[Matthew Mason]

Hi Michael,
I am going to take issue with your last paragraph ( in a collegial manner!). We certainly should not be forcing staff to put their personal safety at risk (although we often do *) but I strongly feel that we should not be allowing staff to make personal choices that put their own safety at risk. This opens the organisation up to liability should the HCW be injured/infected and in the case of a potentially infectious disease puts others such as colleagues, patients, family and the general public at risk. There is also the cost to the organisation of having to replace a HCW while they are excluded from providing care. As stated earlier I can understand why staff would want to go in without PPE but I am not sure we should respect/support that choice, particularly as it doesn’t take very long to put on gloves, gown and a mask/respirator.

* Lack of security in Emergency departments, lack of isolation facilities, equipment and supply shortages, poor skill mix the list goes on.

Cheers Matt

Matt Mason
Lecturer
School of Nursing & Midwifery
Faculty of Science, Health, Education and Engineering
University of the Sunshine Coast

Hi Sony

In terms of HCW safety this is not that much different from knowing (or suspecting) a patient has HIV infection or another infectious disease (even meningococcal infection), and whether staff should protect themselves appropriately. As an employer, I think your duty of care to staff will dictate you must have procedures in place to protect staff, therefore requiring HCW’s to perform CPR without appropriate PPE would not be appropriate. But, if staff make a personal choice to perform CPR without appropriate protection, then they should be supported by the organisation. With MERS, one of the differences will be that if staff come into unprotected contact with MERS cases, they should then be considered contacts, and may need to be treated accordingly (eg exclusion from direct patient contact for a period of time).

I personally think we can have administrative guidelines in place (eg staff must wear appropriate PPE when performing CPR), but recognise that some staff many make a personal choice in order to improve patient outcomes that may put their own safety at risk. Organisations should respect this (eg not penalising HCWS’s who chose to do this), whilst not forcing them to put their personal safety at risk.

I hope that makes sense. Good question to raise.

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@svha.org.au
w:www.holyspiritnorthside.org.au
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[Matthew Mason]

Hi Sony,

This is an interesting question. I personally don’t believe that HCW’s should be putting themselves ( or other patients)at risk to perform CPR and I don’t believe that the time taken don appropriate PPE will influence outcomes to any great extent (if it is not a considerable delay!). Except in intensive care situations it is likely that the patient will be found by a HCW who is wearing PPE and who can start basic life support at that time. In this setting it is also likely that the patient has had some time without adequate perfusion prior to being found anyway. Staff arriving after this can don PPE. In-hospital arrest teams (of whatever name) are often not immediately available so time delays are not a new issue. Aside from putting on a mask/respirator most HCW at an arrest should be wearing PPE anyway given the risks of B&BF exposures in arrest events, whether they do or not is another matter.

In intensive care the situation is a little different as the patient may be monitored and as such response times should be quicker. I can see that in this case there could very well be a delay in commencing CPR, whether or not this is significant in terms of outcomes I simply don’t know, I suspect it will depend very much on the individual setting. Particularly how quickly staff can access and don PPE. I believe survival to discharge is less than 30% (with favourable neurological outcome less than that) so we need to be mindful that by not delaying and putting themselves and other patients at risk staff may be doing so for little return.

Ethically and morally it is a difficult decision as staff are going to want to rush in and help, after all this is why they became health workers. In this situation I can give the example of my training in emergency operations and in particular firefighting. There is no way that a fire fighter is going to run into a burning/smoked filled building to rescue someone. They put themselves and their colleagues at risk if they do. So they take the time to put on their PPE before entering. Why should health workers do differently?

Cheers Matt

Matt Mason RN, CICP, BNSci, M Rural Health, M Advanced Practice (IC)

Lecturer
School of Nursing & Midwifery
Faculty of Science, Health, Education and Engineering
University of the Sunshine Coast
University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558 Australia.
CRICOS Provider No: 01595D
Please consider the environment before printing this email.
This email is confidential. If received in error, please delete it from your system.

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