Find out what you need to do to remain safe while treating patients with Covid-19, and your rights and responsibilities.
Please also see the Protecting yourself section of the workplace and employment FAQs and thepregnancy and vulnerable workers FAQs.
The National IPC "Covid-19: infection prevention and control guidance" was updated on 21 August. It recommends the use of triage to stratify patients into low-, medium- and high-risk categories for Covid-19, and your choice of PPE is related to these categories. After much discussion with PHE and our insurance broker we can now advisethat for the medium risk pathway the eye protection can be risk assessed.
The updated National IPC guidance recommends that services continue to utilise remote consultations rather than face-to-face where possible and clinically appropriate. For more information, see our flowchart for deciding if a face-to-face consultation is appropriate.
Resources to support your PPE decision-making
Frequently asked questions
What PPE should I use when treating patients?
Firstly, you should consider whether a direct physiotherapy intervention is appropriate. Also consider the setting you are working in, the purpose of treatment, and how close you need to be to your patient.
You will need to follow the PHE guidance and decide which pathway (low, medium or high) your patient falls within.
Most physiotherapy out patients will be in the medium risk pathway as most will not have had a test within the last 72 hours. In such cases you will require gloves, a mask, and an apron. We have now had confirmation from PHE that the use eye protection in the medium risk pathway can be risk assessed.
Always wash your hands before and after seeing your patient, regardless of whether you come into contact with them or not.
Resources to support your PPE decision-making
(last updated: 21 Sept 2020)
If I am treating a low risk patient with an AGP what PPE do I wear?
The current PHE guidelines are that patients who have had a negative test within the past 72 hours and are asymptomatic are considered to be on the low risk pathway. If carrying out an AGP on such patients you do not require to wear a FFP3 mask. You should wear a FRSM, disposable gloves and apron and risk assess for a visor.
(updated 9 Sept 2020)
I am confused about which pathway my patient is on when I read the new PHE IPC guidance. Can you advise?
Following the publication of the updated IPC guidance on August 21st there has been some confusion about which pathway we should follow for physiotherapy outpatient treatments. The three pathways described in the main body of the document; high, medium and low risk, clearly describe each but appear to be contradicted by the triage tool in appendix 1.
We have sought clarity on this from PHE who have advised that the triage tool should be completed and if ‘No’ is the answer to all of the questions, the practitioner is directed to the low risk pathway definition to assess whether these criteria are also met. If not, they move to the medium risk pathway.
As the vast majority of our patients seeking outpatient treatment will not have had a negative test within the last 72 hours we believe most of our patients fall in the medium risk pathway.
(last updated 7 Sept 2020)
What do I do if my organisation refuses to provide me with appropriate PPE?
- Raise this with your line manager, head of department and/or infection control department highlighting the CSP guidance and position statement.
- Contact your local CSP representative for support and intervention.
- Your local rep can seek further advice and support from a CSP senior negotiating officer if it is required.
- If you do not have a local rep, contact the CSP to gain advice from the senior negotiating officer for your region.
If physiotherapy staff still cannot obtain the correct PPE for the service they provide, then they can decline to offer this service until their employer provides the appropriate equipment.
(last updated: 3 Apr 2020)
The public health bodies have put out guidance based on the World Health Organisation advice on what to do when there is an extreme shortage of PPE.
Ideally, any potential options will have been agreed locally between unions and the employer.
This will support members to be protected when undertaking their treatment sessions by completing a dynamic risk assessment.
(last updated: 24 Apr 2020)
Should I be fit tested for a mask before treating Covid-19 patients?
Yes. You should be fit tested for an FFP3 mask before seeing high-risk patients.
Once you have been fit tested, then you should carry out a fit check every time you use a mask. Should the model of FFP3 mask you are using change, then a new fit test will be required.
If you were fit tested within the past two years, this will count as having been fit tested unless the shape of your face has changed over this time, in which case you should request to be fit tested again.
We advise that if your employer fails to fit test you as set out in the criteria listed above, you should record this on their incident reporting system – for example, Datix.
Always ensure best practice with hand hygiene before and after patient contact, and also before entering and exiting any clinical area.(last updated: 3 Apr 2020)
What should I do if I cannot get a good fit with an FFP3 face mask and I am due to be on call?
The NHS Staff Council statement suggests that systems should be in place to manage staff who cannot get a good fit with an FFP3 face mask. This may include the use of other equipment such as protective hoods. However, these are very costly and it is unlikely they will be readily available for all staff. In these circumstances, discussions will need to be held locally and, on rare occasions, it may be that a particular member of staff is unable to carry out on-call duties.
If the FFP3 face mask does not fit due to the member of staff having a beard, it is likely that it would be deemed a reasonable management request to shave in order to wear the protective mask unless the beard was necessary, such as for religious reasons.
(last updated: 5 Mar 2020)
Can I record on Datix that my trust failed to give me the PPE I should have received under the government’s guidance?
Yes, we encourage all members to make a notification on their employer’s incident reporting systems every time they are placed in an unsafe situation where they or others may or have been harmed at work. Examples of incidents that should be reported include staff ill-health directly related to their work, violence, and aggression.
The Health and Safety Executive (HSE) recently issued guidance on when Covid-19-related incidences must be reported by employers under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). Reporting now should happen when:
- An unintended incident at work has led to someone's possible or actual exposure to coronavirus. This must be reported as a dangerous occurrence.
- A worker has been diagnosed as having Covid-19 and there is reasonable evidence that it was caused by exposure at work. This must be reported as a case of the disease.
- A worker dies as a result of occupational exposure to coronavirus.
(last updated: 29 Apr 2020)
I am a private practitioner providing urgent and/or essential treatment to patients. Where do I access supplies of relevant PPE?
If you have been commissioned to provide an NHS service by the CCG and/or local authority, you should get in touch with the local CCG and/or local authority through its local Covid-19 arrangements. If you are providing wholly private services to fee-paying patients, then you must make your own arrangements to purchase PPE in the same way that you procure other consumables for your practice.
A list of PPE suppliers can be found at the end of this document:
(last updated: 9 Jun 2020)
What should I do if I experience skin issues from wearing PPE?
The CSP is aware of NHS staff incurring skin abrasions, bruising and pressure sores on the face through wearing their PPE for extended periods.
The key issue with wearing PPE is that your skin can become hot and sweaty when the equipment is worn for too long. Apart from this making the mask uncomfortable, there is a potential risk that its effectiveness may be compromised if it loosens or detaches while you are working. Regular breaks from wearing PPE are therefore essential throughout your shift.
The advice of the Health and Safety Executive (HSE) on disposable FFP3 masks is that they should be worn for less than an hour at any one time. The estimated total time of use should last no more than a work shift of 8 hours.
If you are experiencing skin abrasion or pressure sores on the face as a result of your PPE do:
- Notify your manager and infection control lead as soon as possible.
- Follow your Trust’s reporting processes for this injury incurred at work.
- Make and keep a copy of your report.
- Contact your CSP safety rep (if you have one). They have rights under legislation to investigate and request remedial action.
Check the skin of your hands regularly, particularly if you are experiencing any itching or pain. The signs you need to be wary of are redness, scaling, flaking, blistering, weeping, cracking of the skin, and any swelling.
How can I prevent developing dermatitis when handwashing?
- Thoroughly rinse off residual soap/hand cleanser.
- Ensure your hands are completely dry before you put on your gloves.
- Use emollient creams regularly, especially after you finish work. Check that all parts of your hands are covered.
- Report concerns to your infection control lead and line manager. Early detection can help to prevent the development of more serious dermatitis.
- Ask for hand hygiene products that are effective but gentle on your skin.
- Your employer should provide good hand-drying facilities such as good-quality paper towels, and emollients in suitable dispensers to prevent cross-contamination.
Your employer’s health and safety responsibility
They have a duty of care to you under the Health and Safety at Work Act 1974. They should take prompt action when made aware of problems arising. If you find that your issues are not adequately resolved, then do contact your CSP safety rep or steward for support. If there is no CSP representative at your Trust, please call the CSP enquiries unit on 020 7306 6666 – they will refer you to the senior negotiating officer for your region.
(last updated: 3 Apr 2020)
When I am mobilising or providing rehabilitation to patients, they are coughing. What level of PPE should I use?
Droplet precautions are appropriate for mobilisation, exercise and rehabilitation in most circumstances.
As a minimum, this should entail the use of disposable gloves, disposable apron, fluid-resistant surgical mask (FRSM) and eye protection. Higher levels of protection may be indicated if treatment is delivered in higher risk acute areas. For further information, see Section 5, Table 1.
Government guidance also suggests that it is also acceptable for the patient to wear a surgical face mask as an added layer of protection if it does not compromise their clinical care.
There may be individual clinical situations in which you feel that a higher level of PPE is required. In these circumstances, you should carry out and document a risk assessment and, if needed, this should be discussed with your line manager or infection control department.
(last updated: 15 Apr 2020)
Why does the CSP suggest different PPE requirements for rehabilitation and chest physiotherapy interventions?
The World Health Organisation is clear that coughing and sneezing produce respiratory droplets. Therefore, when providing rehabilitation to patients who are coughing, you should be using droplet precautions as a minimum.
Certain chest physiotherapy techniques are intended to increase the strength and effectiveness of someone’s cough as part of an airway clearance regime. This may include manual techniques such as an assisted cough, expiratory thoracic compressions or mechanical devices.
The World Health Organisation, therefore, suggests that ‘chest physiotherapy’ may be an AGP and it would be prudent to use airborne precautions (Infection control guidance, October 2019).
Because of this, the CSP advises droplet precautions for mobility or rehabilitation where patients may cough or sneeze, and airborne precautions for chest physiotherapy treatments.
It is important to note that there may be individual clinical situations in which you feel that a higher level of PPE is required. In these circumstances, you should carry out and document a risk assessment and, if needed, this should be discussed with your line manager or infection control department.
(last updated: 15 Apr 2020)
What has the CSP done to address members' concerns about AGPs?
In response to members' concerns and emerging evidence, the CSP has actively pursued clarification on the level of PPE that is appropriate to use with the coughing patient. We have also repeatedly requested transparency in the evidence used to define the list of AGPs. A summary of evidence justifying the selection of AGPs was published on 12 May.
Despite our constant lobbying, additional physiotherapy procedures have not been added to the list of AGPs. While this is disappointing, we encourage CSP members to continue to liaise with managers, infection control and CSP representatives should they have any concerns about individual risk in the workplace.
(last updated: 25 Aug 2020)
You should wash uniforms and work clothing at the hottest temperature suitable for the fabric. Check the care label, which is usually near a seam in the garment. A 10-minute wash at 60ºC removes almost all micro-organisms. Washing with detergent at a range of temperatures between 30ºC-60ºC removes most micro-organisms.
The government advice on cleaning uniforms includes the following:
The appropriate use of personal protective equipment (PPE) will protect staff uniform from contamination in most circumstances. Healthcare facilities should provide changing rooms/areas where staff can change into uniforms on arrival at work.
Organisations may consider the use of theatre scrubs for staff who do not usually wear a uniform but who are likely to come into close contact with patients (for example, medical staff).
Healthcare laundry services should be used to launder staff uniforms. If there is no laundry facility available, then uniforms should be transported home in a disposable plastic bag. This bag should be disposed of into the household waste stream.
Uniforms should be laundered:
- Separately from other household linen.
- In a load not more than half the machine capacity.
- At the maximum temperature the fabric can tolerate, then ironed or tumbled-dried.
Note: It is best practice to change into and out of uniforms at work and not wear them when travelling; this is based on public perception rather than evidence of an infection risk. This does not apply to community health workers who are required to travel between patients in the same uniform.
(last updated: 30 Apr 2020)
What should I do if my employer is providing FFP2 masks, when the task I am doing requires FFP3 masks?
You should raise this with your manager in the first instance and challenge the level of PPE being provided to you through the use of a risk assessment.
If this does not resolve the issue, contact your CSP health and safety rep or steward as well as the infection control manager for your employer.
If this does not resolve the issue, your health and safety rep or steward will contact the CSP for support from a senior negotiating officer.
For more information, see the CSP workplace and employment FAQs.
(last updated: 7 Apr 2020)
What PPE should I wear when working with post-Covid-19 patients in rehab settings?
These patients will have been confirmed as having had Covid-19, and as yet there is an absence of robust scientific data for how long the virus remains in the body. You must, therefore, consider these patients as ‘confirmed Covid-19 cases’ and wear the level of PPE required for the task you are doing.(last updated: 7 Apr 2020)
Are there any other considerations with regards to uniform, additional PPE and disposal, and using my own car if I work in the community?
PPE is standard clinical waste. Therefore, when treating patients with confirmed or suspected COVID-19 in their own homes, you can dispose of PPE waste through the householder’s normal waste collection. You can only put disposable PPE into the householder’s bin for non-recyclable waste – this typically includes aprons, gloves and masks (including fluid-repellent items).
You must also follow the current Public Health England (PHE) household guidance on cleaning and disposal of waste that could be infected with COVID-19.
This guidance states that you must securely store the PPE waste in disposable rubbish bags. You must place each bag inside another bag, then tie it and keep it separate from other waste. This waste must be set aside for at least 72 hours before being put in the usual external household bin for non-recyclable waste.
Regarding uniforms, ensure the correct level of PPE is worn for each patient contact, and disposed of in line with your local infection control policies and the guidance above. This, along with good hand hygiene, should reduce contamination of uniforms or cars.
For more advice, please refer to Environment Agency guidance on PPE waste from home healthcare workers treating patients with COVID-19.
(last updated: 2 June 2020)