Australian Health Management Plan for Pandemic Influenza (2009)

Appendix F: Personal Protective Equipment

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The pandemic planning assumptions, relevant to the use of personal protective equipment, are outlined in Part 3. They include:

• Assumption Table 3: Modes of transmission
• Assumption Table 4: Period of communicability
• Assumption Table 5: Respiratory protection zone
• Assumption Table 6: Survival of the virus.

What is personal protective equipment—PPE

PPE, such as P2 masks, surgical masks, goggles, gowns and gloves, is equipment that can be worn by an individual to protect them or other people from infection. The use of protective equipment will be one useful step that can disrupt spread, and should be used in concert with a range of other measures. Along with other resources, PPE may be limited in supply, so needs to be used wisely.

PPE is designed to protect well individuals by:

• providing respiratory droplet protection to prevent the virus from entering the nose or mouth by wearing some form of mask
• protecting eyes from contact with contaminated hands or exhaled virus by wearing eye protection (e.g. goggles, safety spectacles and face shields)
• preventing the transfer of the virus from contaminated surfaces to hands by wearing gloves (note: hand hygiene can also prevent this transfer)
• preventing clothing from becoming contaminated, and then inadvertently transferring virus from one area to another, by wearing gowns.

If a sick person wears a mask, the amount of virus shed into the environment decreases.

What types of masks are available

There is a variety of masks/respirators that could be used during a pandemic depending on the circumstances. They are:

• Surgical masks—reduces chances of inhaling virus that is in respiratory droplets. This protection is most useful in lower risk situations, particularly when the infected patient is able to wear a mask.
• P2 masks (P2 respirator)—reduces chances of inhaling virus that is in the form of fine respiratory particles. This is only recommended for use when undertaking medical procedures that lead to the generation of aerosols, or if the patient is infectious and cannot wear a surgical mask. They are used in high-risk situations where the patient is known to be infectious and distancing is not possible.
• Powered Air Purifying Respirators (PAPR)—may also be used when aerosol-generating procedures are undertaken. Note PAPRs are specialised devices that will be in short supply.
• Other masks. Advice will be provided at the time regarding appropriate alternatives (either homemade or commercially available).

Testing is required so that P2 masks fit properly. A P2 mask fit testing and checking program is needed in hospitals and general practice. Ongoing training (via mask fitting accreditation) will ensure knowledge can be built and sustained. Further details around fit testing will be provided in the Clinical and Infection Control Annex.

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PPE needs to be used in combination with other control measures

The following control measures will reduce the risk of transmission:

• regular hand cleaning with either soap or alcohol based hand rub, especially after removal of PPE
• cleaning of surfaces
• good respiratory hygiene including disposing of soiled items appropriately
• management of patient so that people who are potentially infectious can be readily identified and segregated to avoid further infection (e.g. isolation and use of cohorting)
• standard and additional precautions (contact, droplet and airborne precautions) according to the level of risk, see the Interim Infection Control Guidelines for Pandemic Influenza in Healthcare and Community Settings (June 2006).
• keeping a distance of at least one metre from anyone who might be infectious and using barriers (e.g. screens) where possible
• asking potentially infectious patients to:
• wear a surgical mask
• practice good cough etiquette
• clean their hands with soap and water or an alcohol rub.
• antiviral treatment by providing patients with antiviral medication (if clinically indicated) as the antivirals may help to reduce the amount of virus an infectious patient exhales
• antiviral prophylaxis, see Assumption Table 11 in Part 3
• vaccination when available, see Assumption Table 13 in Part 3.

The Interim Infection Control Guidelines for Pandemic Influenza in Healthcare and Community Settings (June 2006) provides technical details and further explanation on how best to design services, implement other control measures and use PPE to reduce risks to those in contact with infectious patients.

Assessing the risk

Not every situation has the same level of risk, and the risk may change as we move through the phases of a pandemic. The most important aspect of protection from infection is to use the most appropriate combination of measures for the situation.

To assess if PPE is required, a risk assessment should be undertaken. A risk assessment needs to take into account:

• the number of infectious people in the community at the time (thus the likelihood of coming into contact with infectious case)
  • antivirals are likely to reduce respiratory viral shedding that is, people who have been on antivirals for over 48 hours are likely to be less infectious
• the proximity of contact required with an infectious person—can a one metre distance be maintained
• the additional appropriate barriers that can be put in place to decrease the risk of exposure for example:
  • reorganise work spaces to maintain a one metre distance between people
  • avoid creating situations where crowding of people could occur
  • placing screens between customers and staff
  • use other face covering (e.g. helmets).

Who will have access to stockpiled PPE

It is important to note that PPE stockpiled by the Australian Government and state and territory Health Departments is limited. Decisions regarding the use of items stockpiled in the National Medical Stockpile (NMS) will be made on the advice of AHPC based on risk of exposure and availability of supply.

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Health sector

PPE will be prioritised to frontline health care workers who:

• work in a service that forms part of the health sector response sanctioned by the state or territory health department, and
• provide direct clinical or personal care to suspect and confirmed cases of pandemic influenza, and
• are considered to be at high risk of exposure to the pandemic influenza virus.

This may include:

• health professionals working in flu clinics or emergency departments
• a general practitioner who is a designated influenza service
• a general practitioner providing care in areas with no flu clinics.

See Part 1, Section C3.2 for more information on influenza services.

Private hospitals should confirm with their respective state or territory health authorities their role in pandemic plans and if they form part of the sanctioned health sector response.

Other government departments

Responsibility for providing PPE for non-health sector workers in general rests with the employer. There are some circumstances where PPE in the NMS may be issued to certain groups who may be at higher risk. Such groups include:

• International border control—a quantity of PPE from the NMS will be allocated to officers from the Australian Quarantine and Inspection Service, Australian Customs Service, Department of Immigration and Citizenship, and the Australian Federal Police working at the designated international airports and who will be in close contact with passengers from high-risk areas.
• Emergency workers—when there is widespread community transmission, appropriate PPE from the NMS may be issued to emergency workers such as police and fire brigade who encounter infectious people as part of their work. This would be a whole of government decision based on health advice.

Private businesses

Responsibility for providing PPE rests with the employer, and businesses should consider their need to stockpile equipment. Employers should carry out a risk assessment in the workplace as outlined in the section above.

Community

PPE will not be provided for general public use from the NMS or jurisdictional stockpiles. When there is widespread transmission of pandemic influenza in the community, health authorities may advocate use of surgical masks or some alternate covering of the nose and mouth by members of the public entering crowded areas. Advice will be provided at the time regarding appropriate alternatives (either homemade or commercially available). Again, the public should use these measures in combination with good hand hygiene, appropriate cough and sneeze etiquette and the principles of social distancing.

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This information is current for 19 June, 2013
This information was issued on 01 November, 2010