New national face mask guidelines released

Matt Woodley

10/06/2021 4:04:48 PM

All healthcare workers providing direct patient care for individuals with suspected or confirmed COVID-19 should have access to P2/N95 respirators.

N95 respirator
Fit-testing should be completed before first use of a P2/N95 respirator, and a seal check done each time they are used.

The guidelines, published by the Infection Control Expert Group (ICEG) nearly nine months after first being commissioned, state P2/N95 respirators should be worn instead of a surgical mask if there is a ‘likely high risk of transmission’.
These risk factors include, but are not limited to:

  • a patient’s known COVID status and symptoms
  • current prevalence and transmission of COVID-19 in the population and whether there are unlinked cases in the community
  • epidemiological risk factors, such as whether the patient is a close contact with a known COVID case
  • potential for behaviours that increase the risk of SARS-CoV-2 transmission, such as shouting or coughing
  • duration and proximity of contact, along with the type of care
  • physical location, ie ventilation and whether the room has unexpected air movements that could result in wider distribution of droplets and/or aerosols, such as doors opening and closing.

The guidelines also recommend that healthcare workers required to wear a P2/N95 respirator should complete fit-testing before first use, and perform a fit (seal) check properly each time they are used.
Dr Kat Mclean, a GP who works at a Gold Coast respiratory clinic and has been a vocal advocate for aerosol protection since the beginning of the pandemic, told newsGP she is pleased to see ‘some movement’ and the new recommendations for P2/N95 mask use in high-risk settings.
‘It’s a positive step and I’m glad that we’re finally making some progress,’ she said. It’s slow, but we’re moving in the right direction.’
An ICEG statement announcing the release of the guidelines stated that the new recommendations are the result of a ‘significant body of work’ and reflect a ‘balanced risk approach’ to protecting healthcare workers from COVID-19.
‘ICEG has followed the emerging evidence and recognises the potential for transmission of SARS-CoV-2 via aerosols in specific circumstances … such as poorly ventilated indoor crowded environments,’ the statement reads.
‘Throughout the pandemic, the Department of Health, ICEG and the Australian Health Protection Principal Committee have constantly reviewed the medical evidence and regularly updated their advice which has been adopted by governments.
‘Their recommendations are based on the combined experience and expertise of the members involved – and relates to healthcare workers in all settings, including hotel quarantine.’
Dr Phillipa Hore, Co-Chair of the joint National COVID-19 Clinical Evidence Taskforce/ICEG Infection Prevention and Control (IPC) Panel that developed the consensus guidelines, said their release was an important step towards ensuring healthcare workers are adequately protected during the pandemic.
‘We understand the ongoing potential for COVID-19 transmission within healthcare settings and we’re pleased that this published guidance will help healthcare workers and organisations make informed decisions about the use of PPE,’ she said.
‘We recognise the need for guidance that is based on the best available research evidence. The Taskforce has undertaken a broad, rigorous, systematic review of evidence and continues to update it as new research becomes available. This guidance will help healthcare workers to ensure they can safely and confidently care for their patients, clients and residents.’
The Taskforce also published an expanded set of guidelines designed to help healthcare workers perform risk assessments, including some related to general practice:
  • High risk: Prolonged GP consultation in a poorly ventilated room with a distraught pregnant mother, an infant and two children aged under four, one of whom has visible rhinorrhoea in an area of high-community prevalence/transmission.
  • Low risk: Care of a child presenting to a general practice with symptoms of an upper-respiratory tract infection in the context of no community transmission.
  • Low risk: Healthcare workers in a drive-through COVID-19 testing centre who have very brief controlled contact with suspected COVID-19 cases (and where those suspected cases are wearing a surgical mask for most of the time) in the context of no community transmission.
While Dr Mclean has welcomed the new guidelines, she is also unsure about the logistical support GPs will receive to help ensure that they are being followed.
‘GPs are absolutely going to be working in situations where we’re coming into contact with probable cases or really high-risk close contacts,’ she said.
‘My question is – how are we going to undertake fit-testing and access supply of appropriate PPE in primary care and residential aged care facilities?
‘At state-run facilities, there’s probably likely to be more coordination and access, but for those Commonwealth and private-funded residential aged care facilities, what are those processes going to look like? And how are they going to actually include GPs?
‘That’s been my question for quite some time but I still haven’t gotten any closer to getting any answers.’
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Dr James Courts   11/06/2021 7:02:45 AM

"Low risk: Healthcare workers in a drive-through COVID-19 testing centre who have very brief controlled contact with suspected COVID-19 cases (and where those suspected cases are wearing a surgical mask for most of the time) in the context of no community transmission."

Cases such as in the Sunshine Coast highlight that although community risk may present as low you still need to take precaution and presume each case has the potential for infection.

Sample taking is still classified as an Aerosol Generating Procedure and should not be considered "low risk" for the healthcare worker taking the sample.

Dr Ian   11/06/2021 7:41:28 AM

In a high risk setting a mask is not good enough many believe you need a good face shield the best is the face shields that cover to below the chin are able to cover near the ears and are roomy .
Also a gown and if you do not have N95 /P2 mask double masking a surgical and and good cloth .
All efforts ought be made to move to a better ventilated room larger in size with a part open window or door to the outside air even a triage room or tent outside the clinic .
At this time all General Practitioners who see infected patients ought to have had two doses of an m RNA Covid vaccine if under 60 or AstraZeneca over 60 -
otherwise they ought not take these consultations if they are Elective .