- Employees alliance argue authority is making case by selectively highlighting Centres for Disease Control recommendations
- Public Doctors Association chairwoman cautions timing poor for another union-authority row
Hong Kong's Hospital Authority has issued new guidelines on mask usage amid the citywide shortage, citing Centres for Disease Control and Prevention (CDC) standards in encouraging staff to change protective gear such as the N95 respirator less frequently, a move that has met with mixed reaction among health care professionals.
In a statement on Thursday, the Hospital Authority Employees Alliance, which recently led a five-day strike aimed at forcing a complete border closure, slammed the changes as potentially dangerous for frontline health care workers, saying the mask shortage would be better alleviated by putting non-emergency services on hold while the coronavirus outbreak remains ongoing.
The new guidelines, issued on Wednesday by the authority's chief infection control officer, urged "prudent use" of personal protective equipment.
"It is suggested extending the use of N95 respirators for multiple patients during serial patient encounters without removing or re-donning between encounters … unless it is damaged or soiled," the guidelines read.
The N95, a disposable mask that can guard against hazardous substances, was widely used during the severe acute respiratory syndrome outbreak in 2003 that killed 299 people in the city.
"The same principle applies to eye protection," read the new guidelines, which said the approach followed recommendations by the US-based CDC.
But in a statement, the alliance, which was formed out of the anti-extradition law movement and claims a membership of about 20,000, accused the authority of taking the CDC recommendations out of context, saying it had been "misleading and even detrimental to the safety of staff".
While the CDC website does make allowances for keeping the same mask on when dealing with multiple patients infected with the same pathogen, alliance vice-chairman Ivan Law Cheuk-yiu said the authority failed to cite other relevant CDC guidelines on extended equipment use.
Key among those were recommendations that respirators be discarded following use during aerosol-generating procedures, or when they have been contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
They also recommend discarding the N95 following close contact with patients or when exiting from patient care areas.
"Simply issuing guidelines to tell staff not to remove the masks or protective equipment is inadequate. And worse still, the authority claims it is in line with the CDC guidelines, when it takes them out of context," Law said.
"We appreciate we should ensure reasonable use of equipment, and we are not asking staff to waste the masks or equipment. But the authority guideline is so unclear and misleading that some frontline staff could feel pressure and avoid changing equipment. It will only expose them to risk of infection and it does no good in combating the epidemic."
Law's alliance also demanded the authority suspend non-clinical and non-emergency services to reduce the demand for protective gear, and asked the body to liaise with the government to "mobilise all existing stock of personal protective equipment to the authority".
Medical professionals who spoke to the Post on Thursday said while they understood the concerns of health care workers, they also appreciated the authority's difficult position.
We are not asking staff to waste the masks or equipment. But the authority guideline is so unclear and misleading that some staff could feel pressure and avoid changing equipmentIvan Law, Hospital Authority Employees Alliance vice chairman
Dr Arisina Ma Chung-yee, chairwoman of the Public Doctors Association, said she understood the alliance's stance, but that another flap between the union and the authority would be unproductive.
"Their relations with the management are a bit tense, especially after last week's strike. But during this time, the last thing we need is to bury the management in deeper trouble," she said, while also urging the authority to draw up more comprehensive guidelines to ease workers' fears.
"I would rather leave the supplies to the most needy, those who have to deal with high-risk cases. For those handling low-risk cases, the problem of not replacing masks or protective gear should not be too big," she added.
Dr Leung Chi-chiu, chairman of the advisory committee on communicable disease at the Hong Kong Medical Association, agreed that high-risk areas were where the focus should be.
"If you are working in a high-risk area, your N95 mask could get contaminated, and you could also get infected if you change your mask there," he said.
Opposition lawmaker and private medical practitioner Dr Kwok Ka-ki, meanwhile, agreed that the guidelines should be more comprehensive, but conceded that including every potentiality was not always practical.
"It is difficult to include all things in exhaustive details, because frontline medical staff face different situations," he said.
Responding to the complaints on Thursday night, the authority said the guideline revisions were necessary in the wake of the surge in demand for protective gear in hospitals.
"Allowing extended use of equipment is to better use of resources," the body said in a statement, adding it would "continue strengthening internal communication and training in order to provide more clear and concrete examples … to help medical staff understand the relevant practises".
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