Last reviewed 16 February 2021

Fresh Air NHS, a group of frontline healthcare workers and supporters, is campaigning for measures to update personal protective equipment (PPE) guidance for healthcare workers.

Campaigners are urging the UK and devolved governments to take all necessary precautions to mitigate airborne transmission of SARS-CoV-2 in health care settings. In an open letter, which currently has almost 1500 signatures, it says it is essential that healthcare workers have their PPE upgraded to protect against airborne transmission.

The open letter states: “Currently, the Public Health England (PHE) guidance on the type of PPE is categorised according to types of procedures carried out; deemed as either aerosol-generating or non-aerosol generating procedures. This is no longer compatible with what we now know.”

The letter cites research which has shown that healthcare workers are on average three to four times more likely to contract SARS-CoV-2 than the general population, with risk varying upon their role in the NHS. It said notably, while workers on regular hospital wards are significantly more likely to become infected, intensive care unit (ICU) staff have –50% lower risk despite working in an environment which was historically considered to be higher risk. It said: “This correlates with increased aerosol protection provided by higher-grade PPE and increased air exchanges in ITUs. In contrast, hospital wards where infectious coughing patients are also cared for, current guidance does not recommend the use of respiratory-protective PPE. Air exchange is not regulated in these settings either.”

The letter demands that, to mitigate the spread of SARS-CoV-2 in both staff and patients, the Government ensure immediate access to FFP3 masks for all staff working with confirmed or suspected Covid-19 patients. It also calls for a review of national PPE guidance and an immediate increase of natural ventilation as much as is possible in hospitals and all clinical settings where current standard requirements are not currently met.

The recommendation of higher-grade face masks applies to any healthcare setting where patients are likely to cough, according to University of Bristol Consultant Senior Lecturer in Respiratory Medicine Dr James Dodd, who led recent research on aerosol transmission by Covid-positive patients. His study, which is not yet peer-reviewed, stated: “PPE guidance should be updated to ensure medical staff are protected with appropriate PPE in situations when patients with suspected or proven Covid-19 are likely to cough.” Although the study focused on a hospital environment, Dr Dodd told Pulse magazine that the principles “absolutely” also apply to general practice.

British Medical Association (BMA) Council Chair Dr Chaand Nagpaul also said there has been recent evidence that the Covid-19 virus can be spread by aerosol transmission in general settings. He said: “Current surgical masks are insufficient to prevent aerosol spread, which is why the BMA is calling for greater provision of enhanced FFP2/FFP3 masks”.

A Department of Health and Social Care spokesperson responded to Pulse saying: “In response to the new Covid-19 variants that have emerged in recent weeks, the UK Infection Prevention Control Cell conducted a comprehensive review of evidence and concluded that the current guidance and PPE recommendations remain appropriate.”

The University of Bristol and North Bristol NHS Trust research, Aerosol Emission from the Respiratory Tract: An Analysis of Relative Risks from Oxygen Delivery Systems, is published at:

Fresh Air NHS’s open letter is available at: