General Practice Gold Coast (GPGC) Acting Board Chair
I would like to take this opportunity to share with you all some of the resources and recommendations that have recently been published by Australian scientists and updates to PPE guidelines. These recommendations can be applied at a practice level, individual GP consulting room level, and importantly some can also translate to practical things that businesses and schools can consider implementing.
1.Masks are important
Within the GP clinic setting staff should follow current clinical guidelines.
The National Covid-19 Clinical Evidence Taskforce has recently released updated (and simplified) PPE guidelines. In summary these guidelines now emphasise the need for adequate respiratory protection (fit tested P2/N95 masks) in higher risk settings and note that risk can be increased in enclosed areas with low levels of ventilation. Queensland Health will advise on the local risk, in a moderate or high risk setting is the addition of eye protection. ‘Mask + eye protection’.
Adults and older children are now accustomed to wearing masks however there is a compelling argument, in the context of community transmission, that this recommendation be extended to younger children. Dr Natasha Yates and I have recently written an article that summarises the evidence behind this, and some practical tips for keeping our kids safe.
2. Optimise fresh air
Open doors and windows where possible. Consider having patients wait outside (weather and location permitting).
3. Limit recirculation of air
Turn off the recirculation mode of any air conditioning system and switch to fresh air intake. Note that this can also be done in your car.
4. Monitor the air quality
CO2 is a good marker of ‘rebreathed air’, and a proxy for increased risk of infection in the context of someone who is positive for Covid sharing the same space. CO2 monitors can be purchased for less than $200 (some a lot less), it is recommended that you purchase a non-directional infra-red (NDIR) sensor. As a general rule indoor air should be less than 800ppm (outside air is 400 – 415 ppm).
5. Consider indoor air cleaners.
Poor ventilation or high-risk indoor areas? Consider the use of portable HEPA filters.
6. Reduce occupancy in shared spaces
With higher background risk prioritise telehealth. Ensure distancing of staff and patients (including in the staffroom and during meal breaks). Limit those in consultation rooms to the absolute minimum needed. If possible, cohort staff to minimise the impact of exposure.
It will be interesting to see how our practices and processes evolve over the coming months and years. Whilst GPGC continues to advocate for increased funding to support General Practices mitigate risk, there are a number of low, or cost neutral measures that you may be able to implement now. Just as schools are auditing ventilation and governments investing in HEPA filters in Victoria and NSW, we too can do similar within our healthcare settings.
It may well be that improving the air we breathe has benefits far more wide reaching than helping to reduce the risk of Covid. Will ‘cleaner air’ be the silver lining to the pandemic?
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