A negotiation of respiratory risk in the first phase of the Covid-19 pandemic

During the initial phase of the Covid-19 pandemic, rapid clinical adaptations were required. Policy and guidance on pandemic infection control were scarce and evidence was developing. Countries published differing guidance on infection control and use of Personal Protective Equipment (PPE) (Birgand et al., 2020). This shifting guidance led to clinical uncertainty, particularly in respiratory nursing where aerosol-generating procedures (AGP) are commonplace. Local and personal adaptions evolved to minimise infection risk to staff, the public, and patients in clinical areas (Gov.UK, 2020).

We distributed an e-survey to UK respiratory nurses via professional respiratory societies. Demographic data was collected alongside clinical role, use of PPE, and work/life balance.

Just under half of the respondents (48.6%,124/255) reported undertaking AGPs; of these most wore eye protection (96.8%, 120/124), face masks (99.2%, 123/124), and gloves (99.2%, 123/124). Only 70% (87/124) wore surgical gowns. Participants were asked about their concerns about their working environment. Over a quarter focused on PPE (72/255, 28.2%) and unsafe working practices (56/255, 22.0%). Free text comments from participants reported concerns about inadequate/poor quality PPE; inconsistent advice and physical toll of the working environment in full PPE.

Those working in AGP areas were significantly more worried about a lack of PPE (49/124), 39.5% versus 22/96 (22.9%) compared to non-AGP areas (P = 0.001).

To ensure clinical confidence and safety health systems need to adopt evidenced international policy on PPE. Providing need clear and consistent guidance on PPE to all healthcare workers in respiratory areas in future pandemics.