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Thousands of healthcare workers could be wearing ill-fitting masks

The Victorian government initially resisted calls for mandatory testing to check that each worker requiring a N95 mask had one that properly attached to their face, despite fit-testing of such masks being required under Australian standards.

High-risk staff, including those working with coronavirus patients, are now required to undergo fit-testing, according to a new state government respiratory program released in September, but the Australian Medical Association remains concerned that it’s not happening quickly enough.

“At this stage it has not happened in a widespread fashion, despite the department’s commitment to that,” said AMA Victoria spokeswoman Sarah Whitelaw.

“We absolutely need to be prepared for a third wave.”

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Dr Whitelaw said there were about seven varieties of N95 masks in Victoria and she was concerned that some people wrongly believed that their mask was a proper fit.

Respiratory specialist Katie Blair has fitted more than 1500 healthcare workers with high-grade masks in NSW during the pandemic and said that one mask, the BSN Medical Proshield, stood out for its low pass rate.

“It’s about the 30 per cent mark,” she said.

Ms Blair said she was surprised to discover during the pandemic that the majority of Australian hospitals didn’t have a fit-testing program, given it had been part of the Australian standard for more than a decade.

She said fit-testing was able to find a match for most people, a process she said generally took 10 minutes.

In June, the Australian Society of Anaesthetists arranged testing of 129 disposable masks and found that common masks in Melbourne hospitals had low pass rates, including the BSN Medical Proshield, which passed eight of 32 tests, and the Halyard, which passed five of 13 tests.

Despite these results, the society’s president, Suzi Nou, said these models of masks, often called the orange duckbill, remained popular in Melbourne hospitals and it was likely thousands of healthcare workers in Victoria could be wearing ill-fitting masks.

Dr Nou said she recently spoke to a doctor in Melbourne who was flabbergasted to learn during fit-testing that the mask she had been wearing throughout the pandemic didn’t fit her.

“She has looked after many COVID patients, so she was just lucky she didn’t get any illness from it.”

Overall, about 57 per cent of the mask tests resulted in passes.

There is still uncertainty among experts about how much fit-testing can reduce the spread of coronavirus and whether or not ill-fitting masks have played a part in the thousands of Victorian healthcare infections.

“An N95 [mask] that is sub-optimal is probably still better than a surgical mask,” said David Story, chair of anaesthesia at the University of Melbourne, while adding that fit-testing continued to be recommended “on the best available evidence” by the Australian and New Zealand College of Anaesthetists.

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Professor Story said it was “very likely” there were thousands of healthcare workers without N95 masks that fit.

“The minimum you would hope for is a 10 per cent failure rate,” he said. “It’s probably more like greater than 20 per cent and in some hospitals it’s probably more like 40 per cent.”

For the first time on Wednesday, the government revealed how many staff in each Melbourne hospital had been infected by the coronavirus during the pandemic, with the biggest outbreaks detected at the Royal Melbourne Hospital (139 cases), St Vincent’s Hospital (115), Northern Hospital (95) and Sunshine Hospital (88).

The vast majority have since recovered and a Health Department spokeswoman said more staff were undergoing fit-testing each day.

“We are advising our services to target this to the staff at highest risk, including staff working in COVID-19 ward environments, emergency and ICU,” she said.

Amid a global supply shortage of protective equipment, Victorian health authorities continue to insist that they have enough N95 masks to supply those that need it, even as staff at Monash Health were instructed to hold on to a number of 3M brand masks that expired.

“Safer Care Victoria is working with 3M to determine whether these masks are still safe to continue using,  as they have been determined to be in other countries,” the September 18 memo said.

Monash Health and the Victorian Department of Health and Human Services wouldn’t comment on what had happened to the expired masks. Instead, in its response to questions, the department stressed only that it had no plans to use any N95 masks not cleared for safe use.

“Victoria currently has more than 3.4 million P2/N95 respirator masks in its stockpile, with routine deliveries of new respirators being delivered each week,” a department spokesman said.

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