Email from Dr Justine Lancaster, Chief Clinical Advisor l Primary Health Care System Improvement & Innovation| Office Chief Medical Officers, Ministry of Health Kia ora koutou Thank you all for flexing so rapidly into the Alert Level 4 way of doing things (again!). It is so important we all keep ourselves safe whilst we determine the scope of this outbreak and continue to care for our patients. Please use the Primary Care Quick Refence Guide for guidance on assessing and testing the undifferentiated respiratory illness and those at risk of COVID-19 infection. We wish to clarify the instructions in the advice around when a P2/N95 mask might be applicable. As we are all in Alert level 4 the following principles of access to central supply for P2/N95 apply: Health professionals who: • are fit tested (note: this fit- testing requirement for access to Ministry of Health central supplies of P2/N95 is currently exempted to general practice teams for 14 days, although fittesting is strongly encouraged as it provides significant understanding of correct use. Everyone should always fit-check* when donning P2/N95) • are undertaking a clinical assessment or swabbing of symptomatic people (those with clinical symptoms consistent with COVID-19, including less common symptoms), • and are in a close, confined (poorly ventilated) space with the patient. *Fit Checking: Each box of 3M particulate respirators has fit check instructions. To fit check the particulate respirator, users can either perform a positive-pressure or negative-pressure seal check: ·
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A positive-pressure check means covering the mask with your clean hands and exhaling. If the seal is good, the respirator will bulge slightly. If not, that indicates that air is leaking around the edges of the respirator. A negative-pressure check involves covering the mask with your clean hands and trying to breathe in. The mask should collapse slightly as you inhale. If it doesn’t you do NOT have a good facial seal. Readjust the respirator and repeat the fit check process. If you are unable to achieve a good facial seal do not proceed with the activity.
Red streaming of all undifferentiated respiratory illness is necessary. Ideally your Red Stream includes: • Separate workforce • Separate entry/exit • Separate bathroom and break /kitchen facilities • Good ventilation • For many practices this actually means the Red Stream assessment and swabbing will be occurring outside. • When the patient is in a car, ensure ask they open the opposite window to create air flow before opening the window towards you Ngā mihi Dr Justine Lancaster (she/her) Chief Clinical Advisor l Primary Health Care System Improvement & Innovation| Office Chief Medical Officers