In Victoria, more than 1,100 health-care workers have now been infected with SARS-CoV-2, the coronavirus that causes COVID-19. Some 11% of active cases are workers in the health-care sector. Health-care workers are reported to be among those fighting for life in Victorian intensive care units

Dennis, Alicia

Whitelaw, Jane L

English

Research Online

University of Wollongong Research Online Faculty of Arts, Social Sciences and Humanities - Papers Faculty of Arts, Social Sciences & Humanities 1-1-2020 PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus Alicia Dennis Jane L. Whitelaw University of Wollongong, jwhitela@uow.edu.au Follow this and additional works at: https://ro.uow.edu.au/asshpapers Recommended Citation Dennis, Alicia and Whitelaw, Jane L., "PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus" (2020). Faculty of Arts, Social Sciences and Humanities - Papers. 83. https://ro.uow.edu.au/asshpapers/83 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus Abstract In Victoria, more than 1,100 health-care workers have now been infected with SARS-CoV-2, the coronavirus that causes COVID-19. Some 11% of active cases are workers in the health-care sector. Health-care workers are reported to be among those fighting for life in Victorian intensive care units. Keywords ppe, coronavirus, unmasked:, why, health-care, workers, australia, inadequately, protected, against Publication Details Dennis, A. & Whitelaw, J. L. (2020). PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus. The Conversation, 4 August 1-6. This journal article is available at Research Online: https://ro.uow.edu.au/asshpapers/83 AuthorsAlicia Dennis Associate Professor MBBS, PhD, MPH, PGDipEcho, FANZCA, University of Melbourne Jane L Whitelaw Certified Occupational Hygienist, University of Wollongong Academic rigour, journalistic flair In Victoria, more than 1,100 health-care workers have now been infected with SARS-CoV-2, the coronavirus that causes COVID-19. Some 11% of active cases are workers in the health-care sector.Health-care workers are reported to be among those fighting for life in Victorian intensive care units.ShutterstockPPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus August 4, 2020 6.01am AESTWhile we don’t know what proportion of the Victorian health-care workers currently infected with COVID-19 acquired it at work rather than in the community, it’s almost certain a portion of these infections were contracted in the workplace.MJA Editor in Chief@MJA_Editor#Coronavirus Victoria: doctor in ICU after contracting #COVID19  - just devastating. Preventable. Should be “gold standard” PPE use in hospitals in ALL hotspot areas. mja.com.au/journal/2020/c…'Deeply distressing': Young Northern Health doctor in ICU with COVID-19Doctors are calling for greater transparency as the number of healthcare workers that have tested positive for the virus since the pandemic began theage.com.au9:33 PM · Jul 31, 202065 See the latest COVID-19 information on TwitterEarly experience from China found the proportion of health-care workers who contract COVID-19 can be up to 29% in settings with inadequate personal protective equipment, or PPE.Lessons from China also show workplace transmission of SARS-CoV-2 can be reduced to negligible numbers with sufficient supply, and correct use of, airborne precaution PPE.Right now, Australia is sitting somewhere in the middle. National guidance needs to be urgently updated to reflect safest practice and acknowledge what we’re learning about the airborne spread of the virus.Read more: Supplies needed for coronavirus healthcare workers: 89 million masks, 30 million gowns, 2.9 million litres of hand sanitiser. A month.What is PPE?PPE is a crucial part of controlling exposure to hazards in all workplaces. It includes items such as masks, respirators, face shields, gowns and gloves. PPE is categorised into three tiers, corresponding to the type of hazard.Level 1: standard and contact precaution PPEThis PPE limits exposure to standard contact hazards. Examples include face coverings and administrative controls such as hand hygiene, cough etiquette and physical distancing.Level 2: droplet precaution PPEThis PPE prevents exposure to contact and droplet hazards. Examples include surgical masks, eye shields or goggles, long-sleeved gowns, and gloves. Level 3: airborne precaution PPEThis PPE aims to prevent exposure to contact, droplet and airborne hazards. It includes N95/P2 respirators or powered air-purifying respirators with a P2 filter, eye shields or goggles, fluid-resistant gowns, double gloves, disposable head and neck wear, and protective footwear.Current Australian guidelinesThe national guidance on the use of PPE in hospitals during the COVID-19 outbreak has been written by the Infection Control Expert Group and endorsed by the Australian Health Protection Principal Committee. The guidance doesn’t recommend universal airborne precaution PPE for health-care workers dealing with patients suspected or confirmed to have COVID-19. It only recommends level 3 protection for highly specialised procedures such as intubating a patient.Read more: Is the airborne route a major source of coronavirus transmission?A preprint in the Medical Journal of Australia has criticised the current guidance, noting it’s not aligned with increasing scientific evidence regarding airborne transmission of SARS-CoV-2 and is therefore inadequate to protect health-care workers. Inadequate national guidance has led to an inconsistent and non-standardised approach to airborne precaution PPE across all health-care settings. In the absence of strong national safety guidance, some hospitals and jurisdictions are making independent improved safety recommendations to their staff. We’ve heard a lot about PPE in the context of coronavirus. But PPE isn’t just for health-care settings. ShutterstockWhy we need level 3Transmission of SARS-CoV-2 occurs by direct contact with droplets and contaminated surfaces — but emerging data suggests it can also be spread by the airborne route.An analysis of health-care worker deaths in the United Kingdom found none among wearers of level 3 PPE, suggesting airborne precaution PPE was protective.Importantly, surgical masks are primarily designed to protect the environment from the wearer. They’re not designed to protect the wearer from respiratory pathogens.A recent review found N95 respirators offered significantly better protection against viruses including COVID-19 than surgical face masks, while one study found N95 respirators provided 8-12 times more protection than surgical masks against small viral particles.Read more: Rising coronavirus cases among Victorian health workers could threaten our pandemic responseSurgical masks don’t offer as much protection against COVID-19 as respirator masks. ShutterstockCoronavirus Hospital Masks Infection control COVID-19 SARS-CoV-2 health-care workers PPEIn Australia, N95 is synonymous with P2 respiratory protection and refers to the filtration efficiency (so N95 means 95% of particles are filtered). But it’s the total inward leakage — what goes through and around the facemask — that’s the critical factor in determining the level of protection the wearer achieves. To ensure total inward leakage is minimised, respiratory masks used under level 3 PPE must meetcertain standards, including fit testing and the training of wearers in their use.We need immediate actionSARS-CoV-2 is a highly contagious virus with the potential to cause significant ill health and death. In health-care settings, it should be classified as a lethal biohazard and managed accordingly. The safest approach is to consider all people with confirmed or suspected COVID-19 in hospital, being transported to hospital or being tested for COVID-19 as being able to spread the virus via the airborne route. As such, the use of airborne precaution PPE with a correctly fitted N95/P2 respirator is essential.Read more: Health-care workers share our trauma during the coronavirus pandemic – on top of their ownThere’s also an urgent need for a national registry of health-care worker infections, containing data about the category of health-care worker, where the infection was acquired, severity of disease, hospitalisation, intensive care and death numbers. This will give us a better understanding of the scope and specifics of the problem, and inform policy and prevention strategies.Finally, adequate supply of airborne precaution PPE must be available throughout Australia to protect health-care workers from COVID-19.

PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus

https://ro.uow.edu.au/cgi/viewcontent.cgi?article=1089&amp;context=asshpapers

PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus

Abstract

Similar works

Full text

Available Versions

Research Online