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AMA condemns ‘appalling’ approach of governments to ill-fitting masks for Covid healthcare workers

The president of the Australian Medical Association has slammed governments’ “head-in-the-sand attitude” towards ill-fitting face masks, which are disproportionately endangering female and racially diverse healthcare workers.

Dr Omar Khorshid says it is “baffling” that frontline medical workers dealing with Covid-19 patients are not being properly fitted for N95 masks, which require a complete seal around the face to be effective.

“It’s a basic requirement for workplace safety that is not being observed in most states … [many state health departments] have completely dropped the ball on healthcare workers safety and appear to be wilfully ignoring repeated calls from clinicians to make sure that everybody who is likely to be the frontlines, and likely to be required to wear an N95 mask, is being properly fit-tested,” Khorshid said.

“It’s something that must be achieved and it’s appalling that it hasn’t been done already.”

Hospitals are generally being provided PPE through state health departments, but often only one size of N95 mask is available. This is particularly problematic for young female health workers, as the masked are generally tailored for larger faces.

Khorshid said: “It has been our anecdotal experience that standard N95 mask fits certain faces better than other, and smaller women have had a great proportion of test failures, as well as people with different face shapes from different racial backgrounds.”

Dr Amy Touzell, a member of the Royal Australasian College of Surgeons, said it was often the smaller, young doctors with the most contact with potentially positive patients.

“All of the masks we are getting from the building industry, which are designed for men … It’s our junior doctors that are doing a lot of the patient assessment and working in the emergency department,” Touzell said. “They are more at risk if they are woman.

“During surgery, my anaesthetist was saying that she could feel the fresh air coming in and out the sides of the mask. She knew that it wasn’t a good seal … There isn’t an alternative, it’s not like you can try another one, that’s just what you have got.”

As on Monday, there were 1,064 healthcare workers infected with Covid-19 in Victoria – about 14% of all active cases. Khorshid suggested the relaxing of fit-testing procedures were partially to blame.

“We know that healthcare workers are over-represented when it comes to cases of Covid, and the idea that they caught that out in the community and not in health care settings is clearly not the case. There are a few ways that the transmission could happen but ill-fitting or inappropriate masks may well be part of that.”

Khorshid said the AMA – Australia’s peak medical body – had heard of small groups of clinicians or hospitals across Australia organising their own fit-testing, but it was standard procedure only in South Australia.

“It’s completely unacceptable that that groups of clinicians have to band to do things themselves when fit-testing is part of the Australian standard for use of a respirator. It’s just a simple requirement, and it is baffling.”

Fit-testing a mask is a complicated process that can involve spaying different concentrations of scented liquids towards the wearer to ensure no aerosols can make their way inside. This can take more than an hour and must be done every time the wearer uses a new brand of N95 mask as they are all shaped slightly differently.

Touzell said the brand of masks supplied to her hospital by the government changed at least weekly, making repeatedly fit-testing the entire staff impossible.

The Victorian premier, Daniel Andrews, has repeatedly said there was no issue with the supply chain on PPE in the state

And a spokesperson for Victoria’s Department of Health and Human Services said authorities were “monitoring the rise in healthcare worker coronavirus infections and we are doing everything we can to ensure they have access to P2/N95 that fit them best”.

“Fit-testing is a significant part of healthcare worker safety and it’s important that all health services have a plan to fit-test P2/N95 masks for staff, particularly in high-risk areas.

“All Victorian healthcare workers are receiving the recommended PPE.”

Khorshid is sceptical, however, as state PPE guidelines appear to be rationing N95 masks, with workers in Victoria conducting Covid-19 swab tests required to wear only a standard surgical mask.

“It’s a really confusing message and it’s one that’s really led to healthcare workers feeling like there is no one backing them in government,” Khorshid said.

“Why would you not recommend an N95 mask over a surgical mask to somebody getting that close to a possible Covid positive patient if you had plenty of supply? What possible reason would there be to say ‘you can’t have this $3 mask’, other than if you are concern about supply?

“That does seem to be an issue and it needs to be discussed openly.”

Touzell said hearing Andrews talk about the readily available supply of PPE was “frustrating”.

“You just want them to be honest about it … You wouldn’t send a five-foot-two lady to a construction site with size-12 men’s boots.”

Read the original article at The Guardian

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