CPAP and HFNO do not heighten infection risk, studies find

New research has raised the question of whether the non-invasive breathing support procedures CPAP and HFNO should be classed as aerosol-generating procedures, after two studies found no increased risk of infection following their use in patients with COVID-19.

According to the studies, published in Thorax, both CPAP and HFNO did not produce more air or surface viral contamination than supplemental oxygen therapy, which has led researchers to call for re-evaluation of the need for infection control measures surrounding these techniques.

In one study, involving just 30 patients, who each had three air and three surface samples collected from their immediate surroundings, just 4% of air samples tested positive for SARS-CoV-2, while just 7% of surface swabs tested positive.

Also, the researchers found that CPAP and HFNO were not linked with a greater level of environmental contamination than use of supplemental oxygen.

The other study assessed aerosol production via different oxygen delivery systems in 25 healthy volunteers and eight patients hospitalised with COVID-19.

It found that the highest amount of aerosol generated was while coughing, and that aerosol production wasn’t higher in those receiving CPAP and any produced during HFNO originated from the machine rather than the patient.

“CPAP and HFNO should not be considered high risk aerosol generating procedures,” the researchers noted. Instead, “PPE guidance should be updated to ensure medical staff are protected with appropriate PPE in situations when patients with suspected or proven COVID-19 are likely to cough,” they stressed.

MBS item for allied health worker case conferencing

New Medicare items will allow allied health professionals to be reimbursed for taking part in case conferences to support people with chronic diseases or young children with developmental disorders.

From 1 November allied health professionals will be paid to attend multidisciplinary conferences held by the patient’s regular doctor – in person, via video conference or phone –to discuss diagnosis, care and treatment plans.

The new items are for eligible allied health professionals participating in multidisciplinary case conferences for people with chronic disease under the care of a General Practitioner as part of Team Care Arrangements, as well as children aged under 13 years under the care of a specialist, consultant physician or GP to provide early diagnosis and treatment of autism or any other pervasive developmental disorders.

For chronic disease management, eligible professionals include: Aboriginal and Torres Strait Islander health practitioners and health workers, audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists and speech pathologists.

For children with pervasive developmental disorders: Aboriginal and Torres Strait Islander health practitioners and health workers, audiologists, mental health nurses, mental health workers, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech pathologists can take part.

One in four patients wait too long for essential procedures: AMA Report Card

The AMA’s latest hospital report card shows that nationally only 75% of patients classified as Category 2 for elective surgery received treatment within the recommended timeframe.

Federal AMA President, Dr Omar Khorshid said the hospital system was already overwhelmed before the COVID-19 pandemic hit in 2020, due to an relentless decline in the number of beds available per head of population.

“While called ‘elective’ surgery, this really is essential surgery that includes serious conditions like heart valve replacements and cancer investigations,” he said.

“In reality, what this means is that 25% of people will wait longer than 90 days for surgeries, which in this category can include treatment for an unruptured brain aneurism, decompression of a spinal cord and treatment for ovarian cysts or unhealed fractures.

Dr Khorshid said the problem was particularly bad for patients in states such as Tasmania where more than a 63% are waiting longer than the recommended period for essential surgery.

The report card showed that the ratio of beds available for people over the age of 65 (the most intensive users of public hospital beds) has been on a downward trend for 27 years, halving from 33 to just over 15 per 1000 people.