[Lyn Gilbert]

Dear Sue and all,

I appreciate the frustration that HCWs feel about the contradictory advice that is published in the media about the use of PPE which always accelerates in the context of increased community transmission.
I would like to draw you attention to the guidance provided by the Infection Control Expert Group (ICEG) at https://www.health.gov.au/committees-and-groups/infection-control-expert-group-iceg and, in particular to
1. Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID-19 outbreak. https://www.health.gov.au/resources/publications/guidance-on-the-use-of-personal-protective-equipment-ppe-in-hospitals-during-the-covid-19-outbreak
2. Guidance on use of personal protective equipment in non inpatient healthcare settings during the COVID-19 outbreaks. https://www.health.gov.au/sites/default/files/documents/2020/06/coronavirus-covid-19-guidance-on-use-of-personal-protective-equipment-ppe-in-non-inpatient-health-care-settings-during-the-covid-19-outbreak_1.pdf
These documents were published when there was minimal community transmission in Australia, but foreshadowed changes if the transmission rates changed – which will be provided shortly. The CDNA SoNG and ACSQHC advice are based on these ICEG guidance document.

1. The use of face masks and respirators in the context of COVID-19. https://www.health.gov.au/resources/publications/the-use-of-face-masks-and-respirators-in-the-context-of-covid-19

This is a more technical document that aims to provide an evidence base for the guidance documents.

Best wishes

Lyn

Professor Lyn Gilbert AO, MD FRACP FRCPA M. Bioethics,
Marie Bashir Institute for Infectious Diseases & Biosecurity &
Sydney Health Ethics, University of Sydney

Mobile: 0423593385;
email: lyn.gilbert#sydney.edu.au

From: ACIPC Infexion Connexion on behalf of sue greig
Reply to: ACIPC Infexion Connexion
Date: Wednesday, 15 July 2020 at 8:55 pm
To: “ACIPCLIST@ACIPC.ORG.AU”
Subject: Re: [ACIPC_Infexion_Connexion] Precautions for COVID-19 cases

Thank you to all who replied to my query.
The responses received tell me that some of you are as confused about the application of droplet and airborne precautions simultaneously and how to educate HCWs to be consistent and stay safe whilst using appropriate PPE. Some have addressed the potential confusion by creating new terms for precautions e.g. ‘respiratory precautions’ to try to clarify requirements for HCWs where it does not fit with conventional transmission-based precautions.
I also note there appears to be little consistency across the country at a facility or jurisdiction level. This must make it difficult for those HCWs who work in multiple facilities.
The lack of consistent advice between the Australian Guidelines for the Prevention and Control of Infection in Health care on how to apply standard plus droplet and airborne precautions and the CDNA SoNG and then how this is applied by clinicians. Only tonight on the news, I noted several HCWs at NSW COVID screening/testing centres wearing multiple masks simultaneously. Where does it say that in the evidence!!
Many of the research evidence including the Lancet review by Chu et al discusses the benefit of protective eyewear in conjunction with the use of masks and respirators to protect the eyes, this is not new, it is part of standard precautions but hasn’t been well applied by HCWs prior to COVID-19. The research does not seem to clarify why droplet and airborne precautions are applied together or to what benefit. It makes me wonder if it is a ‘more must be better’ recommendation.
I guess we continue to problem solve the confusion and go back to first principles for providing consistent evidence-based advice to health care workers and try to minimise confusion.
On that note, stay safe and thank you again for your feedback.

Kind regards,
Sue
.
Sue Greig RN CICP-E
National Infection Prevention and Control Coordinator
Ramsay Health Care
0407 312 600

On Thu, 9 Jul 2020 at 16:39, John Ferguson (Hunter New England LHD) <John.Ferguson@health.nsw.gov.au> wrote:
Hi Sue

Technically, airborne precautions do not include eye protection whereas droplet do
And so the need to require all three contact+droplet+airborne for COVID as we believe that eye exposure is a significant risk (recent Lancet review by Chu et al)
Obviously a p2/n95 respirator or equivalent is required rather than a surgical mask when airborne required
A risk managed approach is recommended to decide on whether a gown or apron is required

Kind regards
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49223725 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
https://aimed.net.au/2020/03/28/why-are-standard-infection-control-precautions-the-best-bulwark-against-spread-of-covid-19-in-healthcare/
Error! Filename not specified.

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of sue greig
Sent: Wednesday, 8 July 2020 8:49 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Precautions for COVID-19 cases

Dear brains trust,
I am interested in the how ICPs and educators are explaining to HCWs the application of standard plus contact plus droplet plus airborne precautions as required by CDNA latest SoNG, resources provided by the ACSQHC, and NSW Health COVID-19 Policy,
The areas I am interested in particularly are:

1. The practical application of droplet and airborne precautions simultaneously.
2. The PPE you are using fo this level of precautions and why
3. The environmental and patient placement considerations applied when droplet and airborne precautions are applied simultaneously.
Thanks in advance,

Kind regards,
Sue

Sue Greig RN CICP-E
National Infection Prevention and Control Coordinator
Ramsay Health Care
0407 312 600

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Sue Greig

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[Lyn Gilbert]

Dear Colleagues

Thank you to those who have expressed interest in this project. Unfortunately the project outline did not seem to have made it as an attachment to the previous email. It included the important information that the closing date for applications is April 7th. I have included the project outline in the body of this email.

PhD project opportunity with the Australian Partnership for Preparedness Research in InfectouS disease Emergencies (APPRISE) CRE

Project title: A mixed methods study of the significance and practical use of personal protective equipment (PPE) in routine and high-risk hospital practice
Primary Supervisor: Professor Lyn Gilbert, Marie Bashir Institute for Infectious Diseases and Biosecurity & Centre for Value Ethics and the Law in Medicine, University of Sydney; Consultant Emeritus, Western Sydney Local Health District
Associate Supervisor: to be appointed according to professional affiliations of the successful candidate
Literature review: Will include current guidelines (routine transmission-based and high risk e.g. Ebola); attitudes to and differences between standard, transmission-based and high risk IPC precautions; cultural significance of PPE; physical and interpersonal effects on patient care; self-protection vs patient protection.
Methods:
Video-reflexive ethnography project(s): involving staff and patients (or carers/visitors) in selected wards to investigate specific questions raised in previous research, about use of gloves and gowns for routine contact precautions for patients with multi-resistant organism colonisation.

Suitable candidate: Graduate of nursing, medicine, physiotherapy, occupational therapy, health science, social science, psychology etc. with interest in Infection Prevention and Control (IPC) and qualitative/mixed methods research.
Associated research: APPRISE PPE video training project/pilot study.
Closing date for applications: April 7th 2017

Lyn Gilbert

0423593385
Lyn.gilbert@sydney.edu.au

Dear Colleagues,
Some of you, your colleagues or students may be interested in a PhD scholarship, recently advertised, through the University of Sydney.

It is one of several provided by the University to support the Centre for Research Excellence know as APPRISE (Australian Partnership for Preparedness Research in Infectious Disease Emergencies

Hopsital infection prevention and control is one of the themes of this CRE and we are developing a project relating to improved methods of PPE/IPC training for hospital staff (for emergency situations and routine clinical practice).

The scholarship is advertised at http://sydney.edu.au/mbi/news/2017/apprise-phd.php. The project outline is attached.

If you know anyone who may be interested in this PhD project would you draw this to their attention please

Many thanks

Professor Lyn Gilbert
Professor in Infectious Diseases, Sydney Medical School
Senior Researcher, Marie Bashir Institute for Infectious Diseases & Biosecurity & Centre for Value Ethics and the Law in Medicine, University of Sydney
Consultant Emeritus, Western Sydney Local Health District

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