Personal Protective Equipment (PPE)
The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).
Join the NSWNMA to ensure you’re covered at work.
The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.
Escalation to moderate risk
Given the current context of local transmission, NSW Health is advising Local Health Districts (LHDs) and Specialty Health Networks (SHNs) to escalate to a moderate risk level (Amber). This requires all health workers wear a surgical mask if they are within 1.5m of patients. Patients are also required to wear a mask, where possible. This advice applies to hospital and community health settings and came into effect from Friday 24 July 2020.
The new advice on mask use is underpinned by expert risk assessments. The recommendations are detailed in the COVID-19 Infection Prevention and Control Response and Escalation Framework and this poster.
Access Frequently Asked Questions (FAQs) about the escalation to Amber Alert here.
If you are providing care for patients who have or are suspected to have COVID-19 or are working in a high-risk clinical area, your employer must provide you with appropriate PPE to ensure you can do your job safely. Such as:
- You are to wear prescribed PPE as instructed (your employer needs to ensure you are trained in how to use PPE safely).
- Do not undertake tasks requiring PPE if the PPE is not available for use. Any such tasks are not to proceed until required PPE is readily available.
- If you are concerned for your safety, you must raise your concerns immediately with your manager.
Where staff are performing tasks requiring P2/N95 mask use under the CEC guidelines and where the employee has fit checked the available P2/N95 mask sizes and these sizes are not a correct fit, then the employee is to be temporarily redirected to work which does not require the use of a P2/N95 mask until suitable masks with correct fit become available.
CEC guidelines around Respiratory Protection in Healthcare also state:
In NSW, LHDs/SHNs are required to implement respirator fit testing in their facilities for health workers (HWs) performing respiratory Aerosol Generating Procedures (AGPs) on patients with COVID-19 or providing clinical services to patients on airborne precautions in high risk areas.
What PPE do I need?
Refer to CEC guidance to determine the correct use of PPE in your area:
- Special Precautions for COVID-19 Designated Zones (added 28/4/2020)
- Infection Prevention and Control COVID-19 Personal Protective Equipment (added 28/4/2020)
- Quick Guide to PPE for the Emergency Department (27/4/20)
- Application of PPE in Response to COVID-19 Pandemic (added 19/3/2020)
- Principles of fit checking: how to don and fit check P2 and N95 masks (updated 19/3/2020)
Fit testing program
The NSW Government and Clinical Excellence Commission (CEC) have recognised the need for clearer and consistent fit testing thanks to ongoing campaigning from unions. A fit testing program will now be recognised as an addition to current infection prevention and control education and guidance on the adequate use of PPE.
Implementation across NSW will be carried out as a rolling program, commencing by working with Sydney LHD (SLHD) and Hunter New England LHD (HNELHD) who have both been focusing on limited fit testing with high risk staff in high risk areas, caring for high risk patients.
The program will learn from them in the first instance on areas including:
- Appropriate training providers
- Optimal training programs for frontline clinical staff on how to fit test and fit check their masks
- Alternative masks and protection for staff who do not achieve a fit test
- Processes to identify and record which staff have been tested and which mask is a fit for them
- Optimising the current supply chain around fit testing training and implementation
- Embedding this approach into the CEC guidance on Transmission Based Precautions.
- Creating capacity and capability at an LHD level to support sustainability of any approach
Phase 1 Process
Implementation will focus on the high risk areas of anaesthesia and ICU in SLHD and HNELHD. Within these environments it will focus on clinicians who are caring for patients who are COVID-19 positive or symptomatic and who are required to administer Aerosolised Generating Procedures (AGPs) individually or as a clinical team. Staff who are caring for COVID positive or symptomatic patients who are required to apply PPE for contact and droplet precautions, which includes a surgical mask, will not require fit testing.
If clinical staff are required to administer AGPs in anaesthesia or ICU they will be fit tested. Specific AGPs for the relevant specialties would be confirmed in partnership with SLHD and HNELHD clinicians and would include:
- insertion or removal of endotracheal tube
- deliberate or inadvertent disconnection/reconnection of a closed ventilator circuit
- high frequency oscillatory ventilation (HFOV)
- open oropharyngeal or tracheal suctioning
- upper respiratory instrumentation e.g. bronchoscopy, tracheostomy
- intercostal catheter insertion for relief of pneumothorax
- manual or non-invasive ventilation (NIV)
– bi-level positive airway pressure ventilation (BiPAP)
– continuous positive airway pressure ventilation (CPAP)
- collection of induced sputum
- high flow nasal oxygen (HFNO)
- chest physiotherapy
Post Phase 1 Process
This would inform the development of an NSW implementation plan for fit testing and ongoing emphasis on the responsibility of staff to comply with infection control standards and guidance.
Additional masks for healthcare workers
On 8 April, Minister for Health, Greg Hunt, advised 11 million masks will be distributed to healthcare workers across the country immediately.
Seven million will go to hospitals, 2.3 million to the primary health network, including 1.5 million for general practice clinics.
Respiratory clinics, set up by the government for those with mild and moderate COVID-19 symptoms, will receive 160,000 masks.
The National Aboriginal Community Controlled Health Organisation will receive 75,000 masks and 500,000 will to pharmacies.
The aged care sector will receive 1.7 million masks.
Another 500 million have been ordered from domestic supplies and internationally.
NSW Health is also implementing a statewide strategy to ensure all staff have the personal protective equipment needed to protect them at work. This includes:
- collaborating with the Federal Government to access the national medical stockpile
- seeking alternative supply chains
- expediting equipment orders since January
- working around the clock to secure and move stock into NSW to meet future needs
- pursuing all channels of existing supply, new supply and alternative supplies
- engaging new and existing manufacturing opportunities in Australia
- supporting local PPE stock management to maintain consistent standards across the system
- centralising ordering and management of incoming supplies to ensure appropriate and effective allocation of supplies across the state.
Further details to ensure the safety of NSW Health workers at all times and during the COVID-19 crisis, can be found here.
When do I need to wear PPE?
Guidance on 3 April from the Clinical Excellence Commission directs nurses working in high-risk areas to wear PPE (previously it was only when working with confirmed or suspected cases).
Health workers caring for patients in high-risk clinical areas (see list below) should comply with contact and droplet precautions for all close contacts (gown, surgical mask, eye protection and gloves). When performing aerosol generating procedures, comply with contact, droplet and airborne precautions.
High-risk clinical areas include:
- Intensive Care Units (ICU)
- Emergency Departments (ED)
- COVID-19 Wards
- Acute Respiratory Assessment Clinics
A dedicated floor plan in Emergency Departments should be established that clearly designates areas assigned for suspected or confirmed COVID-19 patients. If possible, consider rostering of staff to support the separation of areas and resourceful use of PPEs. For staff working directly in the area of suspected or confirmed cases of COVID-19, PPE should be worn accordingly.
What PPE do I need at work for COVID-19?
This 11-page document provides detailed information about the application of PPE, but does not cover broader infection control issues. It’s a great resource for specific types of masks, gowns etc, that are appropriate when working with confirmed or suspected COVID-19 patients.
Broader infection control guidance (with some PPE info included)
Hospital setting – this 9-page document looks more broadly at COVID-19 infection control in the hospital setting. It includes information about PPE (less detailed than the link above) but also provides information about things like environmental cleaning, linen and waste management.
Residential aged care – this 21-page document looks at COVID-19 infection control in residential aged care. It includes some information on PPE, but also information on what the organisation should do if one or more residents and/or staff have COVID-19, e.g. isolating, cohorting, visitor restrictions etc.
Primary and Community Care – this 6-page document looks at principles for infection control in primary and community settings, including details of PPE, cleaning etc.
The Australian Government has also published recommendations for the use of PPE when caring for people with possible COVID-19 infection.
Report PPE concerns
If you have concerns that your employer is not providing you with the necessary PPE (or is making it very difficult to access) and/or is not training people in its safe use, then you should:
- Put in an incident report at your workplace
- Escalate your concerns to your manager in writing and ask for an urgent response
If your concerns are not being taken seriously, we can assist to ensure appropriate measures are in place. Contact us here. You can also contact SafeWork NSW on 13 10 50.