Home care worker may have fatally infected vulnerable person with COVID-19 due to poor government guidance

A home care worker who did not wear PPE may have infected a ‘clinically extremely vulnerable’ client with COVID-19 due to confusing and poorly communicated guidelines from Public Health England, according to a new report.

The report ‘Personal protective equipment (PPE): care workers delivering homecare during the COVID-19 response’ by the Healthcare Safety Investigation Branch (HSIB) highlights a case in April where a care worker visited the home of a ‘clinically extremely vulnerable’ person and did not wear PPE.

The person later died from coronavirus and showed no symptoms of the virus when the care visits took place.

The HSIB states that it examined guidance given out during that time and found Public Health England’s primary COVID-19 guidance for home care provision, published on 6 April, did not reference the PPE needed when caring for those within the most vulnerable groups.

On 2 April, separate official UK guidance on PPE had been published for people working in outpatient, community and social care settings but was not linked to the PHE primary guidance and not easily accessible. Public Health England then issued newer guidance on 27 April (how to work safely in domiciliary care in England) which did include PPE provisions for the ‘clinically extremely vulnerable’ group. However, the original 6 April guidance was still live and available and did not reference the new update, according to the report.

Guidance protecting workers and patients needs to be as 'clear and accessible' as possible

Medical director, Dr Kevin Stewart said: “Guidance that protects frontline workers and vulnerable patients needs to be as clear and accessible as possible and this is even more important in times of crisis.

“However, there are multiple guidelines for different care sectors and it is easy to see where confusion can occur as new updates overlap with older versions. Our report recognises the challenges in implementing national guidance and that further work is needed to understand the most effective systems that would enable better version control.”

He added: “Whilst our analysis focused on PPE guidance for carers working in homes, the risk to patient safety because of poorly communicated guidance is applicable across all healthcare settings. Our aim is to identify specific safety risks for COVID-19 and share that insight as widely as possible to aid the decision-making process and ensure consistent care for all.”

The report spells out the importance of clear PPE guidelines to to reduce the risk of COVID-19 transmission when delivering care in people’s homes.

HSIB reveals in its report that Public Health England only withdrew the link to the primary guidance and provided a link to the newer guidance on 13 May, when HSIB highlighted the case and raised concerns over safety on 28 April.

Official guidance on PPE has been a 'shambles'

In response to the report, Jane Townson, chief executive of the United Kingdom Homecare Association, said: “HSIB is 100 per cent right. What was going on at the time was unsafe.

“The production of official guidance on personal protective equipment has been a shambles throughout the coronavirus pandemic. Guidance designed for different care settings has been consistently confusing for the organisations who needed to put it into practice.

“In the early stages, an absence of clarity led to inconsistent local interpretations being made by public health, local councils and community health organisations, all with different views about what was required."

She added: “In terms of the process going forward, what would be good would be to involve those who know about the service in the drafting stage, before the guidance is published when it possibly ends up causing extra work and is dangerous.”

For more information, read the report

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