“Best practice is that fit testing should take place to protect health care workers”
Local campaigns by numerous NSWNMA branches have led to a larger uptake of fit testing. The Lamp talked to Shoalhaven Hospital branch secretary Michael Clarke about the experiences of his branch.
As a health worker do you feel you’ve been sufficiently prepared and protected to work effectively?
I don’t think the health system had really prepared for a pandemic; there’s been issues with PPE and PPE supply. We are getting enough through, but all our members are aware that there is a scarcity of appropriate PPE, and that provides some concern.
What was your branch’s position on fit testing?
We’re guided by what the Association is telling us locally. A lot of our members hadn’t heard of fit testing before; they had heard of fit checking, which is something you can do … as a ward-based solution, but if the best practice is that fit testing should take place to protect health care workers, then we believe as a branch that should happen.
Our organiser has been quite active in making sure we have the appropriate PPE at our hospital, and where it has become evident that we’re short, the branch, our organiser and the Association have been quite active in working out what is going on.
Our organiser also made us aware of the importance of fit testing. We had an issue with fit testing of P2 and N95 masks and our branch passed a resolution…to ensure fit testing was made available to members.
Why is it critical that the masks fit properly?
We are using a number of P2 and N95 masks that are made quite differently, and obviously we are working with all sorts of people…so the branch feels it’s essential that the masks are fit tested to protect members from cross-contamination from airborne droplets when dealing with potential COVID-19 patients.
Is it just ICUs or are other wards vulnerable too?
There are a number of hospital areas where our members are wearing P2 and N95 masks … it’s ED, and we also have a medical ward that is dealing with suspected and confirmed COVID-19 patients and a walk-in testing clinic.
What was happening when the masks didn’t fit?
I’m aware of there being a limited supply of P2 and N95 that can fit all face types, so where that has been a problem we’ve encouraged staff to not go ahead and wear the wrong mask and we’ve asked management to make sure that the right mask is made available.
It has been a bit of a learning curve for management as well, so now they know we have a large number of people that need to be tested.
Comparing Australian PPE guidelines with the NHS
The emergence of COVID-19 has led to a rethink on PPE internationally. In Britain the NHS has revised its guidelines on PPE as of April 2020.
The main changes are:
- enhanced PPE recommendations for a wide range of health and social care contexts
- inclusion of individual and organisational risk assessment at local level to inform PPE use
- recommendation of single- sessional use of some PPE items
- reusable PPE can be used. Advice on suitable decontamination arrangements should be obtained from the manufacturer, supplier or local infection control
- guidance for when case status is unknown and SARS-CoV-2 is circulating at high levels
- a recommendation on patient use of face masks.
Key differences between the new UK advice and current Australian advice include:
- The UK has a much wider definition as to who should be considered a potential case
- The masks recommended in the UK for airborne risk are FFP3s; these filter 99 per cent compared to the P2/N95, which filter 94 per cent and 95 per cent respectively
- Surgical masks in the UK are divided into two types – surgical masks, and fluid resistant (Type IIR) surgical masks. There are very few situations where the use of surgical masks is being recommended in the UK, whereas these are the masks being recommended in NSW hospitals for all routine care of COVID-19 patients.
NSWNMA COVID-19 resources available online
All nurses and midwives in NSW have a right to stay safe and be protected at work. The NSWNMA has produced numerous online resources for members seeking information regarding COVID-19:
- COVID-19 updates and guidelines and can be accessed through The Lamp website: thelamp.com.au/professional-issues/covid19/latest-guidelines-for-nurses-covid-19
- Frequently Asked Questions can be accessed through Member Central: online.nswnma.asn.au
- For your rights around PPE, information about the fit testing program and what you need at work for COVID-19 go to: thelamp.com.au/professional-issues/covid19/ppe/
- Posters and shareable memes for public health system and aged care workers can be downloaded from: www.nswnma.asn.au/safer-work-safer-care/ppe-your-right-to-practice-safely/
- Encourage your colleagues to join the NSWNMA. They can join at online at bit.ly/NSWNMAjoin