PPE FAQs

[Philip Russo]

A helpful FAQ from Allen Cheng, reproduced with permission.

Should I wear surgical masks for all patient interactions?
At the current time, almost all cases have had a history of travel or contact with known cases. We continue to test outside of these groups, including those in vulnerable settings, in healthcare workers and in hospitalized patients with acute respiratory tract infection.

It is likely that we may change this policy to require the use of surgical masks for all patient interactions in the future if and when community transmission becomes more common. However, it is important to preserve the PPE that we have currently, to deploy when that time comes. There are ongoing national initiatives underway into securing the supply of PPE.

Should I wear P2 respirators for all interactions with patients with suspected or confirmed COVID-19?
Systematic reviews have consistently found surgical masks and P2 respirators to be substantially better than no protection and no difference between the two for routine care (excluding AGPs). This has again been confirmed by a recent Cochrane review.

Current WHO and national guidelines recommend droplet precautions for routine care of patients with suspected and confirmed COVID-19. This has recently been re-endorsed by WHO.
https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Note that there are two important exceptions
1. Patients with suspected COVID-19 who are undergoing aerosol generating procedures
2. Patients who are critically ill (in ICU). Studies in this group have shown a high viral load, and these patients are more likely to require aerosol generating procedures.

When doing high risk procedures (eg ENT), should I test patients without risk factors for COVID-19 and without acute upper respiratory symptoms?
There has been concern about procedures where there is extensive aerosolisation of respiratory mucosa, such as ENT, maxillo-facial surgery and some neurosurgical procedures (eg pituitary surgery).

Testing asymptomatic patients prior to surgery does not exclude the later development of COVID-19, as the pre-symptomatic period is thought to be less than 24 hours. There is a shortage of PCR test capacity, and the turn-around time for tests is currently at least 24 hours, and in many hospitals may be considerably longer. This would unnecessarily delay urgent surgery in patients at low risk of COVID-19.

When doing high risk procedures (eg ENT), should I use PPE other than P2 respirators?
PAPRs are not widely available in Australian hospitals and there is a global shortage of supplies. This would thus require transfer of the patient to one of the few hospitals in Australia that have these available. PAPRs require extensive training so that operators do not endanger themselves by self-contamination on removal. They also present several practical issues, such as their use with loupes and headlamps used in some specialties.

It should be noted that protection for surgical staff undertaking high risk procedures are more than only PPE. These include the early identification of symptomatic patients with COVID-19, and asymptomatic patients at high risk of developing COVID-19 (including close contacts and those with recent international travel), according to current guidelines which are constantly reviewed. Additionally, measures should be taken to reduce aerosolisation (eg avoiding high speed drills where possible, atomisation of local anaesthesia)

—
Allen Cheng, MB BS, FRACP, MPH, MBiostat, PhD
Director
Infection Prevention and Healthcare Epidemiology Unit, Alfred Health
Professor of Infectious Diseases Epidemiology
School of Public Health and Preventive Medicine, Monash University
Infectious Diseases Physician
Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University

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