ACIPC_Infexion_Connexion modification of surgical masks

[Terri Cripps]

>
>
>
> Hi,
>
> Its funny how we are all addressing the same problem on the same day in each of our places of work. This topic came up for us at Sydney Childrens Hospital Network last Friday and has continued today.
>
> In NSW currently, paediatric and smaller sized surgical masks are in very short supply and we will probably run out this week with not much prospect of getting any in the near future.
>
> So we are looking at videos such as the one Elizabeth included in her email. I know that the clips show people who mention a lack of P2 or N95 masks which have led them to using this technique on ear loop surgical masks.
>
> Whilst I would never presume to advocate that this technique be used in place of an N95 or P2 mask, I feel in my specialty it has a place for use. The reasons you have stated are very valid reasons to be cautious about using this technique. I would certainly continue to encourage and stress that adults with average and larger sized faces continue to wear the surgical mask in the preferred way. We have, and will continue to, impress upon staff that the technique is to be used with a surgical mask only and to use the provided N95/P2 masks for AGPs.
>
> We have tested this technique on ourselves (not for me personally my face is too large), those staff with small faces and those paediatric patients of 12 years and above (this is what the NSW guidelines suggest). Some have found the fit to be an improvement on a mask that has gaping at the sides. It also provides the wearer with more comfort in the knowledge that there may be less chance of them contracting COVID-19 due to the closer fit with less gaps. It has prevented some staff and children from being worried and anxious about this.
>
> We also have a younger age group of children aged 2 years to 12 years who are used to wearing the paediatric sized masks when visiting the hospital for reasons of being immune suppressed, post-transplant or having cystic fibrosis. These children may benefit from using this technique when we only have adult sized masks available.
>
> I think with education of staff and explicit reasons of when this technique is to be used, it may be a useful tool for some but not all, staff and our specialised patient population.
>
> The other technique that is around is a plastic piece which pulls the ear loops back past the ears onto the back of the head in the hair to make the mask fit better to the face. I have more concerns with this as I worry they will contaminate themselves trying to extricate the mask from the pieces of plastic after use.
>
> Happy to be proven wrong on any of the above but just wanted to put my point of view out there.
>
> Thanks,
>
> Terri Cripps | Clinical Nurse Consultant – Infection Prevention and Control | SCHN
> t: (02) 9382 1876 | f: (02) 9382 2084 | e: terri.cripps@health.nsw.gov.au | w: http://www.schn.health.nsw.gov.au
> m: 0436 287 137 | p: 47140
>
>
>
> From: “Sewell, Dallas”
> Date: 27 July 2020 at 12:27:26 pm AEST
> To: “ACIPCLIST@acipc.org.au”
> Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks
> Reply-To: ACIPC Infexion Connexion
>
>
>
> I also agree with Michaels assessment, and we are discouraging this practice at PCH for those reasons.
>
>
>
> Thanks,
>
>
>
> Dallas
>
>
>
> Dallas Sewell | Clinical Nurse Consultant | Infection Prevention and Control
>
> Office 2D, Perth Childrens Hospital
>
> 15 Hospital Avenue, Nedlands | Locked Bag 2010, Nedlands WA 6909
>
> T: (08) 6456 5359 | M: 0436 595 150 | E: dallas.sewell@health.wa.gov.au
>
>
>
> Report Sharp Injuries or Blood and Body Fluid Exposure
>
> Report IMMEDIATELY to:
>
> Infection Prevention and Control: T:6456 2002 Mon-Fri 0730-1530
>
> Hospital Clinical Manager: T:6456 3041 Afterhours/ Weekend/ Public Holiday
>
> Click here for OSH form
>
> Click here for Infection Prevention and Control policies
>
>
>
>
>
>
>
>
>
> From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Marilyn Harris (Sydney LHD)
> Sent: Friday, 24 July 2020 10:42 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks
>
>
>
> I agree with Michaels assessment.
>
>
>
> Stay safe everyone J
>
>
>
> Marilyn Harris
>
>
> CNC Infection Prevention & Control | Sydney Dental Hospital and Oral Health Services, SLHD
>
> Sydney Dental Hospital, 2 Chalmers Street, SURRY HILLS 2010
> Tel 02 9293 3276 | Fax 02 9293 3488 | marilyn.harris@health.nsw.gov.au
>
>
>
>
>
>
>
> From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
> Sent: Friday, 24 July 2020 11:04 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks
>
>
>
> Hi Elizabeth
>
>
>
> The technique itself looks OK, particularly with that specific brand and type of mask. You would have to test it on other brands and types to see if the same technique could be used.
>
>
>
> BUT Im not convinced that using this technique is a good idea or even necessary, for a number of reasons, including:
>
>
>
> 1. It assumes that a loose fitting mask is a risk. If you are using a level 2 or 3 surgical mask appropriately to prevent droplet transmission, there is no evidence to suggest the seal at the sides is so important.
>
> 2. You are, in my opinion, fanning the flames for the aerosol route of transmission being important with routine contact, not just droplet spread.
>
> 3. Using a level 2 or 3 surgical mask with a seal is sending a false assurance about spread from aerosols, as these masks are not designed to prevent inhalation of aerosols like a correctly fitted P2/N95 masks.
>
>
>
> I will be quite interested in other members view on this.
>
>
>
> Cheers
>
> Michael
>
>
>
> Michael Wishart | Infection Control Coordinator, CICP-E
>
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
>
> M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
>
> E michael.wishart@svha.org.au |
>
> W https://www.svphn.org.au
>
>
>
>
>
> St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
> M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
> E michael.wishart@svha.org.au |
>
> W https://www.svphb.org.au
>
>
>
>
>
>
>
>
>
>
>
>
>
> From: ACIPC Infexion Connexion On Behalf Of Elizabeth Carroll
> Sent: Friday, 24 July 2020 10:23 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] modification of surgical masks
>
>
>
> https://youtu.be/2TTg53aAP8Q
>
>
>
> Hello all: I have seen this video on utube which shows how to modify a surgical mask by folding it to achieve a tighter fit.
>
> Is there any benefit in modifying the masks in this way?
>
>
>
> Is there any problem with doing this – assuming of course that its a fresh mas), and also ensuring that that doffing is as per normal infection control procedure?
>
>
>
> I was considering sharing this with my Managers and incorporating into our procedures (in residential and home aged care).
>
>
>
> Any thoughts?
>
>
>
> Elizabeth Carroll | Executive Manager Residential & Chief Clinical Officer
>
> p 07 3223 4444 d 07 3223 4491 f 07 3223 4411 m 0468 522 131
>
> Level 3, 19 Lang Parade, Milton Q 4064 | PO Box 771, Toowong BC Q 4066
>
> Email: ecarroll@prescare.org.au | Web: http://www.prescare.org.au
>
>
>
>
>
>
>
>
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> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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>
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Keven Renshaw]

Hi Terry

I wrote out a similar response yesterday in order to balance out the reason why the tighter mask may help some hospitals deal with the slack fitting issue. I deleted it as it happens and now wish I hadnt.

If nothing else, I felt it was an ingenious method to amend what some people found was a drawback to the surgical mask. Yet I agreed with Michael et al for their equally valid reasons for not using the methodology.

You alluded to having less and less stocks of masks available in your state and it is that point I would like to enlarge upon. Considering the outbreak we are seeing currently and the anticipation that it may get worse and creep across states that I wonder if a war room footing for PPE be adopted country wide. For all hospitals and clinics to pool together just a fraction of their own PPE which can be distributed to those places most needed.

Yes I know there may be a lot of hospitals hoarding PPE stocks similar to the great toilet paper disappearance we witnessed a few months back. Given Queensland has so far not come under the cosh for new cases compared to Victoria, as a nurse I would struggle knowing on my stores shelf a mask that a fellow nurse desperately needs to keep them and their patients safe. I wonder what everyone thinks ?. Yes I am not offering a complete written solution on here but we are all in the care family and ethically, it would be the right thing to do.

Keven Renshaw
Infection Control Practitioner
Mater Health

Infection Control | Mater Hospital | Ward Street | Rockhampton | 4700
t: 07 49313420 e: krenshaw@mercycq.com w: mater.org.au

Human dignity | Justice | Compassion | Service | Special concern for the poor

Please consider the environment before printing this email

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From: ACIPC Infexion Connexion On Behalf Of Terri Cripps
Sent: Monday, 27 July 2020 5:16 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] ACIPC_Infexion_Connexion modification of surgical masks

Hi,
Its funny how we are all addressing the same problem on the same day in each of our places of work. This topic came up for us at Sydney Childrens Hospital Network last Friday and has continued today.
In NSW currently, paediatric and smaller sized surgical masks are in very short supply and we will probably run out this week with not much prospect of getting any in the near future.
So we are looking at videos such as the one Elizabeth included in her email. I know that the clips show people who mention a lack of P2 or N95 masks which have led them to using this technique on ear loop surgical masks.
Whilst I would never presume to advocate that this technique be used in place of an N95 or P2 mask, I feel in my specialty it has a place for use. The reasons you have stated are very valid reasons to be cautious about using this technique. I would certainly continue to encourage and stress that adults with average and larger sized faces continue to wear the surgical mask in the preferred way. We have, and will continue to, impress upon staff that the technique is to be used with a surgical mask only and to use the provided N95/P2 masks for AGPs.
We have tested this technique on ourselves (not for me personally my face is too large), those staff with small faces and those paediatric patients of 12 years and above (this is what the NSW guidelines suggest). Some have found the fit to be an improvement on a mask that has gaping at the sides. It also provides the wearer with more comfort in the knowledge that there may be less chance of them contracting COVID-19 due to the closer fit with less gaps. It has prevented some staff and children from being worried and anxious about this.
We also have a younger age group of children aged 2 years to 12 years who are used to wearing the paediatric sized masks when visiting the hospital for reasons of being immune suppressed, post-transplant or having cystic fibrosis. These children may benefit from using this technique when we only have adult sized masks available.
I think with education of staff and explicit reasons of when this technique is to be used, it may be a useful tool for some but not all, staff and our specialised patient population.
The other technique that is around is a plastic piece which pulls the ear loops back past the ears onto the back of the head in the hair to make the mask fit better to the face. I have more concerns with this as I worry they will contaminate themselves trying to extricate the mask from the pieces of plastic after use.
Happy to be proven wrong on any of the above but just wanted to put my point of view out there.
Thanks,
Terri Cripps | Clinical Nurse Consultant – Infection Prevention and Control | SCHN
t: (02) 9382 1876 | f: (02) 9382 2084 | e: terri.cripps@health.nsw.gov.au | w: http://www.schn.health.nsw.gov.au
m: 0436 287 137 | p: 47140

From: “Sewell, Dallas” <Dallas.Sewell@HEALTH.WA.GOV.AU>
Date: 27 July 2020 at 12:27:26 pm AEST
To: “ACIPCLIST@acipc.org.au” <ACIPCLIST@ACIPC.ORG.AU>
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks
Reply-To: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU>

I also agree with Michaels assessment, and we are discouraging this practice at PCH for those reasons.

Thanks,

Dallas

Dallas Sewell | Clinical Nurse Consultant | Infection Prevention and Control
Office 2D, Perth Childrens Hospital
15 Hospital Avenue, Nedlands | Locked Bag 2010, Nedlands WA 6909
T: (08) 6456 5359 | M: 0436 595 150 | E: dallas.sewell@health.wa.gov.au

Report Sharp Injuries or Blood and Body Fluid Exposure
Report IMMEDIATELY to:
Infection Prevention and Control: T:6456 2002 Mon-Fri 0730-1530
Hospital Clinical Manager: T:6456 3041 Afterhours/ Weekend/ Public Holiday
Click here for OSH form
Click here for Infection Prevention and Control policies

[cid:image006.jpg@01D65147.FF83E490]

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Marilyn Harris (Sydney LHD)
Sent: Friday, 24 July 2020 10:42 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks

I agree with Michaels assessment.

Stay safe everyone

Marilyn Harris

CNC Infection Prevention & Control | Sydney Dental Hospital and Oral Health Services, SLHD
Sydney Dental Hospital, 2 Chalmers Street, SURRY HILLS 2010
Tel 02 9293 3276 | Fax 02 9293 3488 | marilyn.harris@health.nsw.gov.au

[cid:image001.jpg@01D661B7.CFB2A870]

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, 24 July 2020 11:04 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks

Hi Elizabeth

The technique itself looks OK, particularly with that specific brand and type of mask. You would have to test it on other brands and types to see if the same technique could be used.

BUT Im not convinced that using this technique is a good idea or even necessary, for a number of reasons, including:

1. It assumes that a loose fitting mask is a risk. If you are using a level 2 or 3 surgical mask appropriately to prevent droplet transmission, there is no evidence to suggest the seal at the sides is so important.

2. You are, in my opinion, fanning the flames for the aerosol route of transmission being important with routine contact, not just droplet spread.

3. Using a level 2 or 3 surgical mask with a seal is sending a false assurance about spread from aerosols, as these masks are not designed to prevent inhalation of aerosols like a correctly fitted P2/N95 masks.

I will be quite interested in other members view on this.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
E michael.wishart@svha.org.au |
W https://www.svphb.org.au

[cid:image002.jpg@01D639A0.5B5D4C80]

[Stop the Flu before it stops you]

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Elizabeth Carroll
Sent: Friday, 24 July 2020 10:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] modification of surgical masks

https://youtu.be/2TTg53aAP8Q

Hello all: I have seen this video on utube which shows how to modify a surgical mask by folding it to achieve a tighter fit.
Is there any benefit in modifying the masks in this way?

Is there any problem with doing this – assuming of course that its a fresh mas), and also ensuring that that doffing is as per normal infection control procedure?

I was considering sharing this with my Managers and incorporating into our procedures (in residential and home aged care).

Any thoughts?

Elizabeth Carroll | Executive Manager Residential & Chief Clinical Officer
p 07 3223 4444 d 07 3223 4491 f 07 3223 4411 m 0468 522 131
Level 3, 19 Lang Parade, Milton Q 4064 | PO Box 771, Toowong BC Q 4066
Email: ecarroll@prescare.org.au | Web: http://www.prescare.org.au

[PresCare]

______________________________________________________________________
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This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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