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Good afternoon fellow IPC team,
We have had some staff members getting GP certificate saying that they cannot wear masks or face shields ‘due to medical condition’ (alternative offered and blank clearance still in place). Does anyone have any advice/ feedback on how to progress?
Many thanks,
Melissa Ostrouhoff
Clinical Governance Manager
Palm Lake Care
0477706665
Central Support Office,3 Goodooga Drive, Bethania, QLD
Added by moderator from Infexion Conexion response
Hi Melissa
I assume this is for an outbreak situation? My understanding is that if you have an outbreak and are unable to protect yourself wearing the appropriate mask that you are not able to work in that area due to the high risk of getting the infection.
You would have to be furloughed or work somewhere else that did not require PPE for protection. It is duty of care, WHS, to protect the staff members by providing them with appropriate PPE. Unless they signed a waiver saying they are happy to work unprotected I would think this is your only option.
Kind regards
Yvonne
Yvonne Andrews
Clinical Nurse Consultant
IPC Lead
Care Development Unit
Residential
Baptist Care Canberra
14 Wormald St,
Symonston ACT 2609
P: (02) 6195 3119
M: 0482 180 333
E: YAndrews@baptistcare.org.au
“I work Monday to Friday 8am to 4pm”
Hi All,
Some considerations around this matter:
Providers are well placed to have a HR procedure for mask exemption, including different scenarios.
There are no current Public Health Directions in effect requiring someone to wear a face mask.
However, during periods where there is high circulation of a respiratory organism, (demonstrated by increased case numbers and outbreaks in an area/region), as well as a vulnerable population (older person and RACF), care providers may risk assess the situation to require their staff to wear surgical masks in the facility – with the aim to reduce transmission. In this situation and where a staff member has requested exemption, the reason should be considered – i.e. is there a skin allergy/pressure issue -trialling differing masks and brands, or using a barrier cream, taking breaks from consistent use – i.e. risk assess when the mask is worn. Where there may be respiratory issues/asthma, consider work placement in area where there is less risk (and no requirement to wear mask) to others and person exempting.
Note: If the risk assessment has been made that masks are required, the absence of masks poses risk to resident, others and self.In the event that there is a suspected or known infection or facility outbreak of a respiratory (droplet/airborne) infection, we are guided by national, state/territory IPC guidelines to don surgical (droplet) or N95 (airborne) mask. The risk of transmission is higher in this scenario – then above. In this situation and where a staff member has requested exemption, and all avenues have been exhausted to find a suitable mask, consideration to a work location with less risk- i.e. another facility, work outdoors, work from home.
The absence of the mask poses risk to residents, others and self.Regards Carrie
Added by moderator from Infexion Conexion
Hi Melissa,
I think this is quite a complicated situation that, from an IPC point of view, would require escalating or handing over to other areas depending on how your service works. Essentially it comes down to a workplace health and safety matter rather than IPC. Masks, respirators, and face shields are safety equipment to protect the staff member, patients, residents, and others in the facility (regardless of what type of facility). A staff member cannot be medically exempt from workplace health and safety requirements. A risk assessment could be made if the issue was only that of safety for the individual staff member, but in the case of respiratory infection the risks involve more people and risk assessments would need to be dynamic to address changing exposures. As another reply mentioned the options include furloughing the staff member during periods when they would be required to wear this PPE, or reallocating them to a role where the PPE is not required. This would need discussion at a line manager/HR level as to how this would be managed as it may or may not be possible in your situation given it is potentially a permanent move.
It is certainly a tricky situation. I think as a profession we (IPC) probably need to work with regulatory bodies (WH&S, NMBA, etc.) and other interested parties (unions, Health departments etc.) in considering healthcare worker fitness to practice where there are medical or other conditions that mean IPC practices and requirements cannot be implemented. We often focus in these situations on the needs of the healthcare worker with the impacts on those around them taking up a smaller focus, if at all. For me ethically this is challenging as I get the individual has rights as a worker and human but with those rights comes responsibilities. Should we place the medical needs of a staff member (often protected by legislation) above that of the safety of others in the facility? The recently released ethical framework from APIC and IPAC (https://apic.org/apic-ipac-canada-ethical-infection-prevention-and-control-eipac-decision-making-framework/) is a useful tool but I note doesn’t specifically address this sort of situation in it’s examples, probably due to it being so complex! That said it may be useful to use the tool to outline how could mange the situation and use I to frame discussions with decision makers in your facility.
Cheers Matt
Lecturer, Nursing
Academic Lead: Work Integrated Learning
School of Health UniSC
Ph +61 7 5456 5191 (office)
Ph 0498188039 (mobile)
Added by moderator – post from Infexion Conexion.
Hi Melissa,
Below is the Victorian DH respiratory protection program advice:
Respiratory protection programs implement strategies designed to protect workers from workplace respiratory hazards, including COVID-19. All Victorian health services where health care workers, including volunteers and students on clinical placement, have the potential to be exposed to respiratory hazards are required to establish and maintain an RPP. See Victorian Respiratory Protection Program.
Employers are responsible for:
completing a risk assessment that identifies staff who require P2/N95 respirators
ensuring users of respirators undergo AS/NZS 1715:2009 approved fit-testing. Either qualitative or quantitative methods are valid and appropriate
providing education and training on the safe and appropriate use of selected PPE.
Employees are responsible for:using PPE as instructed by the employer
reporting any damage, defects, or malfunctioning PPE
reporting any physical or medical limitations that may impact their ability to safely wear PPE.Discussion on a process of identifying alternative respirator or work arrangements if a worker is unable to wear a mask. Depending on the role and the current public health directions, suitable alternatives may include:
• facilitating the ability to work from home
• offering hypo-allergenic masks
• trying different brands of masks (different materials and chemicals used in manufacturing process)
• redeployment to alternative duties that are not public-facing or do not involve working in a shared space.
I suggest you engage the organisations Human Resource delegate on a case by case basis, for each staff member deemed medically unfit to wear a mask and face shield, to establish a risk assessment and control measures to eliminate or mitigate risks to residents and staff.
Kind regards
Penny
Penny Radalj
IPC Consultant
Baron Health, Victoria
penny.radalj@barwonhealth.org.au
Added by moderator – post from infexion conexion
Hi Melissa,
In the organisations I have worked in, in Victoria, the issue has been addressed by ensuring organisational IPC policy and procedure reflect best practise for the staff who were already employed when these issues arose.
Staff were given the opportunity to follow organisational process and remain employed and if not, whilst it was respectfully understood, employment in the care environment could not continue. If appropriate and feasible, these staff were offered opportunities in support services away from the care environment (i.e. head office). The initial outcome for implementing this, wasn’t as negative as expected and was relative to projected workforce turnover.
We then turned our focus toward the recruitment and interview process to ensure expectations regarding PPE (and vaccination) compliance was addressed prior to onboarding. Then contracts and position descriptions were amended to explicitly list the inherent requirements of each position. Both the position description and contract are then required to be signed off by the recruit.
Happy to share experiences further via phone.
Kind Regards
Tanya McPharlane
Quality & Compliance Manager
Mt Eliza Gardens Aged Care
235 Canadian Bay Road, Mt Eliza, Vic. 3930
T: 03 8001 8000
M: 0459 635 694
