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Reposting this… Keen to hear if anyone has an opinion or experience of implementing PFR use for source control. I don’t think there’s a right answer.
Thanks
Ed
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Hello IPC community,
Are you recommending PFRs for source control in your facilities?
We are considering use for
1. COVID positive patients coming into outpatient areas for infusions/assessment
2. All visitors to very high risk areas, eg bone marrow transplant unit, as we reduce stringency of RAT screening and have increasing levels of non-COVID respiratory illness in community
The available literature seems to provide evidence of only marginal theoretical benefit which needs to be balanced against the cost and confusion of applying this targeted strategy.
Summarised in this systematic review 2022 https://doi.org/10.1007/s00420-021-01775-y which in discussion says: The results of the present review indicate that the use of a surgical mask by the source of the aerosol reaches a higher level of protection than the use of the N95 respirator by the receiver (Diaz and Smaldone 2010; Mansour and Smaldone 2013; Patel et al 2016). These data suggest that traditional surgical masks are useful in preventing the transmission of respiratory diseases when applied at the source of the infected aerosol, significantly reducing the exposure of pathogens, functioning as an inhalation barrier; however, in regard to respiratory protection equipment, there are still doubts about which is the best type to be used for this purpose (Patel et al. 2016 ). In an environment of 27 m3 occupied by five people, although the N95 respirator promotes greater filtration, surgical masks seemed to be more effective in reducing the release of bioaerosol, a difference mainly due to the adjustment and sealing of the mask to the face of the source (Xu et al. 2017).
This is primarily based on the Patel/Smaldone 2016 paper http://dx.doi.org/10.1080/15459624.2015.1043050 which reports findings from an in vitro model that perhaps underrepresents the efficiency and seal achieved in the majority of people with the current generation of soft shell PFRs.
Keen to hear your approach/experience.
Kind regards,
Ed
Dr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
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