General Practice and Urgent Care sector update

The Ministry suggests that those District Health Boards and Primary Health Organisations in possession of portacount machines from the Ministry consider and prioritise fit testing programmes within communities based on the following guidance: 1. Healthcare workers operating in high risk environments such Emergency Departments, Urgent Care, COVID-19 BCP wards, Respiratory Wards, Intensive Care Units and COVID-19 Care in the Community alternative accommodation facilities 2. Healthcare workers providing in-person care to COVID-19 positive people isolating at home as part of COVID-19 Care in the Community 3. Identified staff in an aged residential care facility who will mobilise as part of the ARC BCP response and identified home care, disability support workers and mental health & addiction staff who will provide direct care for COVID-19 positive patients where care cannot be deferred during the isolation period 4. Healthcare workers who will undertaking COVID-19 swabbing with symptomatic people 5. Other healthcare workers and non healthcare workers providing in-person support as part of COVID-19 Care in the Community (e.g. MSD providers, Oranga Tamariki and others).

Please also note, healthcare workers should only be fit tested to a 9320A+ particulate respirator if they do not fit test to any other model of particulate respirator, noting that this would only occur in a small number of instances. The preferred model for fit testing is the 1870+ before trying other alternatives. The 1870+ is a ‘paired fit’ with the 9320A+ and the 1870+ has a superior level of fluid resistance.

Manufacturing of the 9320A+ has significantly reduced. As such, a transition to the 1870+ is advised and supplies are limited to those who have already fit tested to an 9320A+ and those who only fit test to the 9320A+. It is important that we ensure that those who only fit test to a 9320A+ can continue to be protected in the work that they do.

Models of P2/N95 particulate respirators for people who have not been fit-tested The Ministry will supply 1870+ particulate respirators for those people who require a P2/N95 particulate respirator and who have not been fit tested. This model of N95 fits 80-90%+ of the workforce. Workers should perform a fit check (also called a seal check) before engaging with confirmed COVID-19 positive cases, or people considered high-risk based on the IPC risk assessment. If the mask does not fit properly, they should not engage with the patient and look at other options e.g. another staff member conducting the engagement.

The Ministry receives limited supplies of alternative models (e.g. smaller sizes) of P2/N95 particulate respirators. Supplies are prioritised for those who have been fit tested to these models and those working in settings where they are likely to require P2/N95 particulate respirators based on the IPC guidance. We are in continuous conversations with suppliers around accessing appropriate smaller sized models of P2/N95 particulate respirators.

The Ministry will consider case by case circumstances for supplying alternative models of P2/N95 particulate respirators for community settings, however in most instances we expect organisations to utilise the 1870+.

General Practice and Urgent Care sector update

N95s supplied for providing close care for a confirmed case of COVID-19 The Ministry has previously held the position that it will supply P2/N95 particulate respirators to those general practice and urgent care facilities that have confirmed staff have been fit tested. We continue to hold the view that fit testing is a prudent step and is a requirement under the AS/NZS 1715:2009 standard for the selection and use of respiratory equipment.

However, we note the constraints with fit testing capacity and the need to utilise a well fitted P2/N95 particulate respirator when providing close care for a confirmed case of COVID-19.

The Ministry will provide 1870+ N95 particulate respirators to general practice and urgent care without confirmation that fit testing has been completed until further notice. The 1870+ model of N95 fits 80-90%+ of the workforce based on fit testing data. The decision to utilise a particulate respirator without having conducted fit testing to confirm an appropriate level of protection is at the discretion of both the employee and the employer, and in all instances the employee should be informed of all associated risks under the Health and Safety at Work Act 2015.

Ministry IPC guidance and N95 use The Ministry’s current IPC guidance for PPE recommends that all primary and community health and disability care workers complete a risk assessment before interacting with a patient, client or resident to determine their likelihood of exposure to COVID-19. Requests for P2/N95 particulate respirators that fall outside this guidance will not generally be supplied by the Ministry because at the moment it is not deemed necessary.

That said, to provide workers with greater levels of comfort and reassurance of feeling prepared, we will be allowing general practice and urgent care to order reasonable volumes of N95s as contingency supplies to be used only as cases in the community and the consequent risk of exposure to COVID-19 increases. These supplies are not for use now, but for if and when N95s are required, adhering to national IPC guidance.

We have been made aware that P2/N95 particulate respirators are being utilised outside of the Ministry’s IPC guidance. As a reminder, the Ministry does not supply PPE for it to be used outside of the Ministry IPC guidance, and autonomous decisions for receptionists and those screening and seeing patients in low and moderate risk settings to utilise P2/N95 particulate respirators must be met by alternative supply lines. The inappropriate use of P2/N95 particulate respirators compromises New Zealand’s ability to successfully respond to COVID-19 and our ability to utilise this resource in the settings where they are most needed. Note there is scope within the existing IPC guidance for those operating ‘red streams’ with consideration of moderate to high-risk patients in circumstances of widespread cases – we are not yet at this stage.

Please also remember sessional use of PPE can be applied.

9210+ particulate respirators Recently we’ve worked with some fit testers who approached us regarding a small number of staff that did not fit any of the P2/N95 models available to general practice and urgent care facilities. We’ve identified that the 9210+ model successfully fit tests for a portion of these people and have decided to make this available to all general practice and urgent care where the Ministry (via covid.healthsupplychain@health.govt.nz) have received a fit testing declaration to confirm fit testing to this model.

The 9210+ is similar in design to the 9320A+ and 1870+. We’ve confirmed with 3M that it meets level 2 fluid resistance testing and it is acceptable for use in general practice and urgent care