As we move through the stages of COVID-19, my ongoing commitment to you is to provide the most accurate and up-to-date information I can.
Today we have four people who are COVID-19 positive in our hospital at Monash Medical Centre, one of whom is in our Intensive Care Unit. We have a number of other people for whom ‘droplet precautions’ are being used while waiting for their results.
You would be aware that the number of people in the community who are COVID-19 positive is increasing significantly.
It is essential that you become aware of and are trained in the use of Personal Protective Equipment (PPE) if you are in a patient-facing area so you understand when and if you need to use PPE and how to do it effectively.
During this time, however, where information is ever-changing and coming at us in such high volumes, it can be overwhelming and confusing. Much of what is on social media is incorrect and, at times, dangerously misleading. There are concerns and misconceptions around items like surgical masks.
To that end, I’ve invited our Medical Director Infection Prevention, Associate Professor Rhonda Stuart, to outline the facts and give you the latest advice around the use of surgical masks.
If you require a refresher on PPE, you are required to attend the additional training to ensure you are confident in how to keep yourself and our patients protected appropriately and effectively without unnecessary use of resources.
I know that mental and emotional well-being is equally important as PPE at this time. Our health service will experience a strain that many of you may never have experienced before. As individuals, it is understandable that you may begin to feel the tension. Please use the services and resources available to help you look after yourself, your team, and your loved ones.
If you have any questions or concerns, never hesitate to discuss these with your manager, your colleagues, your People and Culture representative, or you can call the Monash Health Employee Hotline.
As always, in such a rapidly changing crisis, please make sure you continue to consult credible information sources such as the Chief Executive COVID-19 Updates, Bulletins, and our Monash Health Employee Coronavirus Webpage.
Use of surgical masks and PPE on wards; the latest
There is some concern regarding the use of personal protective equipment (PPE) and, in particular, surgical masks. Please read the following information carefully as it is critical in times of uncertainty to act on credible information. Our Medical Director Infection Prevention, Associate Professor Rhonda Stuart, outlines the facts for you below:
- Surgical masks protect health care workers against droplet contamination.
- The benefits of continuous use of surgical masks for protection against unknown cases of COVID-19, and a reduced need to change when in COVID-19 wards, need to be balanced against the risk of overusing this vital resource and, paradoxically, increasing the risk of infection due to mask misuse, e.g., wearing around the neck, wearing while eating.
- Employees may have a false sense of security that continuous mask use protects them against COVID-19, and this is simply not the case. More critical proven measures are scrupulous hand hygiene, recognising cases early, and using appropriate precautions, as well as physical distancing.
- At this stage, we are following the latest guidelines set out by the Department of Health and Human Services (DHHS) on Wednesday, 25 March 2020, for the use of surgical masks and other PPE.
- You can read the full guidelines here, but in summary, they state:
- All healthcare workers in high-risk areas – Intensive Care Units (ICU), Emergency Departments (ED), Coronavirus (COVID-19) wards, and Acute Respiratory Assessment clinics – are to wear surgical masks and disposable gloves for all patient interactions. This is in addition to hand hygiene before and after glove use.
- Unless damp or soiled, a surgical mask may be worn for the duration of a clinic or shift of up to four hours.
- Masks and gloves are to be removed for breaks, disposed of appropriately, and then replaced with fresh stock.
- Given the high throughput of patients and multiple presentations of those yet to be diagnosed, our EDs are now considered high-risk areas. To that end, the systematic use of masks for all patient encounters in our EDs is now an appropriate measure (this includes triage and clerking).
- Employees in our ICUs, COVID-19-wards (when commenced), Acute Respiratory Assessment clinics, or who are conducting aerosol-generating procedures will also be required to wear appropriate PPE in line with the guidelines.
- Reminder: N95 masks must be used with high-risk patients during aerosol-generating procedures.
- As the numbers of patients increase in the community and the hospital, the above guidelines will be revisited, and systematic use of masks may potentially be rolled out to wards outside of the currently identified high-risk areas.
- The blanket use of masks and PPE, outside of regular infection control procedures, for areas outside of the high-risk areas is not necessary and will only result in using resources without benefit.
- When COVID-19 case numbers begin to increase in our hospitals, surgical masks can be considered for use when caring for multiple, suspected or positive, COVID-19 patients who are:
- not in high-risk areas, and
- who are not undergoing aerosol-generating procedures.
Surgical masks fast tips
- Masks are not efficient protection when used alone; they are only adequate when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water infection control procedures.
- When wearing masks, follow these instructions:
- Before putting on a mask: clean hands with alcohol-based hand rub or soap and water.
- Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.
- Avoid touching the mask while using it: if you do, clean your hands with alcohol-based hand rub or soap and water.
- Replace the mask with a new one as soon as it is damp (or up to every four hours).
- Do not reuse single-use masks.
- Remove masks when leaving the ward area and when going on breaks.
- Do not drink or eat when wearing a mask.
- Do not lift the mask.
- Do not let it hang around the neck.
- To remove the mask:
- remove it from behind,
- do not touch the front of mask,
- discard immediately in a closed bin,
- clean hands immediately with alcohol-based hand rub or soap and water.
Droplet precautions fast tips
Droplet and contact precautions need to be in place while you are caring for a suspected or confirmed coronavirus (COVID-19) case, including during initial triaging.
- surgical mask
- eye protection (for example, safety glasses/goggles or face shield. Note: prescription glasses are not sufficient protection.)
- long-sleeved gown
- gloves (non-sterile)
If the gown is disposable and soiled, take it off and dispose of it. If the gown is reusable (non-disposable), take it off and get it reprocessed.
Masks, gloves, and gowns are not to be worn outside of patient care areas (for example, between wards, break room, reception area) and are to be removed before proceeding to care for patients that are not isolated for coronavirus (COVID-19).
Aerosol-generating procedures fast tips
Airborne and contact precautions should be used routinely for AGPs regardless of coronavirus (COVID-19) status.
Examples of AGPs include:
- ENT endoscopy and procedures
- intubation and manual ventilation before intubation
- non-invasive respiratory support (for example, BiPAP, CPAP, high flow nasal O2)
- cardiopulmonary resuscitation (If necessary, first responders should commence compressions with droplet precautions until staff with airborne precautions are in place)
- nebuliser use (Nebulisers should be discouraged, and alternative administration devices such as a spacer should be used).
The following PPE is to be used for AGPs:
- P2/N95 respirator (mask) – fit-check with each use
- eye protection (for example, safety glasses/goggles or face shield)
- long-sleeved gown
- gloves (non-sterile)
- Total head covering is not required.
N95/P2 masks should be:
- Discarded and replaced if contaminated with blood or bodily fluids
- Discarded following the AGP
- Replaced if it becomes hard to breathe through or if the mask no longer conforms to the face or loses its shape
- Removed outside of patient care areas (e.g., between wards, break room, reception area) and are to be removed before proceeding to care for patients that are not isolated for coronavirus (COVID-19).
Keeping yourself safe fast tips
- General tips
- You must be bare below the elbows when you are in clinical areas.
- No jewellery or watches on your arms (a wedding band is acceptable).
- Short nails without nail polish/gel/shellac/SNS etc.
- No ties, lanyards, scarves etc.
- Use the hand hygiene product regularly and do not forget your wrists.
- Men – its time to get rid of the beard – if you have facial hair, you won’t be able to use an N95 mask properly (during aerosol-generating procedures) and will put yourself at increased risk.
- Long hair must be tied back and kept off your face.
- Long-sleeved gowns
- The gowns we are using have been in use for many years and are an effective part of PPE when appropriately used.
- Some employees are finding the sleeves are a bit too short or a bit too wide. This is a low risk for COVID-19 transmission given the virus is transmitted via droplets.
- We are working on sourcing long gloves to help cover any small gaps that may be present.
- The most important thing is hand hygiene and to use the hand rub all the way up your wrist.
- N95 masks
- It is important that these are only used for COVID-19 or suspected COVID-19 patients when undertaking aerosol-generating procedures on high-risk patients.
- We have ample supply of these masks, but want to preserve this precious resource for times when they are actually required.
- Surgical masks are sufficient and appropriate for routine care of COVID-19 patients.
- Head cover
- Hairnets are not required during routine care of COVID-19 patients.
- Tie back your hair and keep it off your face.
Keeping pace; Stay updated on the latest
As advice and information evolve, please consult the latest updates and visit credible sources for information:
- Monash Health employee website: coronavirus.monashhealth.org.au
- Department of Health and Human Services: www.dhhs.vic.gov.au/coronavirus
- Monash Health employee COVID-19 hotline: 9594 5815
- 2019 Novel Coronavirus Procedure available on PROMPT
- Monash Health Library COVID-19 Resources Guide
All managers are requested to share these updates with their teams and discuss at stand-ups and handovers. Please print a copy and display it in communication books and on employee noticeboards. Remove previous copies.