Dozens of junior doctors at a London hospital - some of whom care for patients with coronavirus - say the protective masks they are made to wear are "inadequate".
Forty junior doctors at St Bartholomew's Hospital have written to management concerned about a lack of fit-testing of masks on their ward, in a letter seen by ITV News.
The letter claims there are "inadequacies" in the personal protective equipment available to them and "as it stands falls short of the PHE guidelines" which were released on March 28.
The letter states: "The UK recommends FFP3 respirators when caring for patients in areas where high risk aerosol generating procedures (AGPs) are being performed.
"These should be fit tested for all staff and not just fit-checked. The WHO recommends FFP2 respirators for AGPs.
"If for any reason FFP3 masks are not available, we recommend using the FFP2 mask as a safe alternative but please note these should also be fit–tested."
The junior doctors have said that "only a minority of registrars have been fit tested despite the healthcare environments they have been asked to work within where Covid-19 exposure is significant."
They added: "Our concerns have been repeatedly raised via the Chief Registrar who has relayed this to management.
"Despite this, we have not seen the roll out of additional fit testing sessions or provision of a solution.
"Furthermore, the Trust has yet to formally acknowledge our concerns and address us with regards to this particular issue.
"Whilst we remain committed to providing patients with excellent care in what is an unprecedented and extremely challenging medical crisis, the safety and physical wellbeing of our team members is paramount.
"Adequate personal protective equipment is therefore essential in facilitating excellent medical care during the Covid-19 pandemic."
What is the difference between a fit test and a fit check?
According to healthcare manufacturer 3M, a fit test is the test that must be conducted every time a new model of tight-fitting RPE (Respiratory Protective Equipment) is selected. It should be conducted by a competent person appointed by the employer. This test is the employer’s responsibility and is a requirement of COSHH.
In comparison, a fit check is a check that should be carried out by the employee/wearer of the device each time that they put it on, even if this occurs several times per day. Although not a formal requirement like fit testing, a fit check is good practice that gives an indication that the respirator is positioned correctly. The responsibility of a fit check remains with the employee.
Barts Health NHS Trust say staff health and safety is of 'paramount priority'
A Barts Health spokesperson said: "Our senior clinicians endorsed national guidelines that recommended fit checking was suitable and appropriate to protect our staff from Covid-19.
"The decision to fit check is a safe and common practice among NHS trusts.
"In procuring personal protective equipment for our staff, we’ve had to order masks that are available in the national supply chain. The recommendation to fit check staff has enabled us to consistently protect more staff more efficiently than fit testing, and reduced unnecessary waste of time, resources and masks."
ITV News' junior doctor source say they appreciate the response from the trust management but notes there have been multiple iterations of guidance from PHE regarding PPE during this pandemic and the Trust's response did not make mention to the most recent which requires fit testing rather than fit checking alone.
The junior doctor added: "Choosing to base Trust practice on a now defunct set of guidelines is arbitrary at best and potentially putting staff at risk.
"We appreciate that this is a difficult time for all concerned including NHS structures, however there must be an acknowledgement of the current issues and a plan to rectify them. We will, as always, continue to work to the benefit of patients during during this time with all those concerned."