NHS staff 'at risk' from Public Health England's advice that they don't need masks to resuscitate Covid-19 patients

Public Health England’s ‘decision to ignore international experts and previous guidance from its own advisory body sows unnecessary confusion and fear’

Experts have accused Public Health England of putting NHS staff at risk because of its “continued insistence” they do not need respirator masks when carrying out chest compressions to resuscitate coronavirus patients.

The Resuscitation Council UK, which sets standards for CPR in the UK, has issued its own conflicting advice to PHE stating the evidence suggests there is a risk.

Some NHS trusts have followed the Resus UK’s advice, while others have advised their clinical staff to follow the advice of PHE.

The Independent highlighted the concerns of doctors and expert nurses at the start of the month and since then Resus UK said it had tried to engage with PHE which has refused to change its view.

The issue centres on whether chest compressions create aerosol particles that are smaller than normal droplets and can get through surgical masks and pose a risk to infection of staff.

In a statement today Resus UK said: “We are deeply concerned by Public Health England’s continued insistence on designating chest compressions as non-aerosol generating procedures (AGPs). The absence of high-quality evidence for this should not be interpreted as the absence of risk.

“The clinical reality is that chest compressions produce excretions from a patient’s nose and mouth. As such, irrespective of whether this is via aerosol or droplet or both, this poses a demonstrable risk to healthcare professionals.”

It says staff carrying out CPR should wear full personal protective equipment (PPE) including respirator masks to guard against infection.

Resus UK’s said its advice was based on World Health Organisation guidance adding: “We have sought to engage with PHE on the scientific complexities and clinical realities of this issue over the last few weeks. We have also shared with them the latest evidence which serves to reinforce the need to provide level 3 PPE in this situation. It is regrettable that this has not persuaded them to alter their policy on this issue.”

It said as a result there was “significant confusion” across the NHS, with organisations and clinical staff having to choose which policy to follow.

“Our guidance is based on scientific evidence and a wealth of clinical experience across the resuscitation world. Our concern remains that not providing level 3 PPE to healthcare professionals performing chest compressions is a clear risk to their safety.

“In a pandemic where HCPs are tragically dying, we challenge the rationale for advocating a lesser form of PPE where expert consensus states that such a risk to safety exists. We ask PHE to recommend Level 3 PPE for chest compressions to ensure safety for the healthcare workforce.”

In 2016 a sub-committee of the government’s new and emerging respiratory virus threats advisory group (NERVTAG) was asked to advise the Department of Health and Social Care on the “clinical appropriateness” of the UK continuing to stockpile protective equipment for use in a pandemic.

As part of its recommendations NERVTAG, chaired then by deputy chief medical officer Jonathan Van-Tam, suggested aerosol creating procedures were “rarely performed in ward areas” adding “non-invasive ventilation and cardiopulmonary resuscitation being the most likely.”

Dr James Haddock, from the Doctors’ Association UK said: “We support the Resuscitation Council UK’s stance, which is based on the best available international evidence and standards, that CPR is an aerosol generating procedure.

“Therefore, all NHS staff giving CPR must be wearing the appropriate personal protective equipment. We are concerned that Public Health England’s advice is deviating from international consensus.

“It’s decision to ignore international experts and previous guidance from its own advisory body (NERVTAG) sows unnecessary confusion and fear.”

A spokesperson for Public Health England said: “NERVTAG is currently reviewing the evidence for a number of different medical procedures and their risk of transmission. PHE awaits the NERVTAG review and the committee's recommendations.”