16 Apr 2020
The government’s most recently updated PPE guidance has been strengthened significantly, and can be accessed here. We recommend all members follow this guidance, and seek to ensure that their employer does so too. You can access the tables explaining what equipment is required here:
- Recommended PPE for inpatient secondary care setting
- Recommended PPE for outpatient, community or primary care setting
- Visual guide to safe PPE
BDA advice on Aerosol Generating Procedures
The BDA makes one further recommendation in addition to government guidance:
- The insertion of Nasogastric Tubes (NGT) and Nasojejunal Tubes (NJT) should be treated as Aerosol Generating Procedures (AGP). As a result, any dietitian (or other healthcare professional) asked or required to undertake this role (in any setting where there is a risk of COVID-19 transmission), should be provided with appropriate PPE.
We make this further recommendation based on clinical experience of insertion of NGT/NJTs under adverse conditions such as those prevailing now. It is widely known that insertion of an NGT/NJT induces a cough or sneeze in many patients and that this could generate both droplets and aerosols within the range of 1-2 metres required for proximity to the patient during NGT/NJT insertion.
If you are asked to undertake duties without sufficient PPE, you should refuse to do so and notify your Union Rep or our TU team. You may try to find an alternative healthcare professional with appropriate PPE to complete duties on your behalf.
The BDA's opinion is shared by the British Association for Parenteral and Enteral Nutrition (BAPEN), RCN and the Intercollegiate General Surgery Guidance issued by the Royal Colleges of surgery in the UK and Ireland states that "Naso-gastric tube placement may be an aerosol generating procedure (AGP). AGPs are high risk and full PPE is needed."
The BDA is working with others to take action to ensure that our members are provided with appropriate PPE in all circumstances.
- We have formed an AGP Alliance with RCSLT, BAPEN, GMB, UNISON and others to lobby the government and the newly formed AGP panel to review their guidance as a matter of urgency.
- You can read our letter to the Prime Minister and the AGP Panel at the Department of Health and Social Care here.
- Read the latest briefing from the AGP Alliance here.
- Read the Health Service Journal or Daily Mail stories on this topic.
- BDA cosigned a letter to Public Health England with BAPEN and the RCN setting out the lack of robust evidence for NG and NJ insertions being regarded as Non-AGP and urging a change to the guidance.
- We worked with fellow Allied Health Profession bodies, under the auspices of the AHPF, to urging a further review of PPE guidance to include a wider range of AGP.
- BDA Trade Union continue to highlight where PPE is not provided or guidance is not being followed. We are also acting alongside TUC colleagues to push government to take greater steps to ensure all health and care professionals receive the PPE they need.
It is also important to risk assess every situation. If direct patient contact can be avoided, it should be, with digital options utilised where possible. The BDA has issued a statement on this topic as well as guidance on using digital technologies to keep you and your patients safe.