Date published: 
25 April 2020
Type: 
News
Intended audience: 
General public

On this page:

Statement on the recommencement of kidney transplantation

AHPPC has been approached by the Transplant Society of Australia and New Zealand (TSANZ) regarding the recommencement of kidney transplantation in Australia.  

TSANZ has noted the significant reduction in community spread COVID-19 and the pleasing resumption of elective surgery in Australia, as announced by National Cabinet. TSANZ now believes a cautious recommencement of kidney transplantation is warranted.  

TSANZ believes that deceased donor transplantation and living donor transplantation should be safe to recommence on clinical grounds as the balance of risk from the virus versus clinical benefit sits now in favour of transplantation. TSANZ further notes the small number of dialysis and kidney transplant patients that have been affected by COVID-19. 

AHPPC supports the cautious recommencement of kidney transplantation at this time, with COVID-19 screening of donors. 

Updated advice regarding schools

The Australian Health Protection Principal Committee (AHPPC) published Advice on reducing the potential risk of COVID-19 transmission in schools on 16 April 2020.

Among many measures, this statement suggested that smaller class sizes might reduce the potential risk of COVID-19 transmission in schools. AHPPC does not believe however, that the ‘venue density rule’ of no more than one person per four square metres is appropriate or practical in classrooms or corridors, nor maintaining 1.5m between students during classroom activities.

This clarification complements AHPPC’s Advice on reducing the potential risk of COVID-19 transmission in schools.

AHPPC continues to note that there is very limited evidence of transmission between children in the school environment; population screening overseas has shown very low incidence of positive cases in school-aged children. In Australia, 2.4 per cent of confirmed cases have been in children aged between 5 and 18 years of age (as at 6am, 22 April 2020).  AHPPC believes that adults in the school environment should practice room density measures (such as in staff rooms) given the greater risk of transmission between adults.

Statement on the use of PPE in hospital with patients with COVID-19

The Australian Health Protection Principal Committee (AHPPC) met on 22 April 2020 to discuss updated advice from its Infection Control Expert Group (ICEG) on the use of personal protective equipment (PPE) in hospitals as elective procedures restrictions ease during the suppression phase of Australia’s response to coronavirus disease (COVID-19).

AHPPC recommends that procedures on patients with or suspected of having COVID-19 should be delayed until they have recovered or COVID-19 excluded or performed only in an emergency.

Background

The National Cabinet on 21 April 2020 announced partial easing of restrictions in elective surgery in Australian hospitals from 25 April 2020.

AHPPC requested ICEG update its guidance on the use of PPE in hospitals in the context of restrictions being eased for elective surgery.

AHPPC note decreasing cases and the associated risk of transmission of COVID-19 has prompted discussion on re-opening different sectors of the community and industry. Specifically, elective surgery was to be reassessed with a view to recommencement. The discussion has been almost entirely focused on PPE.

In Australia, work related risk is managed under the Work Health and Safety Act (2011), Regulations and the approved code of practice, ‘How to Manage Work Health and Safety Risks’ (2011). These require all Australian workplaces to assess and manage risk ‘so far as is reasonably practicable.’ This also applies to the assessment and management of the risk related to the transmission of COVID-19.

The code requires workplaces to undertake a risk assessment and apply controls using the hierarchy of controls. See Figure 1.

Figure 1. Applying the hierarchy of controls for COVID-19.

Pyramid diagram showing the hierarchy of controls for COVID-19.

Adapted from the CDC website

In order of most effective to least effective, the hierarchy of controls for COVID-19 are:

  • elimination – social isolation
  • substitution – not applicable
  • engineering controls – ventilation, physical barriers
  • administrative controls – work from home, stagger schedules, hand hygiene
  • personal protective equipment – masks, respirators, gloves

Infection Control Expert Group advice summary

ICEG met on Wednesday 22 April 2020 to agree on an updated guideline for the use of PPE in Australian hospitals (public and private) as restrictions on elective surgery ease during the suppression phase of Australia’s response to COVID-19.

ICEG emphasised that care of patients who are not suspected of or who do not have confirmed COVID-19, PPE in operating suites and procedure rooms should be consistent with Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 published by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

When performing aerosol generating procedures (AGPs) on non-COVID-19 patients

Given the relatively low prevalence of COVID-19 in Australia, standard precautions, and the use of standard operating theatre attire and personal protective equipment, are adequate for the performance of AGPs on patients who are not suspected of or not confirmed cases of COVID-19, in the absence of another airborne-transmissible infectious agent. In an operating suite, a surgical mask, theatre cap, theatre gown, gloves and eye protection should typically be worn. A P2 respirator is not necessary in this context.

Previous advice to use airborne precautions for the care of patients with severe coughing has been withdrawn because:

  • viral load does not necessarily correlate with the clinical condition
  • coughing generates droplets, predominantly, and
  • surgical masks used by the patient, if possible, and healthcare worker provide adequate protection.

When performing aerosol generating procedures (AGPs) on COVID-19 patients

Contact and droplet precautions are adequate for managing COVID-19 patients unless AGPs are being performed.

If AGPs are being performed on COVID-19 patients contact and airborne precautions should be considered after assessing the risk.

AHPPC summary

AHPPC notes the current prevalence of COVID-19 in the Australian context does not require asymptomatic individuals to be classified as suspected COVID-19 cases.  AHPPC and local public health units will amend that advice as appropriate.

AHPPC notes and supports the advice from ICEG and emphasises the importance of objectively assessing risk and stratifying the mitigation steps with PPE appropriate to the risk.

AHPPC agrees that for patients not suspected of having COVID-19, the risk of infection, when performing AGPs in an operating suite, is minimal and routine operating suite attire, i.e., surgical mask, theatre cap, gown, gloves and eye protection is adequate.

AHPPC agrees that for patients suspected of or confirmed to have COVID-19, when performing AGPs the actual risk should be assessed and if appropriate contact and airborne precautions should be taken.