Re: PFR for source control

12/07/2022 at 11:33 am #79509

Participant

Author:
adelaidealan@hotmail.com

Email:
adelaidealan@hotmail.com

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State:

Without looking at the literature it would seem logical that a PRF works both ways during the respiratory cycle. It filters inspiratory and expiratory air, but slightly more on inspiratory as the slight negative pressure creates a tighter seal than during the positive pressure expiratory phase that may result in some very minor air leaking.

My thoughts are they will provide much better source control than a surgical mask that is only designed to capture large droplets and not the smaller ones know to spread COVID. The limiting factor is source tolerance to their use.

Regards
Dr Alan McLean
BHlthSc, MHlthAdmin, DrPH, FCHSM,CHE

On 12 Jul 2022, at 10:27, Raby, Edward wrote:

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

________________________________
From: ACIPC Infexion Connexion on behalf of Raby, Edward
Sent: Wednesday, 6 July 2022, 14:45
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] PFR for source control

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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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