Joint COVID infection control guidelines expected within weeks

Last September, Federal Health Minister Greg Hunt and Australian Medical Association (AMA) President Dr Omar Khorshid announced a raft of new measures designed to protect healthcare workers from COVID-19, following a spate of infections during Victoria’s second wave.
 
One of the initiatives was a new joint Infection Protection and Control panel (IPC), comprising members of both the Infection Control Expert Group (ICEG) and the National COVID-19 Evidence Taskforce, which would provide ‘consensus guidelines on specific infection control issues that have emerged during COVID-19’.
 
However, more than six months have passed and the guidelines are still yet to materialise, leading to criticism from the AMA and infection control experts.
 
But despite being announced in September, ICEG Chair Professor Lyn Gilbert – who is not a part of the IPC – told newsGP, the group had only started developing the guidelines this year following an ‘exhaustive, open process of recruiting members’.
 
‘[The IPC] was formed a couple of months ago with a multidisciplinary team, including ICEG members, and [with] joint ICEG/Taskforce chairpersons,’ she said.
 
‘It has been meeting regularly to review evidence gathered by an experienced researcher – which is a time-consuming business – relating to use of masks versus respirators for protection against COVID-19 and [to] develop a consensus statement, which is under final review and likely to be released fairly soon.’
 
In the meantime, more evidence has emerged to suggest aerosol transmission has been responsible for the spread of COVID-19 in a number of different circumstances, including hotel quarantine, a western Sydney Church, and potentially among healthcare workers where there had been no identifiable breach of personal protective equipment (PPE) protocols.
 
However, National COVID-19 Evidence Taskforce Chair, Associate Professor Julian Elliott, told newsGP the IPC had been given a very particular brief by the Federal Government and that it required time to ensure it was carried out properly.
 
‘The desire from the Commonwealth Government was to bring two things into the mix into a very difficult and controversial topic,’ he said.
 
‘One was rigorous evidence-based processes, which we use within the taskforce, and the other was more active engagement of relevant stakeholders, which we do through our partnership model. So both of those things take time.
 
‘We also spent quite a substantial amount of time early on making sure that the processes [were sound]. So that included really rich and broad consultation with stakeholders to make sure that the terms of reference, the composition of the panel, the actual process of seeking nominations and selection of panel members was done in a very rigorous way, to ensure that we’re getting the breadth of views that are really essential for a topic like this.’
 
Associate Professor Elliott also said there had been some delay in terms of receiving funding from Government, but added that the new guidelines will likely be ready for dissemination within weeks.
 
‘We now have draft recommendations for eye protection, and face masks and respirators. And they are going through the final stages of our approval process,’ he said.
 
‘There’s no question that issues around PPE have been particularly difficult, controversial, and provoked a lot of anxiety among healthcare workers.
 
‘Our current focus is on the development of PPE recommendations. But as they’re getting close to completion, we’re also working on recommendations around engineering controls, and then there’ll be additional recommendations coming out after that.’
 
According to Associate Professor Elliott, the consensus guidelines will likely also be followed by a set of recommendations for researchers.
 
‘One of the key lessons, I think, for the global research community … is that there’s been a huge amount of randomised trials looking at drug treatment for COVID, but an absolute dearth of high quality evidence around infection prevention and control, which you could argue is at least as important,’ he said.
 
‘We use a particular methodology called grade methodology, which is widely seen around the world as the kind of gold standard of developing clinical practice guidelines. [But] for infection prevention control, it’s a challenging area … because even if you’re using great methodology you’ve got essentially a sparse evidence base.
 
‘So we’re also developing research recommendations … for key decision makers, including policymakers in government, to recognise that in the context of pandemic preparedness we really need to learn the lesson of the difficult situations we get ourselves into when we don’t invest heavily in research into these non-drug questions.’
 
The lack of evidence is also partly why the first round of consensus guidelines are unlikely to be the last.
 
‘These are living guidelines. And so we expect that recommendations that we issue can evolve over time as more research becomes available,’ Associate Professor Elliott said.
 
‘For example, there is one randomised control trial of masks versus respirators in healthcare workers [currently underway]. Should that trial report its results in the next few months, then that may provide relevant evidence that’s then incorporated into our recommendations, and that may lead to updating other recommendations that we’re making.’
 
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