Find out what you need to do to remain safe while treating patients with Covid-19, and your rights and responsibilities.
- National IPC guidance from NHS England
As all UK countries begin to move beyond lockdown physiotherapists and patients in all sectors need to be aware of what this will or will not mean in practice.
There are no changes at this time to the IPC guidance meaning that the use of face masks and other PPE in healthcare settings has not changed. This means appropriate PPE must still be worn and patients may be asked to continue to wear masks and sanitise hands.
We have been asked many times what should happen where a double vaccinated person has been in contact with a proven positive Covid case. The rules now mean that the person does not have to self isolate and may attend for a physiotherapy session. However, we advise members to continue to use the IPC's Covid screening tool to ensure you minimise the risk to your staff, your patients, yourself and in some instances your business. .
Current guidance is under review and we will post updates as they occur.
(10th August 2021)
Resources to support your PPE decision-making
Frequently asked questions
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 you are carrying out an AGP on such patients, you do not require an FFP3 mask. You should wear an FRSM, disposable gloves and apron, and risk assess for a visor.
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.
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.
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.
Following the updated infection and prevention control guidelines released on 21 August 2020, you may be able to undertake some on call when patients are classified as low risk.
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 accident or incident at work has, or could have, led to the release or escape of coronavirus (SARS-CoV-2). This must be reported as a dangerous occurrence
- a person at work (a worker) has been diagnosed as having COVID-19 attributed to an occupational exposure to coronavirus. This must be reported as a case of disease
- a worker dies as a result of occupational exposure to coronavirus. This must be reported as a work-related death due to exposure to a biological agent
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.
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.
What is the current AGP guidance for clinicians working in education, childcare and children’s social care settings in England?
The CSP is aware of updated guidance for staff working in these settings issued by the Department of Education on 20 June, which explicitly excludes chest physiotherapy as an aerosol generating procedure (AGP), with reference to the Public Health England (PHE) PPE guidance.
The CSP does not agree with this viewpoint and has lobbied PHE to change its position for some time (see other FAQs in this section). We continue to advise all members, working in all contexts, to take aerosol precautions when performing chest physiotherapy with patients on the medium- or high-risk pathways. Members should work with their local infection, prevention and control teams, NHS, education and public health teams to determine and agree local pathways. Risk assessment, in conjunction with national, professional and local guidance, remains key in order to determine the level of PPE required.
What has the CSP done to address members' concerns about AGPs (aerosol generating procedures)?
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 (aerosol generating procedures). A summary of evidence justifying the selection of AGPs was published on 12 May 2020.
The CSP has joined with other professional bodies and trade unions to form part of the AGP Alliance who wrote to Prime Minister Johnson in late September 2020, highlighting concern over the current list of AGP’s and seeking they include a number of physiotherapy interventions.
In January 2021, the AGP Alliance wrote to Health Secretary Matt Hancock directly on the findings of the High Risk AGP Panel and the need for more urgent action on PPE. The AGP Alliance issued a statement about the letter.
In mid-October 2020, Ema Swingwood, Chair of ACPRC was invited to provide her expertise to the AGP panel which is reviewing the evidence regarding AGPs. Following this, in June 2021, the AGP Alliance submitted further evidence to the Public Accounts Committee as they undertook the next stage of their review into the government’s response to the Covid-19 pandemic.
In June 2021, the AGP Alliance delivered a presentation to the Department of Health and Social Care, the Infection Prevention and Control Cell and Public Health England. This was specifically to press the Government to change its UK Infection Prevention Control Guidance to reflect short and long-range airborne transmission of COVID-19 and to recognise the need to provide frontline healthcare workers with enhanced PPE. This was in light of the new urgency created by the Delta variant.
Despite our constant lobbying, additional physiotherapy procedures have not yet 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, while the CSP continues to lobby at a national level.
The CSP continue to be in regular contact with the public health bodies throughout the UK to ensure that our members have the most up to date guidance on PPE.
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.
Are there any other considerations with regards to uniform, additional PPE and disposal, and using my own car if I work in the community?
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 GOV.UK website document: Coronavirus (Covid 19): Disposing of waste when treating patients with COVID-19.
You must also follow the current Public Health England (PHE) household guidance for advice on households with possible or confirmed infection.
Where does the CSP stand on the continued use of face coverings?
From a public health perspective, the CSP believes and would encourage the ongoing use of face coverings and/or face masks in all indoor spaces, as well as spaces that may be classed as outside, however have poor or little ventilation, EG: a lean to or enclosed gazebos.
Evidence supports a reduction in Covid-19 infection where a face covering is used. This protection is increased by the use of face masks as opposed to face coverings, and also by the number of individuals that use a face covering or mask in an indoor setting.
Please do note face coverings continue to be mandated in Scotland
What should I do about PPE requirements for my students at university?
Staff and students at HEIs need to follow their institution's PPE guidelines/policy.