The Marshall Government this week spruiked a solution to SA’s personal protective equipment [PPE] crisis, announcing local packaging company Detmold Group will employ up to 160 extra staff to produce millions of respirator and surgical masks for local and national use.
But in a bulletin sent around to staff at the Central Adelaide Local Health Network yesterday by CEO Lesley Dwyer, the Head of the Infectious Diseases Unit Dr David Shaw warns that “we’re looking at our usage of all of our PPE [amid] a global shortage”.
“As we all know, this is a very difficult time in this COVID era, and we’re all facing uncertainty and anxiety about how this will all pan out in the next month or two,” he said.
“The COVID virus is spread through respiratory secretions – that’s how people get the infection, it comes from the airway… so when we’re dealing with COVID patients we use droplet precautions – surgical masks.”
He said the specialised ‘N95’ masks were to be used “in some circumstances which are very limited”.
“These are used when people are dealing with the airway – particularly providing airway care,” he said.
“They’re not required when dealing with anything else other than close airway care – people in intensive care, people who are severely unwell with COVID, and only in circumstances where we’re dealing with their airway.”
He said it was “very important to preserve the use of N95 masks”.
“There’s a global shortage and we’re attempting to maintain our supply here… we’re looking at other ways, novel ways, ways that haven’t been tried before worldwide.”
These include “re-processing these N95 masks, sterilising them so they’re safe to use more than once”.
“From today we’ll collect used N95 masks and look into ways of safely reprocessing those so they’re sterile and can be re-used by all staff,” he said.
“The end result is we’ve got to look after our co-workers, our colleagues – the people who really need N95 masks in their work.”
SA Salaried Medical Officers Association president Dr David Pope said the issue wasn’t just around supply of the masks, but the fact they need to be “fit-tested” – a procedure to ensure they create a seal against the skin and are safe for individual use.
He said the current fitted mask – the 3M Aura 1870 N95 mask – was running low worldwide.
“The state’s got enough for operations until Sunday – and that’s it,” he warned.
“Hence that decision to try and re-use the masks, which is an extreme measure that’s not standard process by any means.”
He said there were sufficient supplies of other types of N95 – including those being produced by Detmolds, but “that’s not fitted for anybody”.
“If the mask in stock is to be used there has to be a mammoth effort put in to test the fitting for that mask… nobody’s fit-tested it at the moment,” he said.
“That would involve each individual healthcare worker going through a 20-minute testing procedure to see that a particular model will generate a seal… fit testing takes a long time, and we don’t have many machines and technicians.
“There’s a bottleneck in the testing… it would take a wartime effort of fit-testing – there’s very few machines around, unless they can get supplies from other places.”
Asked if the new masks did not pass a fit test whether that meant they could not be used, he said: “Correct.”
If supplies run out, he said “we can’t do anything involving the airway” which includes “most of the intensive care type work… things like putting tubes down people’s throats and putting them on ventilators”.
In her bulletin, Dwyer acknowledges that “the biggest issue for many of us continues to be around PPE – what to use and when”.
She said she was “pleased to be informed that 19,000 masks were delivered to our secure stores onsite at the RAH”.
“While we continue to work on longer term procurement channels, seeing tangible evidence of the work being done to make sure we have these masks onsite was certainly reassuring,” she wrote.
“As a health network, we are not alone in dealing with PPE procurement, and I want our staff to be reassured that it’s of the highest priority within the CALHN COVID-19 Incident Management Team.”
Nursing union boss Elizabeth Dabars said regarding the sterilising and re-use of masks, “fundamentally the issue is – is it safe or not?”
“If it can be done safely and appropriately, wouldn’t that be positive in terms of waste?” she said.
However, she said “there’s an issue here” around “the appropriate use and availability of these masks”.
“We’ve been speaking ad nauseum to the Department about the urgent need for them to release material relating to what types of PPE should be used and when, and making sure they’re made available – and what’s their position in the event PPE is not available,” she said.
“We’ve been talking about this with senior departmental bureaucrats for weeks now, and we’re really at a point that we’re frustrated about the lack of action and lack of urgency… I think there’s an appreciation of what we’re saying, but we still don’t believe adequate material has been released about this issue [and] there’s a climate of confusion relating to what PPE should be used and when.”
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