Has the Welsh Government incorporated into its advice to care homes and general practices, guidance provided by the Resuscitation Council and the World Health Organisation on provision of level 3 personal protective equipment in settings where cardiac arrest is likely?
The Chief Medical Officer and Chief Nursing Officer wrote to NHS Executive Directors of Nursing, Executive Medical Directors and Executive Directors of Therapies and Medical Science on the 7 May setting out the position on personal protection equipment (PPE) for CPR and resuscitation.
That letter was based on advice issued by Public Health Wales (PHW) and Public Health England (PHE) following a request made to the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) to review the evidence base concerning CPR as an aerosol generating procedure (AGP). The work concluded that the evidence does not support chest compressions or defibrillation being procedures associated with a significantly increased risk of transmission of acute respiratory infections. Neither public health body has therefore added chest compressions to the list of AGPs.
The NERVTAG advice did state however that ‘healthcare organisations may choose to advise their clinical staff to wear FFP3 respirators, gowns, eye protection and gloves when performing chest compressions but we strongly advise that there is no potential delay in delivering this life saving intervention.’
The Resuscitation Council UK (RCUK) has acknowledged the stance taken by PHW and PHE. The Welsh Government recognises the concerns expressed by medical and nursing staff and therefore in the letter from the CMO and CNO they suggested individual health boards and trusts may wish to show discretion allowing the use of full AGP PPE when undertaking resuscitation procedures.
I expect this advice to have been cascaded across all health board and trust areas.
In terms of social care, advice on infection prevention and control precautions and the use of PPE in care homes can be found in the UK Infection Prevention and Control (IP&C) Guidance and the associated “Safe Working in Care Homes” document as well as in the PHW advisory note for care homes and social care. Links attached below. The PPE recommended for use in care homes / social care is consistent with the approach across healthcare.
https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes