[Keven Renshaw]

Hi Terry

I wrote out a similar response yesterday in order to balance out the reason why the tighter mask may help some hospitals deal with the slack fitting issue. I deleted it as it happens and now wish I hadnt.

If nothing else, I felt it was an ingenious method to amend what some people found was a drawback to the surgical mask. Yet I agreed with Michael et al for their equally valid reasons for not using the methodology.

You alluded to having less and less stocks of masks available in your state and it is that point I would like to enlarge upon. Considering the outbreak we are seeing currently and the anticipation that it may get worse and creep across states that I wonder if a war room footing for PPE be adopted country wide. For all hospitals and clinics to pool together just a fraction of their own PPE which can be distributed to those places most needed.

Yes I know there may be a lot of hospitals hoarding PPE stocks similar to the great toilet paper disappearance we witnessed a few months back. Given Queensland has so far not come under the cosh for new cases compared to Victoria, as a nurse I would struggle knowing on my stores shelf a mask that a fellow nurse desperately needs to keep them and their patients safe. I wonder what everyone thinks ?. Yes I am not offering a complete written solution on here but we are all in the care family and ethically, it would be the right thing to do.

Keven Renshaw
Infection Control Practitioner
Mater Health

Infection Control | Mater Hospital | Ward Street | Rockhampton | 4700
t: 07 49313420 e: krenshaw@mercycq.com w: mater.org.au

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From: ACIPC Infexion Connexion On Behalf Of Terri Cripps
Sent: Monday, 27 July 2020 5:16 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] ACIPC_Infexion_Connexion modification of surgical masks

Hi,
Its funny how we are all addressing the same problem on the same day in each of our places of work. This topic came up for us at Sydney Childrens Hospital Network last Friday and has continued today.
In NSW currently, paediatric and smaller sized surgical masks are in very short supply and we will probably run out this week with not much prospect of getting any in the near future.
So we are looking at videos such as the one Elizabeth included in her email. I know that the clips show people who mention a lack of P2 or N95 masks which have led them to using this technique on ear loop surgical masks.
Whilst I would never presume to advocate that this technique be used in place of an N95 or P2 mask, I feel in my specialty it has a place for use. The reasons you have stated are very valid reasons to be cautious about using this technique. I would certainly continue to encourage and stress that adults with average and larger sized faces continue to wear the surgical mask in the preferred way. We have, and will continue to, impress upon staff that the technique is to be used with a surgical mask only and to use the provided N95/P2 masks for AGPs.
We have tested this technique on ourselves (not for me personally my face is too large), those staff with small faces and those paediatric patients of 12 years and above (this is what the NSW guidelines suggest). Some have found the fit to be an improvement on a mask that has gaping at the sides. It also provides the wearer with more comfort in the knowledge that there may be less chance of them contracting COVID-19 due to the closer fit with less gaps. It has prevented some staff and children from being worried and anxious about this.
We also have a younger age group of children aged 2 years to 12 years who are used to wearing the paediatric sized masks when visiting the hospital for reasons of being immune suppressed, post-transplant or having cystic fibrosis. These children may benefit from using this technique when we only have adult sized masks available.
I think with education of staff and explicit reasons of when this technique is to be used, it may be a useful tool for some but not all, staff and our specialised patient population.
The other technique that is around is a plastic piece which pulls the ear loops back past the ears onto the back of the head in the hair to make the mask fit better to the face. I have more concerns with this as I worry they will contaminate themselves trying to extricate the mask from the pieces of plastic after use.
Happy to be proven wrong on any of the above but just wanted to put my point of view out there.
Thanks,
Terri Cripps | Clinical Nurse Consultant – Infection Prevention and Control | SCHN
t: (02) 9382 1876 | f: (02) 9382 2084 | e: terri.cripps@health.nsw.gov.au | w: http://www.schn.health.nsw.gov.au
m: 0436 287 137 | p: 47140

From: “Sewell, Dallas” <Dallas.Sewell@HEALTH.WA.GOV.AU>
Date: 27 July 2020 at 12:27:26 pm AEST
To: “ACIPCLIST@acipc.org.au” <ACIPCLIST@ACIPC.ORG.AU>
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks
Reply-To: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU>

I also agree with Michaels assessment, and we are discouraging this practice at PCH for those reasons.

Thanks,

Dallas

Dallas Sewell | Clinical Nurse Consultant | Infection Prevention and Control
Office 2D, Perth Childrens Hospital
15 Hospital Avenue, Nedlands | Locked Bag 2010, Nedlands WA 6909
T: (08) 6456 5359 | M: 0436 595 150 | E: dallas.sewell@health.wa.gov.au

Report Sharp Injuries or Blood and Body Fluid Exposure
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From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Marilyn Harris (Sydney LHD)
Sent: Friday, 24 July 2020 10:42 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks

I agree with Michaels assessment.

Stay safe everyone

Marilyn Harris

CNC Infection Prevention & Control | Sydney Dental Hospital and Oral Health Services, SLHD
Sydney Dental Hospital, 2 Chalmers Street, SURRY HILLS 2010
Tel 02 9293 3276 | Fax 02 9293 3488 | marilyn.harris@health.nsw.gov.au

[cid:image001.jpg@01D661B7.CFB2A870]

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, 24 July 2020 11:04 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] modification of surgical masks

Hi Elizabeth

The technique itself looks OK, particularly with that specific brand and type of mask. You would have to test it on other brands and types to see if the same technique could be used.

BUT Im not convinced that using this technique is a good idea or even necessary, for a number of reasons, including:

1. It assumes that a loose fitting mask is a risk. If you are using a level 2 or 3 surgical mask appropriately to prevent droplet transmission, there is no evidence to suggest the seal at the sides is so important.

2. You are, in my opinion, fanning the flames for the aerosol route of transmission being important with routine contact, not just droplet spread.

3. Using a level 2 or 3 surgical mask with a seal is sending a false assurance about spread from aerosols, as these masks are not designed to prevent inhalation of aerosols like a correctly fitted P2/N95 masks.

I will be quite interested in other members view on this.

Cheers
Michael

Michael 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.au

St 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

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[Stop the Flu before it stops you]

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Elizabeth Carroll
Sent: Friday, 24 July 2020 10:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] modification of surgical masks

https://youtu.be/2TTg53aAP8Q

Hello all: I have seen this video on utube which shows how to modify a surgical mask by folding it to achieve a tighter fit.
Is there any benefit in modifying the masks in this way?

Is there any problem with doing this – assuming of course that its a fresh mas), and also ensuring that that doffing is as per normal infection control procedure?

I was considering sharing this with my Managers and incorporating into our procedures (in residential and home aged care).

Any thoughts?

Elizabeth Carroll | Executive Manager Residential & Chief Clinical Officer
p 07 3223 4444 d 07 3223 4491 f 07 3223 4411 m 0468 522 131
Level 3, 19 Lang Parade, Milton Q 4064 | PO Box 771, Toowong BC Q 4066
Email: ecarroll@prescare.org.au | Web: http://www.prescare.org.au

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[Keven Renshaw]

Hi Terry and Rachel

When doing fit checking of P2/N95 masks, the most common sense approach I’ve found is that when fitted, inhaling and exhaling, is the mask moving ?. This is a similar check that as an anaesthetic nurse I found that if an airway mask is not fitted correctly to the face, you will leak air ergo, no seal and inadequate ventilation of a patient.

I see no difference in this. Every persons face is unique, every contour is different. Putting the onus on the staff to ensure this simple step is managed means they can wear the mask with the confidence that at that time, their airway is as tight as it can be.

I hope this may help ?. I do a series of P2/N95 training to the units at the hospital and as soon as the member of staff are comfortable with the visual seal caused by breathing in and out, I am satisfied a seal is produced.

Keven Renshaw
Infection Control Practitioner
Mater Health

Infection Control | Mater Hospital | Ward Street | Rockhampton | 4700
t: 07 49313420 e: krenshaw@mercycq.com w: mater.org.au

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Thankyou Rachel for raising this challenging issue.

As we reintroduce elective procedures into the privately operated Day Surgery environment and where Aerosol Generating Procedures are being performed, some state and territory guidelines require P2 / N95 masks to be worn for all patients, not just those that have suspected or confirmed COVID-19.

Apart from the issues with lack of supply, there is limited expertise in fit testing / fit checking in this sector healthcare and I am concerned about the risks to the personnel working in these operating rooms.

In my humble opinion, there needs to be a nationally endorsed response to your questions.

Kind Regards
Terry McAuley
Director
MSc Medical Device Decontamination

PO BOX 2249, Greenvale, VIC Australia 3059

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Hi all

We are interested in other states/jurisdictions/facilities approaches to fit-testing, either qualitative or quantitative.

We had a qualitative fit-testing program within our hospital previously and we made the decision to disband this earlier in the year for a number of reasons.

We are now getting significant pressure from a particular clinical group to re-establish fit-testing again.

We had a number of issues with the fit-testing program previously and our rationale for not re-establishing fit-testing currently include the following:

* Fit-testing has not been proven to provide safer P2 (N95) mask use compared with fit-checking alone
* Despite the presence of the Australian Standard, fit-testing is not mandatory and ‘fit-checking is accepted to be the minimum standard’
* There are a number of practical difficulties to be considered with the re-introduction of a fit-testing program;
* If fit-testing is offered to one craft group, all healthcare workers that require a P2 (N95) mask within their clinical role will expect a similar approach. Equitable approach would need to be considered for all.
* Some individuals will not have a successful ‘fit-test’ e.g. do not taste the fit-testing solution, do not have a successful fit-test with any of the available masks. Does this equate to that healthcare worker being unsafe with an appropriately fit-checked P2 (N95) mask?
* Resources required for fit-testing program is not insignificant i.e. human resources and PPE required, with consideration for annual testing thereafter
* What to do for individuals that have not been fit-tested as yet but they are required to work with the requirement of a P2 (N95) mask?
* What to do if individuals’ fit-tested mask is not available at the point of care, particularly in the setting of the current PPE stock issues?

We would be really keen to understand others’ thoughts and experiences and approaches.

Your urgent advice would be much appreciated. Please feel free to email me off-line or even call me if you can

Thanks in advance
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

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[Keven Renshaw]

Hi Susan

Do you have any written documents supporting what the government have told NSW private hospitals ?. I would really be interested in this to support our current limited stock and supplies.

Keven Renshaw
Infection Control Practitioner
Mercy Health and Aged Care Central Queensland Limited
Ward Street, ROCKHAMPTON QLD 4700

Dear All,

NSW Private Hospitals have been informed that the government stockpile of masks will not be available for private hospitals, also that unless a patient is medically unable to be cared for at the private hospital facility, they are not to transferred to a public hospital.

Whilst we are not out of supplies of masks, if we were to have many patients diagnosed with COVID-19, we would struggle with supply, particularly with surgical masks. We are not a surgical hospital, rather, medical, post surgical, rehab & palliative care.

During the SARS outbreak, masks were reportedly re-used, after spraying with a disinfectant and bagging for a nominated period of time. There has also been talk of hand made masks for low risk situations.

I’m wondering what other facilities are experiencing?

Regards,

Susan

Susan Farrugia
Infection Control Coordinator
Arcadia Pittwater Private Hospital
Infectioncontrol@arcadiapittwater.com.au

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