Fit-testing is a 30-minute process to ensure masks do not leak, but more rudimentary fit-checking is far more common
Peak medical groups say hospitals should be protecting frontline staff from Covid-19 by a more rigorous testing regime for face mask fit.
The pandemic has caused a significant loss of life among frontline medical staff in the United Kingdom, where Guardian estimates put the number of reported dead at more than 50.
Doctors there have sounded the alarm on the lack of fit-testing being conducted on masks, saying it was like “playing Russian roulette with doctors’ lives”.
Fit-testing is a roughly 30-minute process to ensure the masks healthcare workers are wearing do not leak. The test is often performed by spraying substances at the wearer to check if they can be tasted, or through the use of dye and particle measurement.
In Australia, fit-testing is recommended in most jurisdictions, but not mandated.
Fit-checking, a rudimentary check for gaps between the mask and the skin, is far more common.
Anaesthetists are some of the most at risk medical practitioners to Covid-19, and can be highly exposed during intubation.
The Australian and New Zealand College of Anaesthetists (Anzca) issued advice last week saying that fit-testing was recommended, but may not be “attainable or practical in all situations and organisations”. It said the “the minimum standard should be fit-checking by a suitably trained person”.
The Anzca president, Dr Rodney Mitchell, said there was no question that fit-testing would be done in every instance in an ideal world, but that the rapid evolution of the crisis meant it wasn’t always possible.
“We recognise that the gold-standard is a formal fit-test. We recognise that we have to minimise risk, and that’s why we wash our hands all the time, we’re wearing long-sleeve gowns, the masks, that’s why we’re doing all these things,” Mitchell said.
“Along the way we are having to accept a certain amount of risk. For example, we do not wear the full protective equipment for every single patient, because we know that the degree of community transmission in Australia does not require it.
“It becomes a question of what’s acceptable.”
Dr Andrew Miller, the Australian Medical Association’s West Australian president, said about one-third of those who underwent fit-testing failed, showing the importance of the test in protecting workers and ensuring they had the right mask.
“So if you’re not doing this sort of checking people will go into a situation where they are exposed to Covid and they have no idea whether or not the mask is going to protect them,” Miller told the Guardian.
Many doctors are also calling for a fundamental rethink of Australia’s approach to ensuring the safety of healthcare workers.
Miller, in his personal capacity, has co-written a paper and submitted it to WA Health, questioning the current approach to PPE.
The paper argues PPE use should be guided by a precautionary principle, which recognises that much is still unknown about Covid-19, including the nature of its transmissibility, and therefore staff should be provided with maximum protection until further evidence emerges. The chief aim should be to ensure not a single medical worker dies in Australia, the paper argues.
Such an approach would upgrade the level of PPE on offer and strengthen infection control systems. It also urged the state to allow healthcare workers to use their own PPE.
“When the science is uncertain, and the workplace is going to be messy and disorganised, and suddenly ramping up to deal with disease we’ve never treated before, those are all reasons why you go more conservative on your safety, not less,” he said.
The Australian Society of Anaesthetists said fit-testing was a “critical part” of preparing for Covid-19, which was “best implemented prior to a pandemic”.
The ASA contacted the chief medical officer, Brendan Murphy, early on when Covid-19 appeared in Australia, expressing concerns that there may not be sufficient time to train and prepare.
“We were pleased to see the suspension of non-urgent elective surgery to allow time for this preparation and to reduce the risk of infection amongst healthcare workers,” Dr Suzi Nou, the ASA president, told the Guardian.
Like Anzca, Nou said the ASA encouraged fit-testing wherever possible but also understood that it “may not be practical to implement in all health services”.
“We commend the many health services that have undertaken fit-testing and all other endeavours in the initial phase of this pandemic to reduce transmission to patients, healthcare workers and the community.”