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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 communityThe 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,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WAMESSAGES 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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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________________________________
CAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
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 communityThe 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,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
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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Hi Ed
Many, many years ago, I had it drummed into me by a wise (well, I thought he was wise at the time!) ID physician NOT to put PFR’s on patients with respiratory compromise because it was hard enough for them to breathe without adding a difficult-to-breathe-through layer. That always stuck with me, so I make sure the policies at facilities I work at don’t mandate patients donning PFRs.
There is also no definitive evidence I have yet seen that would suggest a well fitted surgical mask is any less effective in potentially reducing transmission of respiratory pathogens than a PFR.
So that relates to symptomatic patients, not well visitors, but since we don’t do any form of checking about respiratory compromise I’d be more comfortable in asking visitors as well as non-symptomatic patients to wear surgical masks rather than show them how to don a PFR and hope it didn’t cause an issue.
Just my thoughts.
Cheers
MichaelMichael Wishart | Infection Control Coordinator, CICP-E
St Vincent’s 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 Vincent’s 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[http://i8.cmail19.com/ei/t/6C/F77/A00/141133/csfinal/StaticEmailFooter-SVPHN-Celebrating20Years-650×150-9900000000079e3c.png]
[cid:image001.png@01D72F93.FCA8FC30]
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________________________________
CAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
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 communityThe 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,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
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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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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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,CHEOn 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 controlCAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
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 communityThe 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,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
DISCLAIMER: The information contained in this email message is confidential. If you are not the intended recipient, any use, disclosure, copying or retention of this document is unauthorised. If you have received this document in error, please delete and contact the sender immediately.
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.
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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G’day Dr McLean
As a non-health care person, I have found this issue a little confusing. An
“expert” on the ABC radio recently said that surgical masks were better at
reducing the release of the viral load from an infected person compared to
an N95!The extract below is from the Infection Control Experts Group of the
Australian Government:*This evidence is also supported by several systematic reviews and
meta-analyses of randomised controlled trials (RCTs) that have shown that
surgical masks and particulate filter respirators (PFRs) provide equivalent
protection against respiratory viral infections, with modes of transmission
likely to be similar to those of COVID-19 (30, 41-43).*This document was written in 2020, so I’m assuming things have changed
since then.Regards
Lalith Ramachandra
LR Consulting Engineers
for DIPL
PO Box 40968
Casuarina, NT
p 0401117423
e lalith.ramachandra@gmail.com*In the beginning the Universe was created. This*
*made a lot of people very angry and has been widely*
*regarded as a bad move.** Douglas Adams*On Tue, 12 Jul 2022 at 11:05, Alan mclean wrote:
>
> 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
>
> CAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
>
>
> 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
> *DISCLAIMER:* The information contained in this email message is
> confidential. If you are not the intended recipient, any use, disclosure,
> copying or retention of this document is unauthorised. If you have received
> this document in error, please delete and contact the sender immediately. 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.
>
> 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.
>
> Replies to this message will be directed back to the list. To create a new
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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.
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Hi All,
This paper from a group at Monash University Melbourne does provide data re:
the protection from surgical masks verses fit and non-fit tested N95 masks
along with the addition of heap filters (air purifiers), however the study
is in healthy healthcare workers not patients.*”Fit-Tested N95 Masks Combined with Portable High-Efficiency
Particulate Air Filtration Can Protect Against High Aerosolized Viral Loads
Over Prolonged Periods at Close Range”https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac195/6582
941?login=falseMay be of interest/use.
regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Edward
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
_____
> on behalf of Raby, Edward
<Edward.Raby@HEALTH.WA.GOV.AU >
<ACIPCLIST@ACIPC.ORG.AU >CAUTION External Communication: This email originated from outside of the
organisation. Do not click links or open attachments unless you recognise
the sender and know the content is safe.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 communityThe 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
If you are not the intended recipient, any use, disclosure, copying or
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Yes things have changed significantly since then. With BA4 & BA5 likely to be the most transmittable diseases ever, and most of the evidence is now very old, and in some cases now questionable, I would suggest we use the public health doctrine of not waiting for scientific evidence to act.
Regards
Alan McLeanOn 12 Jul 2022, at 11:46, Lalith Ramachandra wrote:
G’day Dr McLean
As a non-health care person, I have found this issue a little confusing. An “expert” on the ABC radio recently said that surgical masks were better at reducing the release of the viral load from an infected person compared to an N95!
The extract below is from the Infection Control Experts Group of the Australian Government:
This evidence is also supported by several systematic reviews and meta-analyses of randomised controlled trials (RCTs) that have shown that surgical masks and particulate filter respirators (PFRs) provide equivalent protection against respiratory viral infections, with modes of transmission likely to be similar to those of COVID-19 (30, 41-43).
This document was written in 2020, so I’m assuming things have changed since then.
Regards
Lalith Ramachandra
LR Consulting Engineers
for DIPL
PO Box 40968
Casuarina, NT
p 0401117423
e lalith.ramachandra@gmail.com[https://www.engineersaustralia.org.au/sites/default/files/logos/EA_ProfEngineer_Member_RGB.jpg]
In the beginning the Universe was created. This
made a lot of people very angry and has been widely
regarded as a bad move. Douglas AdamsOn Tue, 12 Jul 2022 at 11:05, Alan mclean <adelaidealan@hotmail.com> wrote:
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,CHEOn 12 Jul 2022, at 10:27, Raby, Edward <Edward.Raby@health.wa.gov.au> 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 <ACIPCLIST@ACIPC.ORG.AU> on behalf of Raby, Edward <Edward.Raby@HEALTH.WA.GOV.AU>
Sent: Wednesday, 6 July 2022, 14:45
To: ACIPCLIST@ACIPC.ORG.AU <ACIPCLIST@ACIPC.ORG.AU>
Subject: [ACIPC_Infexion_Connexion] PFR for source controlCAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
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 communityThe 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,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
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