COVID-19: nurses receive conflicting advice on PPE and resuscitation

Public Health England guidance contrasts with Resuscitation Council advice on chest compressions 

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Conflicting guidance about personal protective equipment (PPE) and resuscitation for patients with COVID-19 poses a dilemma for nurses, a nurse lecturer has warned.

Guidance published by Public Health England (PHE) on 3 April says first responders can start chest compressions and defibrillation without donning the strictest level of PPE.

Disagreement over infection risk from chest compressions 

However, the Resuscitation Council UK (RCUK), believes delivering cardiopulmonary resuscitation (CPR) without PPE is an infection risk for healthcare workers.

This is because the RCUK, which sets UK standards on resuscitation, considers chest compressions to be an aerosol-generating procedure. 

A PHE spokesperson said its own guidance had been reviewed by the government’s New and Emerging Respiratory Virus Threats Advisory Group and it would stand by it. 

‘It is their expert consensus that chest compressions and defibrillation are not aerosol-generating procedures,’ they said. 

Contradictory advice leaves nurses with a dilemma

Former nurse consultant in resuscitation Ken Spearpoint said the contradictory advice places trusts and clinicians in a confusing position, adding that he favours the RCUK guidance.

‘The new RCUK guidance introduces a necessary delay in starting chest compressions,’ said Mr Spearpoint, the University of Hertfordshire's principal lecturer in medical simulation.

‘Until an agreed position can be reached, I would urge trusts, resuscitation services and individual clinicians to take an evidence-based and safer position and follow the RCUK guidance.’

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On the conflicting guidance, Open University senior lecturer in health and academic lawyer Marc Cornock added: ‘From a legal perspective, where guidance is available a nurse would need a very good reason to depart from it.

‘Where guidance is contradictory, the nurse has to use their professional judgement as to which to follow; this includes a regard for their own safety.’

Nurses advised to ask their employer about local policy

When asked about the conflicting guidance, a Nursing and Midwifery Council spokesperson said nurses should confirm with their employer which guidelines they were working to during the pandemic and follow them.

An RCN spokesperson said nurses should use their professional judgement whether to provide CPR or not, taking into consideration the individual who needs resuscitation, the current situation and their local policy. 

They said that ‘provided the registrant can justify their actions’ nurses should not face criticism and the RCN would support them. 

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