[adelaidealan@hotmail.com]

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 McLean

On 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

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On 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,CHE

On 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 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
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[adelaidealan@hotmail.com]

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.
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[adelaidealan@hotmail.com]

Hi,

The attached doc from The Federation of European Heating, Ventilation and Air Conditioning associations is a good resource. It is specifically looking at air conditioning during COVID. This is a version from last year so check to see if it have been update.

Kurnitski J BA, Franchimon F, Mazzarella L, Hogeling J, Hovorka F, et al,
REHVA COVID-19 guidance document. Brussels: The Federation of European Heating, Ventilation and Air Conditioning associations; 2020. p. 1-17.

Dr Alan McLean
BHlthSc, MHlthAdmin, DrPH, FCHSM,CHE

Principal Consultant
AMAC-Consulting
Health Systems and Business Consultants
AMAC-consulting@outlook.com

HI All,

Can anyone give me any direction in regards to what to do with air-conditioning/ heating systems at a Residential Aged Care site in the event of a COVID outbreak.

Given that COVID has been spread at some of the medi hotels via air-conditioning systems and in particular the Delta strain.

Is the thought that the air-conditioning would be turned off in zones affected?

Your thoughts and guidance greatly appreciated.

Kind Regards

Kathleen

Kathleen Felstead
Clinical Quality & Education Consultant
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