Read on Twitter
So, lots of (very appropriate) concern among Melbourne HCWs re: adequate PPE amidst current #COVID19 outbreak.
Every hospital has its own bespoke protocol on when & what PPE to wear, stratifying patient risk and exposure risk (AGP?)…
/1
Every hospital has its own bespoke protocol on when & what PPE to wear, stratifying patient risk and exposure risk (AGP?)…
/1
Many of the PPE recommendations are... pretty damn optimistic 
given everything we still don’t know about covid transmission. (Is a heavily labouring 
with covid really NOT aerosol generating?! 
)
Screening questionnaires and pending covid tests are not much use when… /2
given everything we still don’t know about covid transmission. (Is a heavily labouring with covid really NOT aerosol generating?! )Screening questionnaires and pending covid tests are not much use when… /2
...people lie on the questionnaires, don’t disclose the tests or simply don’t understand the importance.
(a team from 1 hosp currently isolated after such lie)
So making PPE decisions on patient screening has, at best, UNKNOWN validity. Not good when HCW safety relies on it. /3
(a team from 1 hosp currently isolated after such lie)
So making PPE decisions on patient screening has, at best, UNKNOWN validity. Not good when HCW safety relies on it. /3
The primary problem once AGAIN is that N95s & other PPE are seriously limited, so their use is rationed. But (again) this isn’t really acknowledged in the protocols which use weaselly terms like “adequate protection”.
(‘Adequate’ for who exactly? Not for HCW already in ICU!) /4
(‘Adequate’ for who exactly? Not for HCW already in ICU!) /4
The disappointing thing is that our understanding of covid transmission AND adequate PPE is not much better than when I wrote about it 2 months ago: 
https://www.metajournal.com/blog/100/thoughts-on-ppe
Same issues exist, with limited progress made. If anything we’re less certain today… (airborne??)
/5
https://www.metajournal.com/blog/100/thoughts-on-ppeSame issues exist, with limited progress made. If anything we’re less certain today… (airborne??)
/5
Some hospitals have sourced reusable elastomeric P2/3 masks, developing processing protocols, but MANY haven’t - relying instead on rationing limited N95s.
(Great work by ARMC, Sundström, @DrPieterPeach and many others
)
/6
(Great work by ARMC, Sundström, @DrPieterPeach and many others
)/6
In fact I hear today from friends & colleagues that one Melb outbreak hospital has specifically PROHIBITED anaesthetists from BYOing reusable elastomeric masks (by Infection Control no less!) and also does NOT provide universal N95 for all theatre cases… 
/7
/7
In this example, it would have been better for Infection Control 
to work WITH anaesthetists to develop protocols for use and processing of their masks, SUPPORTING HCW safety, AND preserving limited single-use N95s - not shutting it down because it doesn’t fit assumptions!
/8
to work WITH anaesthetists to develop protocols for use and processing of their masks, SUPPORTING HCW safety, AND preserving limited single-use N95s - not shutting it down because it doesn’t fit assumptions!/8
Thus it seems hospital administrators and leaders have learnt little from outbreaks in places like NW Tas or Melb’s 1st wave - “we’re different” and “it won’t happen here” still appear as dominant delusions.
Sort your sh%t out and protect my Melb friends you bastards!
/9
Sort your sh%t out and protect my Melb friends you bastards!
/9
On a glass-half-full note, it could always be worse - we’re certainly not the only one’s balancing PPE decisions… 
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/end https://twitter.com/joshuapotash/status/1288353235670126592
⇣ /end https://twitter.com/joshuapotash/status/1288353235670126592
