During the first wave of COVID-19, we developed a ‘PPE Helper’ programme. This ward-based programme put PPE experts on the front line to spend time with staff to improve PPE knowledge, promote safe and effective use, and address staff anxiety. The programme was evaluated through a survey of staff views about PPE at the conclusion of the programme. This found that staff who had had contact with a PPE helper responded more positivity to questions about PPE and felt less PPE-related anxiety too.
In April/May time, acute hospitals across England were experiencing the peak of the first wave of COVID-19. We had talked about the prospect of a pandemic for years, but nobody (myself included) predicted the scale of the impact, as our hospitals slowly turned ‘red’ to care for patients infected with COVID-19. This was a frightening experience for many staff, especially for those who were redeployed to the frontline and to the ICU. One of the most challenging and contentious aspects of the management of the first wave of COVID-19 was PPE. The evolution in national PPE guidance was especially challenging. Initially, COVID-19 was classified as a ‘high-consequence infectious disease’, meaning that “Ebola-style” PPE was worn. Then, the PPE was gradually declassified to the level that is recommended today – a surgical mask, eye protection, apron, and gloves. The reason for this ‘PPE journey’ is understandable: as our scientific understanding of the transmission routes of this new virus developed, PPE recommendations changed accordingly. However, this was difficult to accept for frontline staff, who were asked to wear less PPE and still expected to feel safe. Therefore, one of the key roles of the PPE helpers was to explain the reasons for the changes in the guidance, flag the latest PPE information, and to listen to staff concerns.
Another key aspect of PPE is that safety relies on much more than the PPE you select to wear. Safe donning, especially doffing, and disposal are all crucial contamination points that need to be managed carefully. There is evidence that enhanced training and in-the-moment prompts can improve the safe use of PPE. So, another key role for the PPE helpers was to observe practice in the clinical setting and coach the safest and most effective use of PPE.
The programme began with a group of clinical staff from very diverse backgrounds redeployed from their usual role to become PPE helpers. We then developed a training programme to provide them with the right expertise to become PPE helpers. Over the course of six weeks between April and May, the helpers made 268 ward visits to 30 clinical areas to support best practice PPE use. In order to measure the impact of the programme, at the end of the programme, a survey was issued to all staff to measure perceptions about PPE. A total of 261 staff responded.
Staff who had contact with PPE helpers were significantly more likely to respond positively to these questions (see Figure 1):
- ‘PPE is easily visible on the ward’;
- ‘PPE is immediately available for me where and when I need it’;
- ‘This ward has adequate facilities for donning and doffing’; ‘I find it easy to use PPE appropriately’;
- ‘I have had enough PPE training’;
- ‘We remind each other to use PPE appropriately on this ward’.
Furthermore, staff who did not have contact with a PPE helper were significantly more likely to agree with the following statements: ‘I feel anxious that the PPE provided is not enough’; and ‘Other staff don’t seem to use PPE appropriately’.
Other important findings included:
- Staff of black, Asian, and minority ethnicity (BAME) were significantly more likely to feel anxious about the adequacy of PPE than white staff.
- Redeployed and non-clinical staff felt more positive about PPE helpers than other staff.
- A review of free text findings was undertaken. Staff were generally very positive about PPE helpers, although would have liked the programme to have been available earlier.
One of the things that I learnt from my time on the wards as part of this programme and from the regular dialogue with the PPE helpers was that the best way to get key messages about safe and effective PPE use over to staff was to go back to the transmission dynamics of SARS-CoV-2. Encouraging people to think about how the virus spreads from A to B, and what each piece of the PPE ensemble is deigned to do seemed to be the best way to promote good practice. A good example of this came from the nuclear medicine experts who became PPE helpers. They have spent their clinical careers using PPE to manage risks associated with radiation exposure, and all the related staff and patient worries that are attached to this. They were able to transfer these skills really easily to preventing virus transmission!
This may not be the most blinding bit of science you’ll read this year. And it comes with all of the usual caveats associated with a cross-sectional study of staff opinions. However, I am really proud of everybody involved in this programme, especially the PPE helpers themselves (some of whom also happened to be eminent academic clinicians who collaborated on this publication)! Some of the PPE helpers had not worked clinically for years, and all were well outside of their comfort zone in becoming experts in PPE. Also, I cannot emphasise enough how important the ‘pastoral’ aspects of the role PPE helper was. Staff were very worried – about PPE and COVID-19 in general – so many hours of the programme were spent listening to staff. So I was really pleased to see that contact with a PPE helper reduced PPE-related anxiety.
The publication of this work in the midst of the ‘second wave’ of COVID-19 is well timed, and I’d encourage this sort of programme right now, as PPE once again comes to the fore! If you’d like to know more details about the programme, please get in touch.