The implications of the biggest epidemic since SARS, the COVID-19 coronavirus, are far reaching. As health professionals, we are charged with the responsibility of ensuring the safety and wellbeing of the patients under our care. Kristin Trafford-Wiezel, case manager at Dental Protection, explores the vital role of mask use
One of the basic standards of care is appropriate infection control and one of its basic pillars is Personal Protection Equipment (PPE), specifically masks. As many of you are aware, due to the huge need for masks worldwide we have been experiencing restrictions in access and a rise in prices. The threat of a shortage such as this has led to questions like: “Do I need to change my mask for EVERY patient?”
The lead document for the relevant advice is the Dental Board’s Guidelines on Infection Control, which states each practice must have access to four key infection control documents:
1. A practice manual – setting out the infection control protocols and procedures used in that practice
2. The Australian and New Zealand Standard on office-based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment (dental practitioners work under AS/NZS 4815 unless they work within an organisation that operates under AS/NZS 4187: cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities)
3. National Health and Medical Research Council (NHMRC), Australian Guidelines for the Prevention and Control of Infection in Healthcare
4. Australian Dental Association (ADA), Guidelines for Infection Control
These four documents set out our obligations and help us in the implementation of these requirements in our daily practice life. Our practice manual should be our how-to guide for our own practice, and the remaining three documents have a much broader scope. Two of these specifically address mask usage.
The ADA’s infection control guidelines state that the filtration abilities of a mask begin to decline with moisture on the inner and outer surfaces of the mask after approximately 20 minutes, and that they must be fitted and worn according to the manufacturer’s instructions. However, there is no specific mention of one per patient, so maybe we can?
What are the manufacturer’s instructions though? What is "disposable" and what does the symbol with a crossed-out '2' mean? A quick search shows that it indicates a medical device that is intended for one use, or for use on a single patient during a single procedure. The overarching and more finely detailed NHMRC guidelines provide even more helpful information, which is summarised below.
What is a mask?
The guidelines specify that surgical masks are loose-fitting, single-use items that cover the nose and mouth. Healthcare workers wear a mask if there is risk of them inhaling an infectious agent and masks; eye protection or faceshields are worn by a healthcare worker in situations where the patient’s body substances may splash onto his or her face.
Are they disposable?
The Surgical masks section (page 129) of the NHMRC guidelines reinforces that masks should be changed between patients and when they become soiled or wet, and then goes on to state that masks should never be reapplied after they have been removed.
Taken together, the various guidelines give us a clear overall picture of what is expected of us regarding the single use of masks. Overall, it is important to remember the responsibility we have to the health and wellbeing of our patients and co-workers, and that correct infection control is imperative for everybody’s safety. Let us all take the advice by the NHMRC and lead by example, and champion the appropriate use of PPE in all our settings.