CFNU Welcomes the PHAC’s Updated Infection Protection and Control Guidance for Acute Health Care Settings

January 8, 2021 – Earlier today, the Public Health Agency of Canada (PHAC) released updated COVID-19 guidance for acute health care settings. This is the first update to the PHAC’s guidance document since April 30, 2020 and since the agency recognized, last November, that the virus can spread through infectious respiratory aerosols suspended in the air.

Respiratory droplets are created when an infected person coughs, sneezes, shouts or talks; these vary in sizes from large droplets to small ones, also known as aerosols, which linger in the air and may be inhaled. Most transmission occurs when individuals are in close contact with an infected person (within 2 metres).

CFNU’s position statement on COVID-19 states that in aerosol-generating medical procedure (AGMP) ‘hot spots’ (e.g.: intensive care units, emergency rooms, operating rooms, post-anaesthetic care units and trauma centres) or in designated COVID-19 units, health care workers should be provided with, and use, fit-tested, NIOSH-approved N95 respirators given the high risk of aerosol transmission in these acute care settings.

In addition to updating the science on the main modes of transmission, the PHAC has also made a number of positive improvements in the guidance that could serve to protect health care workers from the risks of aerosol transmission:

• The updated PHAC guidance recognizes the primacy of the point-of-care risk assessment in determining the appropriate personal protective equipment. It also recognizes for the first time that exposure to aerosolized virus may occur in the absence of an AGMP. The guidance states that, in determining whether an N95 respirator is required, the health care worker must consider whether a) they are undertaking an AGMP, b) whether frequent or unexpected exposure to AGMPs is anticipated (e.g., on dedicated COVID-19 units) or c) whether there is a risk of exposure to aerosolized virus.
• PHAC recommends that health care workers and visitors wear medical masks at all times in acute care facilities. Patients should also wear masks (if tolerated) outside of their rooms and when staff enter the room.
• PHAC is also recommending for health care workers to don eye protection throughout their shifts, such as full face shields or well-fitted goggles.
• In addition, PHAC recognizes that organizational factors can contribute to the spread of the virus within acute care settings; health care workers without proper access to leave may feel pressured to keep working after being exposed to COVID-19. While PHAC’s guidance recommends “non-punitive sick leave”, CFNU holds that paid sick leave would better empower health care workers to stay home from work when they have been exposed to COVID-19 or have contracted the disease. In the event of multiple absences due to exposures or illness, employers must also ensure they have sufficient personnel to avoid dire staffing shortages that that would negatively impact patient care.
• Many of these improvements follow CFNU’s repeated calls for governments to heed the precautionary principle, a core lesson from SARS that holds that, in the absence of scientific certainty about how an illness is spread, we must err on the side of caution.

Sadly, CFNU is concerned that the guidance still fails to fully embrace the precautionary principle with respect to ensuring that workers receive the highest level of protection, such as fit-tested, NIOSH-approved N95 respirators or higher (reusable elastomeric respirators or powered air purifying respirators). It also continues to put the onus on health care workers to request appropriate personal protective equipment, with the possibility that appropriate protection could be denied.

Troublingly, the guidance mentions the practice of reusing surgical masks and N95 respirators, a practice that the guidance further acknowledges goes against the “foundational concept[s] in [infection protection and control] practice”. Reuse is also discouraged by occupational health and safety specialists because it poses an additional risk to health care workers through the donning and doffing of potentially contaminated PPE. Rather, to address shortages, we should consider alternative and reusable respirators as a sustainable solution.

While CFNU recognizes that the updated guidance is a step in the right direction, much more work needs to be done to protect Canada’s health care workers. The CFNU recommends, as it has since the SARS crisis, that the PHAC embrace the precautionary principle in developing all infection prevention and control documents in order to better protect health care workers and their patients.

“For months now, Canada’s health care workers have battled COVID-19, often in less than ideal conditions and all too often while putting their own health and safety at risk,” explained CFNU President Linda Silas. “Yes, we are all in this together, but that doesn’t mean it’s acceptable for health care workers to continue being needlessly exposed to COVID-19; governments need to step up their efforts to truly protect those on the front lines of this global pandemic.”

“Health care workers are selfless and courageous people, but they deserve to go into work feeling protected and to come home to their families safe and sound – just like the rest of us.”