AMA advice on PPE: surgical masks for routine care and taking swabs

Public Health

By Mardi Chapman

7 Apr 2020

The Federal AMA has issued a statement on PPE and COVID-19, reinforcing the view that standard precautions – surgical masks, eye protection, gowns and gloves – are appropriate for doctors and other healthcare workers when managing the vast majority of COVID-positive patients.

The statement, authored by Federal AMA Vice President and thoracic physician Dr Chris Zappala said the standard level of precautions was also suitable when collecting nasopharyngeal/throat swabs from suspected patients.

However precautions should be stepped up to P2 masks, eye protection, gown and gloves (donned and doffed correctly) for aerosol-generating procedures such as endotracheal intubation or when caring for patients with severe respiratory disease in ICU and high dependency units.

“Routine care of non-COVID patients can proceed as usual with standard precautions only. There is no need to apply extra precautions or use P2 masks for non-COVID patients (excepting those who are suspect cases who are undergoing further testing),” it said.

The recommendations also state that surgical masks are of no value for people in the community who are well. Masks gave people a false sense of security and diverted PPE from doctors and hospitals where they were urgently needed.

That viewpoint has been reinforced recently by Australian researchers at the University of Australia’s JBI (formerly Joanna Briggs Institute) who said wearing of masks or respirators by uninfected people in the general community is not necessary or effective.

Their evidence summary, based on systematic reviews and WHO interim guidelines, said best practice was “a multifaceted approach (e.g. the use of masks during high risk exposure and the practice of evidence-based hand hygiene techniques) to prevent the transmission of respiratory infection in the community is recommended.” (Grade A recommendation)

“A mask may be worn by persons at high risk of exposure (e.g. persons living in a household with an infected individual). (Grade B)”

“The wearing of masks or respirators by uninfected persons in the general community are not recommended. (Grade B)”

Cloth (e.g. cotton or gauze) masks were not recommended under any circumstances.

Out of step is the CDC in the US that has recently advised the community to wear cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) and especially in areas of significant community-based transmission.

“The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance,” it said.

The University of Adelaide’s JBI best practice recommendations for health care workers were:

  • During high risk exposures the use of respirators and evidence-based hand hygiene techniques to prevent the
    transmission of respiratory infection is recommended. (Grade A)
  • A medical/surgical mask should always be worn when providing direct patient care to a patient with known or suspected respiratory infection. (Grade A)
  • An N95 respirator (or equivalent P2) should be worn continuously during high-risk situations such as
    aerosol-generating procedures with patients known to have a respiratory infection. (Grade A)
  • If a mask is worn, it should be placed to cover the mouth and nose and tied securely to minimize any gaps. (Grade B)
  • A mask should not be touched while wearing or when removing; if inadvertently touching the mask, hands must be
    immediately cleaned with soap and water, or alcohol-based hand rub. (Grade B)
  • Medical/Surgical masks should not be worn for more than six hours and should be changed immediately when they become damp. (Grade B)
  • Cloth (e.g. cotton or gauze) masks are not recommended under any circumstances. (Grade B)

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