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.
Your rights
As a result of ongoing advocacy from the NSWNMA and other health unions, both NSW and national guidance has been changed to advise that fit testing should be undertaken for health workers wearing P2/N95 masks.
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.
What PPE do I need?
Refer to CEC guidance to determine the correct use of PPE in your area.
- COVID-19 Infection Prevention and Control Manual (added 21/05/2021)
- Quick Guide to PPE for the Emergency Department (05/01/20)
- 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) has recognised the need for clearer and consistent fit testing thanks to ongoing campaigning from unions. A fit testing program is now recognised as an addition to current infection prevention and control education and guidance on the adequate use of PPE.
Further details to ensure the safety of NSW Health workers at all times and during the COVID-19 crisis, can be found here.
FAQs
When do I need to wear PPE?
Guidance on from the Clinical Excellence Commission directs workers to wear a P2/N95 when providing care of a patient who is suspected/confirmed COVID positive.
Airborne Precautions (includes the use of P2/N95 respirator and eye protection) is required in the following circumstances:
- Confirmed COVID-19 cases
- Suspected cases (a person who meets clinical AND epidemiological criteria)
- A person identified as a close contact by the NSW Public Health Unit, regardless of symptoms
National guidelines
The Australian Government has also published recommendations for the use of PPE when caring for people with possible COVID-19 infection.
Do I need to be wearing a P2/N95 respirator mask if I am caring for patients who are suspect, confirmed or a close contact of a person with COVID-19?
Yes, in light of the increasing evidence of airborne transmission of Covid 19, the NSWNMA has continued to advocate for improvements in PPE. As a result, the CEC has now changed their guidance to airborne precautions for any care of patients who are suspected or confirmed of having COVID-19 or who are a close contact of a COVID-19 case.
Airborne precautions include the wearing of a P2/N95 respirator mask, eye protection, gown and gloves. If you are wearing a P2/N95 mask you should be fit tested to ensure it offers suitable protection.
NOTE: These same rules apply regardless of the setting you are working in, e.g. to community health staff; as well as staff working in inpatient environments and those in testing clinics.
Do I need to be fit tested, or is fit checking alright when using a P2/N95 mask?
If you are required to wear a P2/N95 mask then it is important that it fits you. The best way to know that a particular make or model of mask is able to form a proper seal on your face is to be fit tested.
Fit testing is a process where a portacount machine is used to measure the fit of the mask while the wearer undertakes a range of exercises, (or alternatively there is another test which relies on a user’s ability to detect a particular taste, smell or irritant while wearing the mask – at this stage we are mostly seeing the use of portacount machines, though we are aware of the other type of fit testing in some private hospitals) .
Fit testing is not to be confused with fit checking which you do yourself every time you put on a P2/N95 mask to make sure you have put it on properly.
Fit testing must be done by a suitably trained and competent person. Each LHD has had people trained as fit testers and these are the people who can do the fit testing. Additionally, some LHDs have been contracting qualified external fit testers to expedite the process of getting staff fit tested.
I haven’t been fit tested. What should I do?
Given the increased incidence of COVID-19 infection in the community in Greater Sydney in particular in West & South West Sydney, as well as the increased number of patients in hospital, the need for fit testing of staff who are providing care to suspected, confirmed COVID-19 patients, and close contacts of people with COVID-19 case is now urgent.
Recent changes to the CEC COVID-19 guidance indicate that staff caring for patients confirmed or suspected to have COVID-19 or who are close contacts of people with Covid 19 should be wearing a P2/N95 respirator and eye protection. If you have not been fit tested, we encourage you to submit an incident report in IMS+ around the delay in fit testing and to raise it with your manager in writing as a matter of urgency.
A common reason for the delay in the roll out of fit testing appears to relate to insufficient numbers of portacount machines and/or staff trained properly to use them. If this is the case, your LHD should look to contract this work to external fit testing providers in order to get staff fit tested as soon as reasonably possible, (as has been done in several LHDs).
If you are having unreasonable delays in accessing fit testing, you should submit an incident report in IMS+ and raise this with your manager. If this does not resolve the situation, contact the NSWNMA office for assistance to progress the matter, which may include a referral to the NSW Safety regulator, SafeWork NSW.
Until such a time as you have access to a P2/N95 respirator that fits you properly you should be redeployed to an area where you don’t need to utilise airborne precautions.
In the meantime, if asked to provide care to a known or suspected case of COVID-19 or close contact of a COVID-19 positive case, you should bear in mind that under s84 of the Work Health and Safety Act, you have the right to refuse unsafe work where you have a reasonable belief that carrying out that work will expose you to a serious and imminent risk to your health. If exercising this right, you must report to your manager and remain available to undertake alternate duties.
I have been fit tested but failed the fit test. What should I do?
If you are working in an area that requires PPE, it is your employer’s obligation to provide you with PPE that fits you properly. If none of the P2/N95 masks fit you, they need to either find another mask that does fit you or ensure you are working in an area where you don’t require the use of a P2/N95 mask.
The CEC’s Infection Prevention and Control Manual specifies at p103 that “No member of staff is required or expected to undertake any work requiring a P2/N95 respirator unless an adequate facial seal can be achieved.”
If you have been fit tested and have “failed” the fit test, you should submit a worker incident report in IMS+ around the lack of suitably fitting PPE and raise the issue with your manager in writing as a matter of urgency.
Until such a time as you have access to a P2/N95 respirator that fits you properly you should be redeployed to an area where you don’t need to utilise airborne precautions.
You are within your rights under s84 of the Work Health and Safety Act to refuse unsafe work where you have a reasonable belief that carrying out that work will expose you to a serious risk to your health. If exercising this right, you must report to your manager and remain available to undertake alternate duties.
I have been fit tested but the masks that fit me are not available, what should I do?
No member of staff is required or expected to undertake any work requiring a P2/N95 respirator unless an adequate facial seal can be achieved, (p6 CEC Respiratory Protection in Healthcare & p103 of the CEC’s Infection Prevention and Control Manual).
Your employer has an obligation to provide you with PPE that fits properly. You should not be using a mask that doesn’t fit you properly. You should raise the matter with your manager in the first instance to request that the appropriate masks are provided and submit an IMS+ concerning the difficulty in accessing the appropriate PPE.
Until such a time as you have access to a P2/N95 respirator that fits you properly you should be redeployed to an area where you don’t need to utilise airborne precautions.
Under s84 of the Work Health and Safety Act, you have the right to refuse unsafe work where you have a reasonable belief that carrying out that work will expose you to a serious and imminent risk to your health. If exercising this right, you must report to your manager and remain available to undertake alternate duties.
Contact the Association if you require any further assistance.
I had an allergic reaction to the mask. What should I do?
Where you have experienced an allergic reaction to a particular brand of mask, you should submit an incident report in IMS+ (as a worker incident) and raise the matter with your manager. There are about 7 different P2/N95 masks approved for use in NSW Health and the matter may be quickly and easily solved by using a different mask.
If the matter is not resolved at the level of your manager it will need to be escalated. It is important to understand that an allergy to the PPE is an identified hazard that your employer must resolve.
Managing this risk is a relatively straightforward matter for your employer. Relevant control measures include:
- Trialling different brands of masks, to see whether there is a brand that you are not allergic to; (e.g. there are several that do not use latex if this is the allergen)
- If you cannot find a brand of P2/N95 mask that you are not allergic to – then your employer has the option to provide a powered air purifying respirator
- If your employer is not able to provide either of the above, then you will need to be reallocated to a task or area that does not require you to employ airborne precautions.
Until such a time as you have access to a P2/N95 respirator that fits you properly and doesn’t cause allergic reactions you should be redeployed to an area where you don’t need to utilise airborne precautions.
Under s84 of the Work Health and Safety Act, you have the right to refuse unsafe work where you have a reasonable belief that carrying out that work will expose you to a serious and imminent risk to your health. If exercising this right, you must report to your manager and remain available to undertake alternate duties.
Do I have to/am I allowed to provide my own PPE?
No, you do not have to and should not have to provide your own PPE.
It is not your responsibility to buy your own PPE. Your employer has an obligation to provide you with the PPE that you need to do your job safely. Until suitable PPE is provided you should be allocated work that does not require you to use PPE.
Do I need to clean and reuse face shields or are they single use items?
It depends of the face shield. The CEC’s Infection Prevention and Control Manual states that ‘only PPE labelled as reusable should be cleaned, disinfected and reused, according to the manufacturer’s reprocessing instructions; all other PPE must be disposed of after use’ p90
The manual also identifies that there may be times of critical shortage where reuse may occur and sets out how to do that on page 152-153.
Importantly the manual states: ‘Reprocessing single-use PPE must not be undertaken without prior written approval from the NSW Ministry of Health’
Can you be deployed to work in another area if you are not fit-tested for a P2/N965 mask?
The Association is aware that there are a lot of NSW Health staff being redeployed due to a range of COVID-19 related issues. If you are being redeployed into an area where there is a high risk that you will be exposed to a patient who is suspected/confirmed COVID-19 positive or is a close contact of someone with COVID-19, then you should be fit tested.
No member of staff is required or expected to undertake any work requiring a P2/N95 respirator unless an adequate facial seal can be achieved, (p6 CEC Respiratory Protection in Healthcare & p103 of the CEC’s Infection Prevention and Control Manual).
Employers have an obligation to ensure a safe workplace, this requires them to take steps to eliminate risks associated with exposure to COVID-19 as far as possible. Where the risk cannot be eliminated, they need to minimise the risk as far as possible.
With increased risk of COVID-19 infection in the community in greater Sydney and in particular South West Sydney, part of the strategy to minimise the risk could be to redeploy staff that are not fit-tested out of high-risk areas, to areas of lower risk for their own safety.
Speak with your manager to organise fit testing prior to your redeployment.
Community/ non-hospital environments
Should home visiting still be occurring in current areas of high community transmission of COVID-19?
We understand the concern given the current community transmission in greater Sydney. However, healthcare workers are not able to refuse care to patients when we can minimise the infection risk in other ways. Your concerns however should be escalated to your manager to ensure systems are in place to mitigate the risk.
Pre-screening should be put in place and PPE provided as per risk assessment of exposure.
Prior to routine and scheduled face-to-face appointments, a risk assessment should be undertaken to identify any potential COVID-19 cases. Further guidance for Community health visits for NSW Health may be found from the Clinical Excellence Commission – CEC – COVID-19 Infection Prevention and Control Manual – Pg 173.
All NSW Health staff providing care to patients who are suspected or confirmed to have covid-19 or are a close contact of someone with covid 19 should be using contact and airborne precautions including the use of a P2/N95 mask and eye protection. If you are wearing a P2/N95 mask you should be fit tested to ensure it offers suitable protection, and appropriately trained in donning and doffing in a community setting.
Can I carpool with other staff and/or student nurses when undertaking community visits?
The available evidence regarding COVID-19 indicates that it can be transmitted when people are in close proximity with others, within enclosed/confined spaces and in poorly ventilated spaces.
It is important to note that employers have an obligation to ensure a safe workplace, this requires that risks are eliminated so far as reasonably practicable, and if they can’t be eliminated they should be minimised – we know there is a risk associated with carpooling (hence the public health order). The best way to eliminate this risk is to stop car-pooling.
If it is not possible to stop carpooling, then controls should be put in place. This may include things like including having a process to identify risk, wearing PPE, using largest car possible, seating passenger in the rear of the car, diagonally opposite the driver, wearing PPE and ensuring that air-conditioning is not recirculating the air.
Workers have a right to refuse unsafe work under s 84 of the WHS Act where they have a reasonable belief that there is a serious risk to their health and safety arising from an immediate or imminent exposure to risk. If members were to refuse to carpool, they need to notify their manager that they are doing this under s 84 of the WHS Act as they believe it constitutes a serious risk to their health and safety.
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
AND - 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.
