Open AccessA position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2
Author(s) -
Keertan Dheda,
Salome Charalambous,
Aaron S Karat,
Arné von Delft,
Umesh Lalloo,
Richard van Zyl-Smit,
Rubeshan Perumal,
Brian Allwood,
Aliasgar Esmail,
Man Sau Wong,
Adriano Dusé,
Guy A. Richards,
Charles Feldman,
M Mer,
Kennedy Nyamande,
Usha Lalla,
Coenraad F. N. Koegelenberg,
François Venter,
Halima Dawood,
Shahieda Adams,
Ntobeko Ntusi,
HeleneMari van der Westhuizen,
M-Y S Moosa,
Neil Martinson,
Harry Moultrie,
Jeremy Nel,
Harry Hausler,
Wolfgang Preiser,
Lance Lasersohn,
Heather J. Zar,
Gavin Churchyard
Publication year - 2021
Publication title -
african journal of thoracic and critical care medicine
Language(s) - English
Resource type - Journals
eISSN - 2617-0205
pISSN - 2617-0191
DOI - 10.7196/ajtccm.2021.v27i4.173
Subject(s) - respirator , medicine , tuberculosis , covid-19 , personal protective equipment , intensive care medicine , environmental health , infection control , triage , pandemic , emergency medicine , disease , infectious disease (medical specialty) , pathology , materials science , composite material
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death.