Questions on mask guidance and protection against Covid-19 aerosol

Calls for nurses to be provided with a higher level of personal protective equipment (PPE) have been renewed, as more evidence is coming out about Covid-19 airborne transmission.

In a new editorial published in The BMJ, respiratory experts say it is now clear that the absorption of aerosols is the primary way the virus is transmitted.

“Aerosol scientists have shown that even speaking and breathing are a way to generate an aerosol”

Editorial writers

They said the possibility of shifting would occur between people standing at a short distance less than one meter from each other.

However, they warned that some respiratory particles from people infected with Covid-19 would still disperse, linger in the air for several hours and could be caught by a person more than two meters away. -on.

In contrast, transfer to Covid-19 after facial contact is now considered “relatively minor”, ​​according to authors from the universities of Leicester, Edinburgh Napier and Hong Kong, Virginia Tech, and NHS Lanarkshire.

They said that, as well as appropriate, an “important implication of air circulation is that the quality of the mask is essential for effective protection against inhaled aerosols”.

“Masks usually prevent many droplets from landing on the covered areas of the face, and most are the least effective part against breathing aerosols,” they added.

However, the same filtration efficiency and good absorption are necessary to improve protection against aerosols, since small airborne particles can find their way through any gaps between the mask and face.

Under the current Covid-19 guidelines in the UK, specially fitted FFP3 respirators are only recommended for nurses in areas where aerosol-making procedures (AGPs) are implemented.

However, the editorial authors said they were aware of examples of health workers wearing common Covid-19-infected surgical masks that were not included in the AGPs.

They said, while the airborne diffusion of Covid-19 has become more well known, the definition of AGPs should also be considered.

“Aerosol scientists have shown that even talking and breathing is a way to create an aerosol,” they said.

Other recommendations on The BMJ the editorial for “giving extra weight” to be placed on ventilation in buildings to prevent the spread of Covid-19.

“This editorial and supporting evidence are important contributions to how best to protect nurses and midwives”

Rose Gallagher

“People tend to be trapped in an environment with windows that cannot be opened or without any ventilation system,” the editorial authors warn.

The Royal College of Nursing has been campaigning since last year for better ventilation in NHS buildings and for more careful guidance on PPE for nurses.

Responding to The BMJ article, Rose Gallagher, RCN’s leading professional for infection prevention and control, says: “This editorial and supporting evidence are important contributions to the best protection of nurses and midwives operating in a variety of situations. from Covid-19.

“This includes the need for appropriate PPE for short-term infection when providing patient care and adequate ventilation to protect from distant aerosol.

“This call goes even further than the need to wear FFP3 masks only when practicing aerosol-generating procedures,” Ms Gallagher said.

Rose Gallagher

He said the RCN has called on the government to change the instruction so all nursing and midwifery staff – whether in the hospital or in the community – are given a much higher level of PPE when working with suspected or confirmed patients. patient Covid-19.

A spokesman for the Department of Health and Social Care said: “The safety of NHS staff and social care has always been our top priority and we continue to work tirelessly to deliver PPE. to protect those ahead.

“PPE recommendations for infection prevention and prevention guidelines were approved by an expert team of clinicians and scientists from across four UK countries based on clinical evidence, and kept under review.

“Progressive evidence and data are continuously monitored and reviewed, and the instruction will be revised sequentially as necessary.”

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