Why IPC Guidance Must Evolve to Reflect the Science
BAPEN recently spoke with Dr Barry Jones, Chair of the Covid Airborne Transmission Alliance (CATA), to discuss the latest developments following the Covid-19 Public Inquiry Hearings and ongoing correspondence with officials. Representing 65,000 healthcare professionals, including BAPEN, NNNG, the British Dietetic Association, the British Society of Gastroenterology, the Royal College of Speech & Language Therapists, the British Occupational Hygiene Society and the College of Paramedics. CATA is calling for urgent updates to Infection Prevention and Control (IPC) Guidance to ensure frontline staff are properly protected against airborne viruses such as Covid-19.
CATA has been involved in the Covid-19 Independent Inquiry – can you tell us more about this? What sort of evidence were they interested in?
CATA was pleased to play a key role in the Covid-19 Public Inquiry. We contributed as a witness in Module 1, which examined the UK’s resilience and preparedness, and as both a witness and one of 30 core participants in Module 3, focused on the pandemic’s impact on healthcare systems across the four nations.
I appeared on behalf of CATA and BAPEN during the fourth day of Module 3 evidence sessions, following testimony from Professor Clive Beggs. As one of the Inquiry’s independent expert witnesses, he has published an important report on the science underpinning Covid-19 transmission and its implications for infection prevention and control in healthcare settings. I strongly encourage BAPEN members to read his report; it aligns closely with the position CATA has maintained since the outset of the pandemic: Covid-19 is predominantly airborne, with droplets of over 100 microns playing only a minor role and fomite transmission almost not at all.
My own oral evidence reinforced this view, challenging the Government’s consistent reliance on scientifically flawed infection prevention and control (IPC) Guidance. Being sworn in and questioned by King’s Counsel was a unique experience, but above all, it was gratifying to have a formal platform to advocate for changes we have been urging for years through letters to the Prime Minister, First Ministers, Ministers, Chief Nursing Officers, NHS England officials, and others.
What does it mean for the IPC Guidance to be incorrect?
The IPC Guidance sets out the level of protection healthcare professionals are entitled to while carrying out their work. Because it was based on the outdated assumption that Covid-19 spread mainly through droplets of 5-100 microns, healthcare professionals were only provided with surgical masks. Had the Guidance reflected the scientific evidence that Covid-19 is airborne and the virus is carried mostly in the smaller particles, not droplets, then healthcare workers would have been entitled to FFP3 respirators or power assisted personal respirator hoods (as in Southampton), which offer proper protection by filtering out fine infectious particles, especially at close range of 1-2m.
When are we likely to hear the outcomes of the Covid-19 Inquiry?
Together with the BMA and a number of Bereaved Family and Long Covid core participants from the Inquiry, we wrote to Baroness Hallett on 20th December 2024. We asked her to consider publishing an interim recommendation to the Government advising or mandating an urgent review of the IPC guidance which remains predicated on the now-discredited paradigm of droplet transmission and use of fluid resistant surgical masks (FRSM) for all non-aerosol-generating procedure (AGP) care or exposure. Regrettably, Baroness Hallett has confirmed she will not publish an interim recommendation and so we will have to wait until 2026 for her final report.
What should BAPEN members do if they feel unprotected from airborne pathogens at work?
The British Occupational Hygiene Society (BOHS) has published a new guidance document for healthcare workers on the use of Fluid Resistant Surgical Masks and respirators to comply with the requirements of the Control of Substances Hazardous to Health Regulations (COSHH) 2002. This document aims to ensure that employers and healthcare workers can have a clear understanding of the differences between medical devices used as source control, particularly surgical masks and respiratory protective equipment (RPE), particularly filtering facepiece respirators used as wearer personal protection.
This guide aims to help employers and workers with a clear statement to outline the differences between medical devices used in IPC (such as the Type IIR mask) on the one hand and RPE on the other. It aims to outline how compliance with IPC measures may not automatically equate to COSHH compliance. Similarly, compliance with COSHH may not necessarily meet IPC standards. I would encourage you to have a read of this document here. BAPEN members should not accept a surgical mask as PPE when faced with a suspected or confirmed respiratory pathogen such as Covid-19.
What are the next steps for CATA?
Since our participation in the Covid-19 Inquiry, we have written to the four Chief Nursing Officers, who unfortunately said they would not look at changing the IPC Guidance until Baroness Hallet’s report is published.
We’re deeply concerned by the communication we have had from Government officials in recent months, which doubles down on the droplet transmission route, despite significant and widespread contrary opinion including from the Centers for Disease Control and Prevention, World Health Organization and European Centre for Disease Prevention and Control.
We will continue to fight hard to achieve a change in the guidance that accurately affects the science and protects people who work in healthcare settings. We know that BAPEN members continue to work within 3-4 feet of patients for long periods of time and more needs to be done to ensure they have adequate respiratory protection (RPE) for their job.