New pulmonary function testing advice for the ‘endemic’ era

Public health

By Michael Woodhead

17 Feb 2022

New advice on the safe performance of pulmonary function testing has been developed to reflect the transition of SARS-CoV-2 from pandemic to endemic in Australia.

A joint working party for Pulmonary Function Testing (PFT) and COVID-19 convened by the Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) has drawn up nine points to guide providers of PFTs on aspects such as patient access to testing, use of masks, PPE and ventilation.

The Working Group says its messages reflect a precautionary approach to protect the safety of both healthcare workers and those being tested following the recent rise of the highly infectious Omicron strain.

As with previous guidance for PFT such as spirometry, the advice notes that SARS-CoV-2 is transmitted by aerosols as well as droplets, and therefore mitigating strategies need to be tailored to individual circumstances such as the practice environment and the likely proximity to the patient, as well as local COVID-19 transmission levels

The advise that all individuals be screened for SARS-CoV-2 symptoms and exposures prior to testing, and that vaccination status or a recent negative COVID-19 test should not be used to inform PPE use.

N95 masks and eyewear (face shields or goggles) are recommended as the minimum standard for healthcare workers performing PFTs, and fit testing is essential.

Additional PPE such as gowns and gloves may also be required where higher levels of aerosol generation or cough are expected such as with cardiopulmonary exercise tests and bronchial provocation tests.

Other basic measures recommended to prevent COVID-19 transmission include the wearing of surgical masks by patients, routine hand hygiene and cleaning between tests and the use of inline filters that reduce but do not eliminate aerosols.

The new guidance also stresses the importance of room ventilation as essential to minimise persistent aerosol exposure.

A minimum of six air changes per hour is recommended for patient care areas and 12 air changes per hour for rooms where aerosol generating procedures occur.

“In the absence of adequate ventilation, strategies such as leaving rooms unoccupied between testsi or use of HEPA filtration systems to supplement room ventilation are strongly encouraged,” they advise.

And to minimise transmission to others, PFTs should be performed in single rooms, not shared spaces, they recommend.

The TSANZ says the working party preliminary advice will be supplemented by a full document to be published in early 2022. It is aimed at providers of pulmonary function tests across all clinical, occupational and research settings and is intended to supplement rather than replace local infection prevention and State or Territory Government directives

It recommends that the number of PFTs performed should be minimised if there are high levels of local transmission or shortages of staff.

“Strategies such as triaging referrals or limiting test types to those essential for clinical decision making may be useful,” the working group advises.


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