Personal Protective Equipment (PPE) has always been a vital resource in care homes. Social care workers are accustomed to safety equipment such as masks, gowns and gloves. The performance and quality of facemasks however, has become increasingly important and is likely to remain so in the post-pandemic years to come.
Different facemask grades present significantly variable levels of protection from respiratory diseases and airborne viruses. Here we explore the contrasting PPE grades, and which models are most appropriate in care home settings.
The Importance of Safety in Care Homes
Of course, PPE isn’t only for the protection of care workers but is equally vital for vulnerable and immunocompromised residents. Care workers may be required to undergo more thorough decontamination and take additional preventative measures to avoid transporting viral particles into a care facility. Covid-19 is most commonly transmitted through close contact, or by contact with contaminated objects, and so hygiene is essential to avoid transmitting the virus.
Those at higher risk from Coronavirus fall into two categories:
- High risk – those who are considered clinically extremely vulnerable.
- Moderate risk – those who are considered clinically vulnerable.
Many social care settings will look after a majority of patients who fall into one of these categories. This includes people who have a serious heart condition, take medications such as steroids, are aged 70 or over, or have diabetes, as a few examples. Outside of care homes, vulnerable people are advised to ‘shield’ – i.e. to avoid contact with anybody outside of their home. Since this is impossible for care home residents, the social care sector has a responsibility to do everything possible to avoid exposing such vulnerable people to a potentially deadly virus.
Sanitation and safety are fundamental working practices for all care homes, but it has never been so crucial to the wellbeing and protection of residents.
Care Home Safety in the Fight Against Covid-19
The most common way for Covid-19 to transit from person to person is through close personal contact. For care workers, it is impossible to avoid direct contact, as indeed this is an essential requirement of providing personal care and support to elderly or less capable residents.
Therefore, the use of PPE continues to be highlighted as a critical resource in tackling the spread.
Along with measures such as regular, thorough handwashing, and being vigilant in the lookout for symptoms, Public Health England recommends:
- Single-use disposable gloves
- Wearing disposable plastic aprons
- Provision of fluid repellant surgical masks
- Using eye protection where there is a risk of contamination through the eyes
The most appropriate type of PPE depends on the task at hand. For example, when performing meal rounds, if no direct contact is required and you will remain at a two-metre distance, then disposable gloves and aprons may not be necessary. Likewise, in communal areas such as dining rooms and lounges, when distance can be maintained, full PPE might not be needed. However, in any care home setting, a surgical facemask is recommended.
Facemasks are important since anybody could be carrying Covid-19, and yet be displaying no symptoms. It is possible to transmit the virus to a vulnerable person without having had any awareness of being infected. Wearing a facemask ensures that you limit the potential of passing on the virus. This could happen if you were to touch your mouth or nose, and then a door handle – any person using that door handle within a certain time may pick up the viral particles.
The Role of PPE in Care Home Safety
PPE performs a variety of duties. It protects care workers from illnesses or infections carried by their patients, protects residents from particles brought in from outside of the care home setting, and makes the work environment safe.
This type of protection is essential to prevent the transmission of Covid-19 but is also necessary for securing the welfare of social care workers. The core reasons we use PPE in professional settings are to:
- Reduce worker exposure to hazards
- Protect against health and safety risks
- Prevent staff illnesses, shortages and emergencies
- Improve the health of employees
- Promote a safe, secure, work environment
Given the significance of facemasks during the pandemic, it is crucial to understand the difference between coverings to ensure you have the most appropriate PPE for your social care placement.
There are three main types of mask, all of which have varying protective properties:
- Surgical Masks: protect your mouth and nose from respiratory particles. This protects both care workers and residents by minimising the risk of transmitting infection from one person to the other.
- Fluid Repellent Surgical Masks (FRSM): protect you and your patients from respiratory droplets, usually passed through a cough or sneeze, by providing a barrier against your mouth and nose.
- Face Coverings: the general public must wear a face-covering – although this does not have to be a surgical-grade mask as required for social care workers. Face coverings can be made of cloth for reuse and can help reduce transmission levels when widely used throughout public settings.
If you are in any doubt as to the right facemask required for your role, it is essential to seek support from your manager or a social care professional.
Not All FaceMasks are Created Equal: Different Facemask Grades
Discussions around the properties of surgical grade facemasks have arisen, primarily due to PPE shortages. Any face covering is better than none, but in a care home setting where most residents are likely to be vulnerable, it is vital to have the right safety precautions in place.
Many facemask models have similar names and use varying international standards – which can make it complex to identify the best option. One of the key factors is to understand the measurement basis, which dictates the numeric element of a facemask model number. This works on the percentage of particles captured; so the higher the number, the more effective the protection.
For example, a facemask that captures 95% of particles has the designation ’95’, such as in the commonly used models KN95 and N95. There are other surgical standards to bear in mind, such as:
- Filtration efficiency
- Fit tests
- National safety standards
- Pressure drops – which impact the ease of breathing for the wearer
In the UK, surgical-grade masks that are suitable for care worker and patient protection are considered a Class I Medical Device. That means that they must conform with the design and safety standards laid out by the Medical Device Regulations (MDD/MDR) and be CE marked.
European surgical grade masks must conform with European Standard EN 14683, which classifies masks into three primary categories:
- Type I – bacteria filtering of 95% or above
- Type II – bacteria filtering of 98% or above
- Type IIR – bacteria filtering of 98% or above, and splash-resistant
Sterile surgical masks must also carry a CE certificate for the sterility aspects of the product. These standards are essential for care worker safety, as they are more robust than the criteria required for general use PPE which is designed to protect the wearer, without necessarily offering the same degree of protection for care home residents.
The Most Common Facemask Grades and What They Mean
Here are the most common types of facemask in use throughout social care:
N95 – N95 facemasks capture at least 95% of airborne particles. They must meet particular standards for pressure drops, airflow rates and leakage rates of under 30 ml per minute (mL/min).
KN95 – a KN95 facemask meets the same standards as an N95 when it comes to 95% or above particle protection. They must also be fit tested on people, and be shown to provide a maximum of 8% leakage (this requirement does not apply to N95 masks).
FFP2 – an FFP is a Filtering Face Piece, and is the European equivalent of the N95 respirator masks used through US healthcare. FFP2 covers meet the World Health Organisation (WHO) guidance for protection against Covid-19 transmission and must meet minimum protection based on concentration levels.
Disposable Facemasks – disposable facemasks are appropriate for single use in non-high-risk settings. However, in care homes, this is not recommended unless no other PPE is available, or in an emergency, since they will not offer the same protection as surgical-grade facemasks.
For care homes, the recommendations are that:
- Type I surgical facemasks must be worn at all times, even when not in direct contact.
- Type II surgical facemasks should be worn whenever within two metres of a resident, even if not touching.
- Filtering Face Pieces (FFPs) or N95 respirators should be worn when aerosol-generating procedures (AGPs) are carried out. This is less usual in a care home but could be required where residents require ventilatory support.
Choosing The Right Facemasks for Social Care Workers
The right facemasks for care homes will depend on multiple factors, such as whether there are vulnerable or high-risk residents on-site, the type of care administered, and other health and safety control measures in place. However, we can be sure that permanent wearing of facemasks in social care will continue for the foreseeable future, and ensuring you have the proper protection is vital for your own health, and for that of your patients.
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