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Hi All,
With the change in guidelines in relation to the use of N95s in VIC I have
been assisting a HCF to identify a suitable N95 masks.As a start I have reviewed a number of N95 masks on the market to see if
they pass a seal check (fit check) on myself.adjustments a mask that fails a seal check (fit check) on myself will also
fail fit check.A user seal check should be done every time a N95 mask is to be worn to
ensure an adequate seal is achieved.In the last 2 weeks I have obtained and reviewed six N95 masks. Four have
been supplied to healthcare facilities from stockpiles (i.e. hospitals
and/or aged care facilities), one masks was supplied by a manufacture and
one mask was provided by a distributor.Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of
failure issues I noted – see attached.In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN
SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published
online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to
this issue which may also be of interest/assistance if you are reviewing
such masks.Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Thank you Glenys,
Really worthwhile information that can be disseminated to practitioners.
Warm regards
KristinKristin Ryan-Agnew
Kristin Ryan-Agnew (MPH/Grad Cert IP&C)
Infection Prevention & Control Clinical Nurse Consultant
The Tweed Hospital[cid:image001.png@01D36E89.D6B88C30] National Standard 3 : Preventing and Controlling Healthcare Associated Infections
[Description: Description: Description: Description: cid:image001.png@01CC899A.70FE88C0]
I acknowledge the Bundjalung people as traditional owners of the land on which I work and live.
‘Bulla Yana Yabur’ Standing Together As OneHi All,
With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted – see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES 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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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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Great assessment, Glenys. Your findings underline the necessity of proper
fit testing – and not just fit checking – when using respirators.Here’s a great article on fit testing:
https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:textThe%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington
wrote:> Hi All,
>
>
>
> With the change in guidelines in relation to the use of N95s in VIC I have
> been assisting a HCF to identify a suitable N95 masks.
>
>
>
> As a start I have reviewed a number of N95 masks on the market to see if
> they pass a *seal check (fit check) on myself*.
>
>
>
> Note: Im assuming that if worn correctly and with correct/recommend
> adjustments a mask that fails a *seal check (fit check) on myself* will
> also fail *fit check*.
>
>
>
> *A user seal check *should be done every time a N95 mask is to be worn to
> ensure an adequate seal is achieved.
>
>
>
> In the last 2 weeks I have obtained and reviewed six N95 masks. Four have
> been supplied to healthcare facilities from stockpiles (i.e. hospitals
> and/or aged care facilities), one masks was supplied by a manufacture and
> one mask was provided by a distributor.
>
>
>
> Of the 6 masks only 1 passed a *seal check (fit check) on myself.*
>
>
>
> Happy to share my assessment to date which includes details and images of
> failure issues I noted see attached.
>
>
>
> In addition I have attached two recent articles (MAGAZINE OF THE
> AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and *JAMA Intern
> Med. *Published online August 11, 2020.
> doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may
> also be of interest/assistance if you are reviewing such masks.
>
>
>
> Regards
>
>
>
> Glenys
>
>
>
> Glenys Harrington
>
> Consultant
>
> Infection Control Consultancy (ICC)
>
> P.O. Box 6385
>
> Melbourne
>
> Australia, 3004
>
> M: +61 404816434
>
> E: infexion@ozemail.com.au
>
>
>
>
>
>
>
>
> 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.
>
> Archive of all messages are available at http://aicalist.org.au/archives
> – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new
> message send an email to acipclist@acipc.org.au
>
> To send a message to the list administrator send an email to
> admin@acipc.org.au
>
> You can unsubscribe manually from this list by sending ‘signoff acipclist’
> (without the quotes) to listserv@aicalist.org.au
>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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Hi Everyone,
Just to clarify further my assessment on a selection of N95 masks:
What I was doing when assessing these masks was a user seal check (fit check) not a fit test.
Staff should perform a user seal check (fit check) every time they put on an N95 to check the N95 mask-to-face seal.
My understanding is that if you cant get a good user seal check (fit check) on yourself after following all the instructions from the manufacturer then that particular mask does not fit. Hence if it fails a user seal check (fit check) it will also fails a fit test.
While a user seal check (fit check) is person specific I noticed that most of the masks I was assessing were all very large and would be too big for me. Hence they would also be too big for someone who was smaller than me, particularly someone with a small narrow face.
Hence, if an N95 mask fails a user seal check (fit check) there is no point in doing a fit test until you find a different mask (model or size) for the user that can pass a user seal check (fit check).
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Great assessment, Glenys. Your findings underline the necessity of proper fit testing – and not just fit checking – when using respirators.
Here’s a great article on fit testing: https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:textThe%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
On Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington <infexion@ozemail.com.au > wrote:
Hi All,
With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
To send a message to the list administrator send an email to admin@acipc.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.
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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
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Hi all,
At the risk of making controversial comments, I think that as Infection Prevention and Control professionals, we need to very carefully consider the perceived gold standard in staff safety that may be provided by undertaking fit-testing. I believe that it is important for us to remember that a fit-test provides an individual with a single opportunity to assess the fit of a mask either qualitatively or quantitatively. This does not provide assurance of competence with PPE use more broadly, especially in the clinical milieu.
My open disclosure is that from 2007 until this year our service ran a targeted Qualitative fit-testing program in our organisation. We suspended this program early on in the pandemic when it became apparent that the task of fit-testing all staff was more than we could resource both in terms of time and PPE. In addition, the information available to us did not indicate increased adverse outcomes in those facilities where fit-testing was not offered both in our own State and within Australia, and where the focus was on PPE training including appropriate mask selection and fit-checking. Our organisation was the only one in our State undertaking fit-testing.
I am becoming extremely concerned that if organisations go down the path of fit-testing that any process must be equitable. Will all craft groups be given access to this? Who will determine who is most important? In some settings there are programs suggesting that high-risk staff be offered fit-testing. Who really is high-risk? I think that this is a slippery slope and wonder where the line would be drawn? If offered to all staff, the resource implications in terms of initial fit testing and repeat interval fit-testing are not insignificant. I wonder if this is the best use of our precious healthcare dollars?
I believe that rigorous and thorough PPE training, provision of trained spotters to support staff when they are using PPE in all care settings; PPE use auditing with direct and timely feedback; implementing and maintaining COVID-Safe work plans; working to prevent presenteeism etc. will all provide increased safety. I do not believe that there is evidence to link the current Australian situation to fit-testing or lack of fit-testing.
In addition, I believe that there are numerous potential unintended consequences of implementing a fit-testing program which includes, but are not limited to, the following;
* Use of PPE will be significantly increased to support fit-testing for larger numbers of staff
* Will staff members not fit-tested be allowed to work? (Think of locums, casuals, agency staff)
* Will staff member not fit-tested to the masks available be allowed to work?
* What if the mask that a staff member is fit-tested to is unavailable at the point of care?
* What frequency of fit-testing will be acceptable? Annual? Who will oversight and this for the 1,000s of staff requiring fit-testing across our country?
* If staff fit-test frequency lapses, will they be allowed to continue to work?
* Will there be WH&S risks and claims associated with any program gaps?A friend of mine working in support of COVID activities recently told me a phrase they had heard commonly used in the Department of Health (not specifically about fit-testing), but what are the optics on this? I wonder if fit-testing is more about being seen to do something to build on the safety culture, rather that actually implementing something with a strong evidence base in preventing disease transmission?
I hope that these thoughts and comments assist in others contributing to discussions and providing input to processes being considered in your facilities and jurisdictions.
Kind regards
Rachel..
Rachel Thomson
Nurse Unit ManagerInfection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South: 03 6166 7882/ 6166 8658
Mobile: 0400 718 574
Email: rachel.thomson@ths.tas.gov.auLevel 4, H Block
48 Liverpool Street
Hobart, 7000From: ACIPC Infexion Connexion On Behalf Of Crystal Polson
Sent: Tuesday, 1 September 2020 9:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksGreat assessment, Glenys. Your findings underline the necessity of proper fit testing – and not just fit checking – when using respirators.
Here’s a great article on fit testing: https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:text=The%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington <infexion@ozemail.com.au> wrote:
Hi All,With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
Note: Im assuming that if worn correctly and with correct/recommend adjustments a mask that fails a seal check (fit check) on myself will also fail fit check.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES 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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
To send a message to the list administrator send an email to admin@acipc.org.au
You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Thanks for that Rachel.
I agree with your concerns about fit-testing, and my understanding is that the evidence that a fit-testing program actually increases safety to healthcare workers against respiratory infections is fairly thin.
Some states have already moved to make fit testing mandatory for healthcare workers wearing N95/P2 masks, and so facilities in those states will need to comply.
But for facilities where there is not yet a mandate from their regulator, my personal view is that they should pause and consider the wider ramifications of running such a program at the current time. And get advice on what benefit it may have for staff, versus what negative impact it could have on staff.
Doing something for the sake of doing something is not really useful nor helpful, in my opinion.
Cheers
MichaelMichael 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.auSt 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 On Behalf Of Thomson, Rachel EA
Sent: Tuesday, 1 September 2020 4:53 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksHi all,
At the risk of making controversial comments, I think that as Infection Prevention and Control professionals, we need to very carefully consider the perceived gold standard in staff safety that may be provided by undertaking fit-testing. I believe that it is important for us to remember that a fit-test provides an individual with a single opportunity to assess the fit of a mask either qualitatively or quantitatively. This does not provide assurance of competence with PPE use more broadly, especially in the clinical milieu.
My open disclosure is that from 2007 until this year our service ran a targeted Qualitative fit-testing program in our organisation. We suspended this program early on in the pandemic when it became apparent that the task of fit-testing all staff was more than we could resource both in terms of time and PPE. In addition, the information available to us did not indicate increased adverse outcomes in those facilities where fit-testing was not offered both in our own State and within Australia, and where the focus was on PPE training including appropriate mask selection and fit-checking. Our organisation was the only one in our State undertaking fit-testing.
I am becoming extremely concerned that if organisations go down the path of fit-testing that any process must be equitable. Will all craft groups be given access to this? Who will determine who is most important? In some settings there are programs suggesting that high-risk staff be offered fit-testing. Who really is high-risk? I think that this is a slippery slope and wonder where the line would be drawn? If offered to all staff, the resource implications in terms of initial fit testing and repeat interval fit-testing are not insignificant. I wonder if this is the best use of our precious healthcare dollars?
I believe that rigorous and thorough PPE training, provision of trained spotters to support staff when they are using PPE in all care settings; PPE use auditing with direct and timely feedback; implementing and maintaining COVID-Safe work plans; working to prevent presenteeism etc. will all provide increased safety. I do not believe that there is evidence to link the current Australian situation to fit-testing or lack of fit-testing.
In addition, I believe that there are numerous potential unintended consequences of implementing a fit-testing program which includes, but are not limited to, the following;
* Use of PPE will be significantly increased to support fit-testing for larger numbers of staff
* Will staff members not fit-tested be allowed to work? (Think of locums, casuals, agency staff)
* Will staff member not fit-tested to the masks available be allowed to work?
* What if the mask that a staff member is fit-tested to is unavailable at the point of care?
* What frequency of fit-testing will be acceptable? Annual? Who will oversight and this for the 1,000s of staff requiring fit-testing across our country?
* If staff fit-test frequency lapses, will they be allowed to continue to work?
* Will there be WH&S risks and claims associated with any program gaps?A friend of mine working in support of COVID activities recently told me a phrase they had heard commonly used in the Department of Health (not specifically about fit-testing), but what are the optics on this? I wonder if fit-testing is more about being seen to do something to build on the safety culture, rather that actually implementing something with a strong evidence base in preventing disease transmission?
I hope that these thoughts and comments assist in others contributing to discussions and providing input to processes being considered in your facilities and jurisdictions.
Kind regards
Rachel..
Rachel Thomson
Nurse Unit ManagerInfection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South: 03 6166 7882/ 6166 8658
Mobile: 0400 718 574
Email: rachel.thomson@ths.tas.gov.auLevel 4, H Block
48 Liverpool Street
Hobart, 7000From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Crystal Polson
Sent: Tuesday, 1 September 2020 9:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksGreat assessment, Glenys. Your findings underline the necessity of proper fit testing – and not just fit checking – when using respirators.
Here’s a great article on fit testing: https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:text=The%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington <infexion@ozemail.com.au> wrote:
Hi All,With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
Note: Im assuming that if worn correctly and with correct/recommend adjustments a mask that fails a seal check (fit check) on myself will also fail fit check.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Glenys I have also noticed that some of the masks are impossible to fit check- all I can suggest to staff is to try to get the best seal possible. I hope part of the reason is that they are made of such a rigid material that its not possible to get them to suck in and out with breathing but I am not convinced of that being the only reason
[cid:image003.jpg@01D2E9BF.C675F410]
Cathy Mowat
Clinical Nurse Consultant
Infection Prevention and Control
Central Gippsland Health
T. 03 5143 8518
E. cathy.mowat@cghs.com.auCentral Gippsland Health is located on the traditional land of the Gunai Kurnai people
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From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Glenys Harrington
Sent: Tuesday, 1 September 2020 11:05 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [EXTERNAL] Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksHi Everyone,
Just to clarify further my assessment on a selection of N95 masks:
What I was doing when assessing these masks was a user seal check (fit check) not a fit test.
Staff should perform a user seal check (fit check) every time they put on an N95 to check the N95 mask-to-face seal.
My understanding is that if you cant get a good user seal check (fit check) on yourself after following all the instructions from the manufacturer then that particular mask does not fit. Hence if it fails a user seal check (fit check) it will also fails a fit test.
While a user seal check (fit check) is person specific I noticed that most of the masks I was assessing were all very large and would be too big for me. Hence they would also be too big for someone who was smaller than me, particularly someone with a small narrow face.
Hence, if an N95 mask fails a user seal check (fit check) there is no point in doing a fit test until you find a different mask (model or size) for the user that can pass a user seal check (fit check).
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au
[Description: ICC Diagram ICCversion]From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Crystal Polson
Sent: Tuesday, 1 September 2020 9:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksGreat assessment, Glenys. Your findings underline the necessity of proper fit testing – and not just fit checking – when using respirators.
Here’s a great article on fit testing: https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:text=The%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington <infexion@ozemail.com.au> wrote:
Hi All,With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
Note: Im assuming that if worn correctly and with correct/recommend adjustments a mask that fails a seal check (fit check) on myself will also fail fit check.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES 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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Very well said Rachel. Every state (and nationally) expert groups have been established to identify evidence based best practice only to find their advice is sometimes ignored.
The only way we can arrive at good solutions is to have open debate and discussion.Robyn
Robyn Birch
Clinical Nurse Consultant | Infection Control
Bayside Health Services | Metro South Health
PO Box 585, Cleveland QLD 4163
t. 07 3488 3518 m. 0412 585 099
e. Robyn.Birch@health.qld.gov.au | metrosouth.health.qld.gov.au
[We care about you][Facebook][Twitter][LinkedIn][Instagram]From: ACIPC Infexion Connexion On Behalf Of Thomson, Rachel EA
Sent: Tuesday, 1 September 2020 4:53 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksThis email originated from outside Queensland Health. DO NOT click on any links or open attachments unless you recognise the sender and know the content is safe.
________________________________
Hi all,At the risk of making controversial comments, I think that as Infection Prevention and Control professionals, we need to very carefully consider the perceived gold standard in staff safety that may be provided by undertaking fit-testing. I believe that it is important for us to remember that a fit-test provides an individual with a single opportunity to assess the fit of a mask either qualitatively or quantitatively. This does not provide assurance of competence with PPE use more broadly, especially in the clinical milieu.
My open disclosure is that from 2007 until this year our service ran a targeted Qualitative fit-testing program in our organisation. We suspended this program early on in the pandemic when it became apparent that the task of fit-testing all staff was more than we could resource both in terms of time and PPE. In addition, the information available to us did not indicate increased adverse outcomes in those facilities where fit-testing was not offered both in our own State and within Australia, and where the focus was on PPE training including appropriate mask selection and fit-checking. Our organisation was the only one in our State undertaking fit-testing.
I am becoming extremely concerned that if organisations go down the path of fit-testing that any process must be equitable. Will all craft groups be given access to this? Who will determine who is most important? In some settings there are programs suggesting that high-risk staff be offered fit-testing. Who really is high-risk? I think that this is a slippery slope and wonder where the line would be drawn? If offered to all staff, the resource implications in terms of initial fit testing and repeat interval fit-testing are not insignificant. I wonder if this is the best use of our precious healthcare dollars?
I believe that rigorous and thorough PPE training, provision of trained spotters to support staff when they are using PPE in all care settings; PPE use auditing with direct and timely feedback; implementing and maintaining COVID-Safe work plans; working to prevent presenteeism etc. will all provide increased safety. I do not believe that there is evidence to link the current Australian situation to fit-testing or lack of fit-testing.
In addition, I believe that there are numerous potential unintended consequences of implementing a fit-testing program which includes, but are not limited to, the following;
* Use of PPE will be significantly increased to support fit-testing for larger numbers of staff
* Will staff members not fit-tested be allowed to work? (Think of locums, casuals, agency staff)
* Will staff member not fit-tested to the masks available be allowed to work?
* What if the mask that a staff member is fit-tested to is unavailable at the point of care?
* What frequency of fit-testing will be acceptable? Annual? Who will oversight and this for the 1,000s of staff requiring fit-testing across our country?
* If staff fit-test frequency lapses, will they be allowed to continue to work?
* Will there be WH&S risks and claims associated with any program gaps?A friend of mine working in support of COVID activities recently told me a phrase they had heard commonly used in the Department of Health (not specifically about fit-testing), but what are the optics on this? I wonder if fit-testing is more about being seen to do something to build on the safety culture, rather that actually implementing something with a strong evidence base in preventing disease transmission?
I hope that these thoughts and comments assist in others contributing to discussions and providing input to processes being considered in your facilities and jurisdictions.
Kind regards
Rachel..
Rachel Thomson
Nurse Unit ManagerInfection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South: 03 6166 7882/ 6166 8658
Mobile: 0400 718 574
Email: rachel.thomson@ths.tas.gov.auLevel 4, H Block
48 Liverpool Street
Hobart, 7000From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Crystal Polson
Sent: Tuesday, 1 September 2020 9:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] FW: Poorly fitting N95 masks – My assessment of six masksGreat assessment, Glenys. Your findings underline the necessity of proper fit testing – and not just fit checking – when using respirators.
Here’s a great article on fit testing: https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:text=The%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington <infexion@ozemail.com.au> wrote:
Hi All,With the change in guidelines in relation to the use of N95s in VIC I have been assisting a HCF to identify a suitable N95 masks.
As a start I have reviewed a number of N95 masks on the market to see if they pass a seal check (fit check) on myself.
Note: Im assuming that if worn correctly and with correct/recommend adjustments a mask that fails a seal check (fit check) on myself will also fail fit check.
A user seal check should be done every time a N95 mask is to be worn to ensure an adequate seal is achieved.
In the last 2 weeks I have obtained and reviewed six N95 masks. Four have been supplied to healthcare facilities from stockpiles (i.e. hospitals and/or aged care facilities), one masks was supplied by a manufacture and one mask was provided by a distributor.
Of the 6 masks only 1 passed a seal check (fit check) on myself.
Happy to share my assessment to date which includes details and images of failure issues I noted see attached.
In addition I have attached two recent articles (MAGAZINE OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may also be of interest/assistance if you are reviewing such masks.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES 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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Thank you glenys
This has been very helpful
Vicki Geary
Hesse rural health
Victoria 3241On Mon, 31 Aug 2020 at 22:43, Glenys Harrington
wrote:> Hi All,
>
>
>
> With the change in guidelines in relation to the use of N95s in VIC I have
> been assisting a HCF to identify a suitable N95 masks.
>
>
>
> As a start I have reviewed a number of N95 masks on the market to see if
> they pass a *seal check (fit check) on myself*.
>
>
>
> Note: Im assuming that if worn correctly and with correct/recommend
> adjustments a mask that fails a *seal check (fit check) on myself* will
> also fail *fit check*.
>
>
>
> *A user seal check *should be done every time a N95 mask is to be worn to
> ensure an adequate seal is achieved.
>
>
>
> In the last 2 weeks I have obtained and reviewed six N95 masks. Four have
> been supplied to healthcare facilities from stockpiles (i.e. hospitals
> and/or aged care facilities), one masks was supplied by a manufacture and
> one mask was provided by a distributor.
>
>
>
> Of the 6 masks only 1 passed a *seal check (fit check) on myself.*
>
>
>
> Happy to share my assessment to date which includes details and images of
> failure issues I noted see attached.
>
>
>
> In addition I have attached two recent articles (MAGAZINE OF THE
> AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and *JAMA Intern
> Med. *Published online August 11, 2020.
> doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may
> also be of interest/assistance if you are reviewing such masks.
>
>
>
> Regards
>
>
>
> Glenys
>
>
>
> Glenys Harrington
>
> Consultant
>
> Infection Control Consultancy (ICC)
>
> P.O. Box 6385
>
> Melbourne
>
> Australia, 3004
>
> M: +61 404816434
>
> E: infexion@ozemail.com.au
>
>
>
>
>
>
>
>
>
>
> 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.
>
>
>
> Archive of all messages are available at http://aicalist.org.au/archives
> – registration and login required.
>
>
>
> Replies to this message will be directed back to the list. To create a new
> message send an email to acipclist@acipc.org.au
>
>
>
> To send a message to the list administrator send an email to
> admin@acipc.org.au
>
>
>
> You can unsubscribe manually from this list by sending ‘signoff acipclist’
> (without the quotes) to listserv@aicalist.org.au
>MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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