a new mask should be used for the next duty period. If the item is reusable then you must ensure it is appropriately cleaned before reusing it. There may be circumstances that you would need to remove and replace your face mask or eye protection before the end of your shift, these are detailed below.

A face mask should be discarded and replaced and NOT be subject to continued use in any of the following circumstances:

•• if damaged
•• if soiled (e.g. with secretions, body fluids)
•• if damp
•• if uncomfortable
•• if difficult to breathe through

Eye protection should be discarded and replaced (or decontaminated if the item is re-usable) and NOT be subject to continued use in any of the following circumstances:

•• if damaged
•• if soiled (e.g. with secretions, body fluids)
•• if uncomfortable

When removing and replacing PPE ensure you are 2 metres away from residents and other staff.

Q. When can I re-use PPE?

Whilst most PPE items are for once only use, certain PPE items are manufactured to be re-usable.  This most commonly applies to eye/face protection items such as goggles or visors. Re-usable items should be clearly marked as such and identified in advance by your organisation/manager.

Re-usable PPE items may be used providing they are appropriately cleaned or stored between uses, according to the manufacturer’s instructions or local infection control policy.

  1. What is a risk assessment and who does this?

Your organisation or manager will perform a risk assessment and provide specific guidance to you as to when/for which residents you need to wear additional items such as eye protection or fluid resistant masks instead of standard surgical masks.

Risk assessment involves assessing the likelihood of encountering a person with COVID-19, considering the ways that infection might be transmitted and how to prevent this with use of PPE items.

So for example your manager may instruct you to wear eye protection when you are providing direct care for a resident(s) who is persistently coughing or actively vomiting (to prevent droplets or secretions from the resident reaching your eye).

You may wish to discuss with your manager any situations in which you are uncertain.

Q.What is the “extremely vulnerable group” and “shielding” and what do I need to do?

Individuals with certain serious health conditions (such as those with particular cancers, lung diseases and with suppressed immune systems) are considered extremely vulnerable to COVID-19.  Shielding is a measure to protect people who are extremely vulnerable by minimising all interaction between them and others.

As a minimum, residents in the extremely vulnerable group should be separated from others (e.g. reside in a single room). It is important that when providing care to a resident considered extremely vulnerable that you wear PPE including as a minimum, disposable plastic apron, fluid resistant surgical mask and disposable gloves; and practice excellent hand hygiene to minimise risk of infection. In practice, there is no difference in PPE guidance between providing care to a resident in the extremely vulnerable group and others (though the primary purpose in this case is to protect the vulnerable resident).

It is helpful to be aware of who is most vulnerable in your care home. Your manager will help you identify which of your residents is in the extremely vulnerable group.