PPE access a concern for specialists in private practice

Public Health

By Mardi Chapman

24 Mar 2020

In the face of the COVID-19 pandemic, the RACP is advocating for better access to personal protective equipment (PPE) for all Fellows and trainees including community-based specialists.

In the latest President’s message, Associate Professor Mark Lane said the College was emphasising the need for government support for the frontline of the crisis, “specifically in relation to Personal Protective Equipment (PPE) and health and safety considerations”.

“Through the media, we’re calling on governments to ensure all specialist physicians, as well as GPs, have access to PPE. We have also raised the issue with the Australian Federal Health Minister’s office and the Department of Health and are also talking with New Zealand authorities,” his message said.

The RACP had received “concerning reports” of difficulties accessing PPE, particularly outside the hospital system. 

“The inability of specialist physicians in private and non-hospital community-based practices to access PPE may lead to some services not being able to continue,” his colleague and RACP President-elect Professor John Wilson said earlier.

“This is the last thing we need in the current environment.”

Sydney gastroenterologist Dr Katie Ellard told the limbic she was more concerned about procedures such as endoscopy which had been identified by GESA as a risky environment.

“The concern is when we do an upper endoscopy, we are putting little droplets into the air which stay there for about 30 minutes – particularly when you are using transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).” 

I‘ve just done a list at the Mater and normally I would wear a gown and gloves and my normal glasses, but today I am wearing a theatre mask and I am also wearing a visor over my face and changing obviously after each patient.”

“The anaesthetist opted not to use THRIVE because he didn’t want to have this problem of putting increased droplets into the air.”

Dr Ellard said the hospital had made sure she had all of the necessary equipment as per the GESA guidelines. 

“The GESA guidelines have also suggested that the patients wear a theatre mask when they come into the unit. Now some people feel that if that happens we will run out of theatre masks.

So what happens at the Mater and other hospitals is that patients are contacted a couple of days beforehand and they are asked if they have any symptoms, or have had any contact with someone who is COVID-19 positive, or if and when they came back from overseas, etc.” 

“So the patients are triaged and if there are concerns, then they are cancelled. By the time they are coming in the door, they are low risk patients.”

Dermatologist Dr Mei Tam told the limbic it was difficult to know how much to gear up in order to effectively protect against a new virus with an unknown or at least fluid infectivity rate.

And unfortunately, masks and hand sanitisers were on backorder. 

“So technically if we are taking each patient as though they were potentially infective, we should have several hurdles for the patient to first clear before they even come in for a face to face.”

She said the move to tele-health consultations should be made as soon as possible for all but emergency cases.

“For face-to-face emergency cases, then we should have P2 N95 masks, gowns, enough gloves and hand sanitisers. 

She said doctors typically had enough information on the use of PPE particularly if they worked in public hospitals where annual updates were required.  

However a recent article, authored by Professor Raina Macintyre  from the Kirby Institute’s Biosecurity Program, suggested even hospital workers had a limited knowledge of infection control guidelines and training with face masks or respirators.

Many were not involved in the selection of PPE, were not fit tested for respirator use and compliance with use was perceived as low.

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