For those of us who were teenagers or young adults in the 1980’s and 90’s there is one slogan that probably still rings in our memories that was used to promote Safe Sex, especially in the very scary onslaught and impact of HIV-AIDS as it spread across the world.
“If it’s not on – it’s not on!”
Like the current COVID-19 Coronavirus, the arrival of the Human Immunodeficiency Virus (HIV) also induced a change in our human habits as we sought to reduce its spread, and the escalating death rates. This time it’s not about condoms and safe sex but a different form of protection: PPE.
In our last post we wrote about the very topical issue of Face Masks, however that’s just one aspect of Personal Protective Equipment (PPE). In Victorian Hospitals, Health and Aged Care settings, where staff are seeking to manage and contain outbreaks of COVID, PPE is used as a key strategy to reduce infection transmission. In these settings, staff are often more aware of the risks and commonly use PPE in their day to day practice. But it raises the question; why are such high rates of infections occurring?
Is the PPE used Fit for Purpose?
One reason that may have been a contributing factor to high infection rates in health and aged care settings is access to correct and fit for purpose PPE. We now know that key transmission routes of COVID-19 can be via aerosol (droplets) and contaminated surfaces (touch).
Our bodies are susceptible to exposure via our respiratory system and through organs such as our eyes. The closer contact or higher exposure we have to the virus, the greater the risk, hence some forms of PPE just aren’t adequate in a highly contagious context like a hospital or residential or care setting.
For information on PPE there are some key Federal and State Resource portals, like:
- Personal protective equipment (PPE) for the health workforce
- the Victorian State Health Department site
Some key points of note in relation to both State and Federal advice include:
- “Due to an increased risk of transmission of coronavirus (COVID-19) the PPE Taskforce has updated its advice for all healthcare workers in Victoria.This advice will be reviewed on 9 September.“
- “All PPE should be used in line with the principles in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), acknowledging the unique circumstance of COVID-19 – Health care workers who use particulate filter respirators (PFRs) such as P2 or N95 respirators, must be trained in their correct use, including how to perform fit-checking and safe removal. Unless PFRs are used correctly, their effectiveness will be compromised and the risk of infection (to the wearer) increased.“
Key messages that these State and Federal resources and statements infer are:
- What we knew before in terms of PPE and how we use it (put on, take off, dispose of and otherwise ‘handle’) has changed because this virus is not like any other infection we have dealt with before.
- That the right PPE at the right time for the right circumstance is needed, i.e. in a full COVID environment it’s full PPE (masks, visors, gowns, gloves, over boots)
Where errors are made, and these would be mostly quite unintentional, the effectiveness and safety of the PPE user is greatly compromised. Unfortunately, human ‘error’ is an undeniable fact when it comes to risk.
So what can Aged Care and Disability Support providers, in both residential or community settings, do to enhance the safe use of PPE and reduce the potential for transmission where PPE is worn?
Have access to the right ‘gear’
Ensure you maintain adequate stocks of appropriate PPE that can be readily accessed by staff providing care and support to clients and residents.
Providers can request access to essential PPE from the National Stockpile by emailing your request to: AgedCareCOVIDPPE@health.gov.au or liaising with their relevant State Public Health Unit contacts.
Management needs to ensure that people are personally trained in the correct use and disposal of PPE. In some settings, such as community care, direct supervision may be limited, so it’s important that staff receive essential and timely information on and support to use PPE correctly.
Train – ensure training both practical and resource based is provided and in an appropriate manner for your staff cohort – considering factors like language or other learning barriers that may need to be addressed.
Monitor – Speak to clients, providing them with information on what they should expect from staff around the use of PPE. This can be reinforced via letters, social media, brochures etc and helps clients to understand why certain practices are being put in place and how they can support these.
Practice, Practice, Practice
For staff who aren’t used to ‘donning and doffing’ – especially the extent of PPE that is required in an outbreak context, it really is not “so simple”.
There are multiple components and sequences that have to be followed in order for the right outcome to occur. A simple failure of omitting the correct hand hygiene with sanitiser or proper washing as part of the donning and doffing sequence can totally undermine the integrity of the PPE being used.
Safe Work Australia also has good information.
Further information on correct ‘donning’ and ‘doffing’ techniques can also be found by watching this short video: Donning and Doffing Facial Protection – Mask alone.
If you are working in a COVID positive or potentially COVID positive environment, practice is critical – and having staff ‘watch’ online videos is no substitution for practicing using the real thing.
Resources in plain English, such as work instructions, posters and visual or audio cues, can be used to reinforce practical training.
Create a culture
Using a visual Storyboard, like the Aged Care Quality and Safety Commission’s recent one on Safe Care at Home can potentially assist clients to understand and reinforce a culture of safety in your staff and service delivery.
PPE is not comfortable, it’s not always easy to wear, however, in many settings, it’s currently a necessity. The risk of people being too relaxed about using PPE is also a potential problem, as is PPE fatigue. Rules need to be clearly articulated and demonstrated by management.
Speaking to a Home Care manager in rural Victoria, they have even instilled the term “nudie run” in their vernacular. The culture and compliance expectation in the organisation is that you wear a face mask at all times… and being in regional Victoria at the present time, this is also a regulatory requirement. So for this organisation, if you are out in a communal area you do not want to be caught ‘naked’ without your mask.
“Nudie runs” are definitely not allowed – because if it’s not on – it’s not on!
We hope this post is helpful on this very topical issue of PPE and COVID. We would love to get your feedback on problems you and your team are facing or questions you have on this and related issues, so please feel free to drop us a line on our contact page or email us at firstname.lastname@example.org.
If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Resource Hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.