COVID outbreaks increase urgency of PPE fit-testing for GPs

It was earlier this month that the Infection Control Expert Group (ICEG) updated its guidelines, recommending that all healthcare workers wear P2/N95 respirators instead of a surgical mask in the ‘likely high risk of transmission’, and that they be fit-tested before use.
 
Dr Kat Mclean, a GP who works at a Gold Coast respiratory clinic and has been a vocal advocate for aerosol protection, welcomed the move as a ‘positive step’.
 
But in the ensuing three weeks, she says GPs have not received any communication on how they will be supported to implement the guidelines. 
 
‘I know a lot of practice owners that are sitting waiting for guidance or support on how to actually approach the conversation,’ Dr McLean told newsGP. ‘I certainly have not heard anything, and I’ve been asking the questions.’
 
Since the guidelines were released, the more infectious Delta variant that has seen case numbers climb around the world has started to spread through the community, with parts of New South Wales, Queensland, Western Australia and the Northern Territory in lockdown.
 
Dr McLean says the variant’s presence has added further urgency to the need for adequate PPE to be supplied given the increased transmissibility GPs are facing.
 
‘We’re starting to hear from public health now that even if people are in surgical masks and patients are in surgical masks, that you’re going to be essentially deemed to be a close contact if you come into contact with a COVID-positive patient with the Delta strain,’ she said.
 
‘We’ve had a number of general practices now that have been deemed to be exposure sites with significant implications on those practices and teams, and the income of the practitioners who are impacted by that.
 
‘The risk has really increased … and we’re just not equipped within general practice to actually have the airborne precautions in place.’
 
GP and practice owner Dr Maria Boulton told newsGP there is a double standard GPs face in comparison to the level of protection afforded to colleagues in tertiary settings.
 
‘Queensland Health makes face fit-testing available for their staff, why not GPs?’ she said. ‘For too long we have been told that general practice is a private business; however, we are in a pandemic and have had inadequate access to adequate PPE, let alone face fit-testing.
 
‘We have been underfunded for decades, are [now] funding the vaccine rollout, and don’t have the buying power that governments have.’
 
With the exposure risk heightened in the wake of Delta’s emergence, Dr Boulton has drawn on her practice’s expertise in offering fit-testing for the mining industry, and it is offering it to all of her staff.
 
‘We feel strongly that our staff need to be protected,’ she said.
 
A new pre-print study by Cambridge University Hospitals NHS Foundation Trust has further cemented the benefit of high-grade fit-tested face masks for healthcare workers, noting that use of FFP3 respirators on a COVID-ward saw infection exposure fall significantly.
 
But Dr McLean says it is not just about supplying respirators and points to Brisbane-based GP and practice owner Dr Jared Dart, who has introduced high-efficiency particulate absorbing (HEPA) filters into his consulting rooms to help combat the risk of aerosol spread as an example of other measures that can help protect against aerosols.
 
However, Dr McLean says that many GPs are feeling ‘very disempowered’, as practices in a position to be proactive are ‘the exception rather than the rule’.
 
‘We can’t organise fit-testing if we don’t actually know what the brand of masks are that are available,’ she said. ‘It’s exceedingly difficult to not know what PPE will be supplied, if any, and what the circumstances are that they will be distributed.’
 
Dr Boulton fears that without government support, states could see a resurgence of infections among healthcare workers, as was seen in Victoria last year.
 
‘We need to be more vigilant than ever,’ she said. ‘We need the federal, state and territory governments to work together and provide us with adequate PPE, including N95/P2 masks and face fit-testing – or else funding to arrange it.
 
‘Above all, GPs and clinic staff don’t want to become infected as we don’t want to infect our patients or our loved ones, and we want to stay open so we can continue to care for all the non-COVID issues.’
 
With the vaccine rollout stalling and current outbreaks threatening much of the country, Dr McLean says it is less than ideal timing to be developing a fit-testing program for primary care. Rather, she says it should have been done months ago.
 
‘It’s challenging, especially when you look to other countries; even New Zealand are a lot further in terms of organising fit-testing and a process around that. We haven’t even had the conversation in Australia,’ she said. ‘It really does feel like acknowledging the airborne risks is the elephant in the room.
 
‘I heard [Health Minister] Greg Hunt referring to GPs as absolutely being the frontline – but you can’t have your frontline unsupported with very little communication around how to actually apply airborne proportions into primary care settings.
 
‘We seem to be repeating the same mistakes and, unfortunately, there really doesn’t seem to be a lot of leadership from the Commonwealth in regard to really strengthening infection control.’

The Department of Health was contacted for comment but did not respond prior to publication.
 
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