The All India Institute of Medical Sciences, the country’s premier healthcare institute, has issued a notice saying that it will provide only 5 N95 masks each to its doctors, residents and other staff to be used over the next 20 days. Issued by Medical Superintendent D K Sharma, it instructed doctors and staff to reuse the masks by disinfecting it and keeping it in open after use.
The notice accessed by NewsClick read, “As desired by the competent authority, viz Director AIIMS, it has been decided that N95 masks will be provided to all healthcare workers involved in direct patient care...it is imperative that in accordance with evidence based scientific literature, these N95 masks are to be disinfected by individual users (by keeping them in open after use or by other methods) and reused at least 4 times each whereby these will suffice for about 20 days.”
The notice comes days after the doctors at the hospital had expressed concerns about the lack of Personal Protective Equipment (PPE) which exposed them to severe risk of infection. Interestingly, the guidelines by AIIMS contradict the notice, which say that disinfecting the masks may compromise its quality substantially. The guidelines read, “Currently, decontamination of PPEs for purposes of reuse is not recommended,
primarily because of concerns that decontamination would degrade the performance especially of the respirator. Preliminary work on the decontamination of N95 masks has been published in recent years. However, given the uncertainties on the impact on decontamination of respirator performance these should not be worn by HCWs (Healthcare Workers) when performing or present at an aerosol generating procedure.”
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Commenting on these contradictory guidelines and notices, Dr Srinivas Rajkumar T, Secretary of the Resident Doctors Association told NewsClick that the institute needs to come up with clear guidelines regarding reuse of the masks. He said, “It is not clear how the masks should be disinfected. We cannot take these masks to our homes because it will infect other persons too.”
The doctors at the institute are battling the risks of infection after one doctor was found infected with COVID-19. Similarly, a few doctors at the Delhi Government Cancer Hospital were also tested COVID-19 positive. Later, at least 12 nurses and staff, reportedly developed the symptoms. Another staff who requested anonymity said that they have not been briefed over usage or disinfection.
Public health organisations maintain that the situation could have been averted had the government acted proactively. In a statement, Jan Swasthya Abhiyan had raised concerns about the depleting resources in the fight against the pandemic. “The role of the government over the past two months is also baffling. The first case of COVID-19 was registered on January 30 in India. Taking cognisance of the seriousness of the issue, the government issued an order prohibiting export of all PPE. But it was amended on February 8 allowing export of surgical masks and all gloves except NBR gloves. The restrictions were further relaxed to include more items on February 25.The WHO issued an interim guidance regarding PPE on February 27 noting that there is going to be a global shortage of PPE and hence came up with a document on its rational use. Taking cue from this, the government should have moved fast to prohibit export of domestically produced PPE and raw material so as to ensure its availability in the country. But that order came only on March 19,” the JSA statement reads.
It added,”Current government efforts at procurement are far too little, and very late, making it unlikely that we would have adequate PPE anytime soon. The government has placed the order of 7.5 lakhs body overalls to be supplied by May. However, the need could be upto 5 lakhs of body overalls a day. Similarly the order of 60 lakh N95 masks and one crore three ply masks will be grossly inadequate in the current scenario.”
The acute shortage of PPE has left leading countries issuing guidelines over reuse and extended use of the N95 masks. The Centre for Disease Control and Prevention maintains that health workers should, “discard N95 respirators following use during aerosol generating procedures. Similarly, they should discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients or after following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.”
Also read: COVID-19: Rs 50 Lakh For PPE Diverted to PM CARES, Allege AIIMS Doctors