16 Apr 2020
Seeking change to PPE guidance
The BDA is working with others as part of the AGP Alliance, and alongside organisations such as Fresh Air NHS, the Royal College of Nursing and British Medical Association to take action to ensure that our members are provided with appropriate PPE in all circumstances. This should include provision of FFP3 masks and other suitable PPE when interacting with COVID patients/spending time in indoor spaces with COVID-19 patients.
We most recently met with senior civil servants and government scientific advisors in early June, and are awaiting the date of a further meeting. Read our latest joint statements below:
- AGP Alliance Statement on provision of PPE (January 2021)
- AGP Alliance Statement on recognition of airborne spread (April 2021)
- AGP Alliance Statement following meeting with IPC Cell (June 2021)
- Read the Royal College of Nursing's review of the current PPE guidance, which identifies numerous serious flaws.
- You can also read our letter to the Prime Minister and the AGP Panel at the Department of Health and Social Care here.
- Read the Health Service Journal or Daily Mail stories on this topic.
- Read the latest AGP Alliance statement here.
- 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.
Aerosol Generating Procedures and wider PPE
The BDA believes that a wider range of procedures should be categorised as Aerosol Generating and makes one specific 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.
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."
- 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.
The government’s most recently updated PPE guidance can be accessed here. This guidance should be regarded as the minimum standard. 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
We are here to help
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.
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.