Page 9 - ONLINE – Nursing Matters October 2020_Vol 11

current issues

• Flammability testing to prevent transmission. For the 31 million+ people who
• Good breathability, internal and external sides clearly have contracted and survived COVID-19, no one is sure
identified, structured design that does not collapse against how long immunity will last. Researchers at King’s College
the mouth. in London from March to June this year repeatedly tested 90
people with COVID-19 and found that by 2 months many of
Gowns/Aprons their antibodies (B-cells that intercept and bind to invading
molecules) had disappeared. The study did not account for
• Cotton gowns and aprons should be changed when the T-cells which seek and destroy infected cells, so further
they become wet or contaminated, and then they can be research is needed and several vaccine trials are underway.
washed to use again
• Plastic aprons are single-use, fluid resistant, mid-calf length Why does transmission appear to be slower in Africa? Why
to cover the top of the boots do some younger people develop a hyper-immune response?
• Gowns ideally have thumb/finger loops or elastic cuffs to Is HIV status relevant? Who will have not only their lungs, but
anchor sleeves in place major organs or their central nervous system affected by the
• Option 1: Fluid penetration-resistant: EN 13795 virus? It is the unknowns that are most frightening. There are
high performance, or AAMI PB70 level 3 at least 320 000 viruses known to infect mammals alone and
performance or above, or equivalent the pathogens rarely stick to one species. Most pandemics
• Option 2: Blood-borne pathogens penetration- affecting humans have come from ‘zoonoses’ or pathogens
resistant: AAMI PB70 level 4 performance, or (EN coming from animals, and with the rapid environmental
14126-B) and partial body protection (EN 13034 changes currently underway, scientists say, humans have
N95 or not including total inward leakage standard compliance or EN 14605), or equivalent created opportunities for viruses to evolve, while increased
and/or SANS 50149 as a minimum • Ideally of light colors to better detect contamination. travel aids rapid dispersion around the globe.
Before COVID-19, few people had ever heard of an N95 • All must have good breathability and a design that
mask – only people working in the mines or with TB patients. does not collapse against the mouth with qualitative or Hands Despite launching a rapid early response, staff in South
With the onset of COVID-19, sales of N95 masks became a quantitative fit testing carried out at least once a year African hospitals and clinics found themselves without
burgeoning industry, with masks flooding in from all over the for each healthcare worker for each brand or type of Good hand hygiene is essential as COVID-19 can be spread enough PPE. The international demand for masks, gowns
world, including an incredible number of fake N95 masks. particulate respirator provided by touching the eyes, nose or mouth. Both soap and hand and ventilators outstripped supply. Many facilities and
Millions of donated masks had to be ‘re-purposed’ as medical • No ear loops, as these compromise protection due not sanitiser work well to destroy the virus. practices struggled with high costs. It has taken time for local
staff were not safe from inhaling the virus. At the time of writing, sealing the face and risking leaking at the sides, chin or manufacturers to produce PPE that consistently meets strict
at least three South African companies have developed the nose • Wash hands with soap and water for at least 20 seconds industry standards and where the supply of raw materials
capacity to produce an equivalent mask and the new regulation • If performing aerosol-generating procedures (e.g. sample • Use an alcohol-based hand rub if hands are not visibly can be sustained. If we can get this right, we can support
will require that all surgical masks and respirators may only be collection) on several COVID-19 patients sequentially, dirty; hand sanitiser gels need to contain 75% isopropanol nurses across South Africa, and maybe across the continent.
manufactured, imported, exported, distributed or wholesaled then the same N95 respirator and eye protection can be or 80% ethanol to be effective – this breaks down over
by establishments holding a valid medical device establishment used throughout the session, but the apron and gloves time, so check production and expiry dates SAHCS will continue advocating for the identification
license from SAHPRA and with NRCS pre-approval. need to be changed between patients • Gloves – take care to wash or sanitise before putting on of suppliers who can deliver the quality certified PPE at
• The outside surface of the N95 respirator may become or removing gloves. affordable prices. We will continue linking healthcare workers
How to check N95 quality heavily contaminated with virus during aerosol-producing to guidelines, online trainings and updated information. This
procedures, so take great care not to touch the outside How long will this outbreak last? has been one of the biggest challenges ever faced by our
• A genuine N95 respirator filters out >94% of particles surface and clean hands thoroughly after mask removal health system, and we are in it with you for the long haul.
larger than 0.3 microns. The equivalents are: • Respirators with an exhalation valve are not recommended Epidemiologists say, ‘If you’ve seen one pandemic,
• South Africa: SANS1866-2:2018, for source control, as they allow unfiltered exhaled breath you’ve seen one pandemic.’ This is a new virus, so while Shortages or stockouts can be reported as follows:
SANS50149:2003, SANS50143:2003, to escape. the genetic code was determined quickly, scientists and www.COVID19PPEshortages.co.za or contact our
SANS10338:2009, SANS10220:2010, medical professionals are still working out how to treat staff on [email protected] or 011 728 7365.
SANS50136:1998 (N94) Surgical masks serious cases and running various vaccine trials to be able
• Australian standards: AS/NZS1716:2012
and AS/NZS1715:2009 (P2) Surgical or medical masks are deemed sufficient for working
• European Union Standards: EN149-2001 in most medical and outreach settings. They need to be of a
and EN529:529:2005 (FFP2/3) three-ply material and fit snuggly around and fully cover the
• United States: NIOSH Approval 42CFR84 mouth and nose. Patients with COVID-19 symptoms should References
and OSHA29CFR1910.134 also wear a mask. To check for quality, look for a Quality CDC. 10 July 2020. Cleaning and Disinfection for Households: Interim Recommendations for U.S. South African National Department of Health. April 2020. COVID-19 Disease: Infection Prevention and
• China: Standard effective 01-07-2020: GB 2626- Certificate indicating compliance with SANS1866-1:2018 Households with Suspected or Confirmed Coronavirus Disease 2019, Atlanta, USA. Control Guidelines, Version 1.
2019 and GB19083:2010 (KN95) or SANS1866:2008: CDC (15 July 2020). Interim Infection Prevention and Control Recommendations for Healthcare Personnel World Health Organization. 19 March 2020. Infection prevention and control during healthcare when
COVID-19 is suspected. Interim guidance.
During the Coronavirus Disease 2019 (COVID-19) Pandemic. Atlanta, USA.
• Particulate filter penetration (PFP) minimum NaCl filtration Cook TM. 2020. Personal protective equipment during the COVID-19 pandemic – A narrative review. World Health Organization. 2 April 2020. Requirements and technical specifications of personal protective
• The box should not be damaged, should carry the 26% (paraffin oil and latex where possible) Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK. equipment (PPE) for the novel coronavirus (2019-ncov) in healthcare settings. Interim recommendations.
manufacturer’s details, and note a batch/lot number • Determination of breathability (differential pressure) De Waal A. 3 April 2020. We should be wary of simplistic uses of history, but we can learn from the logic World Health Organization. 6 April 2020. Advice on the use of masks in the context of COVID-19. Interim
guidance 6.
of social responses. New Pathogen, Old Politics. Science & Nature.
• Respirators manufactured locally will be labelled as FFP2 • Water adsorption rate (fluid permeability/imperviousness)
European Centres for Disease Control. 12 September 2020. Transmission of COVID-19.
or FFP3 standard and should meet SANS 1866-2:2018 minimum 120 mmHg pressure Kaplan S. 15 May 2020. Climate change affects everything — even the coronavirus, Washington Post.
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