1/12 Thread on #COVID19 #PPEforTheNHS, and some added questions on #PPE in inpatient #mentalhealth settings. Thoughts on this welcome @theRCN @Unite_MHNA @MHNAUK @MhnExpert @minifeet2 @Safewards @napicu @rcpsych @PHE_uk

Beginning with today's @MarrShow [next tweet]

2/12 Link here: https://www.bbc.co.uk/iplayer/episode/m000h4hq/the-andrew-marr-show-05042020

Listen from 48.32.

3/12 At 49.21:

@AndrewMarr9: ‘To be absolutely clear, first of all the current guidance that we’ve seen says aprons, not gowns. But that has now been changed, has it?’

@MattHancock: ‘Yes, that was upgraded on Thursday of this week.’

4/12 Here is a link to the summary of one of the upgraded guidelines @MattHancock refers to; specifically, ‘Recommended PPE for healthcare workers by secondary care inpatient clinical setting, NHS and independent sector’:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877728/T1_Recommended_PPE_for_healthcare_workers_by_secondary_care_clinical_context_poster.pdf

5/12 This summary table, very clearly, still lists the use of aprons without gowns in some contexts.

Two examples:

(i) ‘Working in an inpatient, maternity, radiology area with possible or confirmed case(s)-direct patient care (within 2 metres)’

And [next tweet]

6/12 (ii) ‘Working in an emergency department/acute assessment area with possible or confirmed case(s)-direct patient care (within 2 metres)’

The meaning of ‘possible or confirmed cases’ is here: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection

7/12 Is it only me who interpreted @MattHancock as saying that gowns, not aprons, are now to be used by health workers in *all* contexts (including these)? This is also what @WHO says:

https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf

Now, the #PPE in inpatient #mentalhealth care questions:

8/12 In this context there are people who are detained, distressed and frightened and who are agitated, aroused or disturbed. Some are in wards for people who are ‘possible or confirmed’ #COVID19. Staff and service users need to be safe. Current staff #PPE recommendations are:

9/12 ‘For direct care of possible or confirmed cases in facilities such as […] mental health inpatient units […] plastic aprons, FRSMs [fluid-resistant (Type IIR) surgical masks] and gloves should be used. Need for eye protection is subject to risk assessment […]’.

10/12 The link for the above abbreviated extract is here: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe

11/12 So, knowledgeable inpatient #mentalhealth people: are aprons, FRSMs and gloves sufficient #PPE? Are some interactions and interventions (eg, restrictive/physical?) likely to increase chances of #COVID19 transmission? Should recommendations be for gowns? Respirator masks?

12/12 Which, in the case of gowns at least, is what @MattHancock on the @MarrShow seemed to be saying for *all* contexts.

And finally:

@PHE_uk, what evidence have you used to inform your specific, current, inpatient #mentalhealth #PPEforTheNHS recommendations?