References

8.1. Acronyms and abbreviations

Acronym	Description
ABHR	alcohol-based hand rub
aBL	antiviral blue light
ACH	air changes per hour
AGB	aerosol-generating behaviour
AGP	aerosol-generating procedure
ACIPC	Australian College for Infection Prevention and Control
ACSQHC	Australian Commission for Safety and Quality in Health Care
ARI	acute respiratory infection
BiPAP	bilevel positive airway pressure
CDC	Centres for Disease Control and Prevention (United States of America)
CDNA	Communicable Diseases Network Australia
COVID-19	Coronavirus disease 2019
CPAP	continuous positive airway pressure
ED	Emergency Department
EPA	Environmental Protection Authority Victoria
GP	general practitioner
HEPA	high efficiency particulate air
HVAC	heating, ventilation, and air-conditioning
HCW	healthcare worker
ICEG	Infection Control Expert Group
IPC	infection prevention and control
LPHU	Local Public Health Unit
NHMRC	National Health and Medical Research Council
NEPT	non-emergency patient transport
PCR	polymerase chain reaction (test for COVID-19)
PPE	personal protective equipment
RCF	residential care facility (includes RACF)
RACF	residential aged care facility
RAT	rapid antigen test
SARS-CoV2	severe acute respiratory syndrome coronavirus 2
SCOVID	suspected COVID-19
TGA	Therapeutic Good Administration
WHO	World Health Organisation

8.2. Glossary of terms

Term	Definition
Aerosol-generating behaviour (AGB)	Behaviours that are more likely to generate higher concentrations of infectious respiratory aerosols such as persistent or severe coughing, screaming, or shouting, or heavy breathing and panting during active labour.
Aerosol-generating procedure (AGP)	A procedure that is more likely to generate higher concentrations of infectious respiratory aerosols, such as bronchoscopy, tracheal intubation, non-invasive ventilation (for example, BiPAP, CPAP), high-flow nasal oxygen therapy, manual ventilation before intubation, intubation, cardiopulmonary resuscitation, suctioning, sputum induction, and nebuliser use. Collection of nose and throat swabs is not considered an AGP.
Air cleaner/air scrubber/air purifier/air filter	A portable device which filters air to remove particles.
Clean air change rate (ACH)	The rate at which clean air volume is moved into and out of a space within an hour. This is measured in air changes per hour (ACH).
Cohorting (also see zoning)	Grouping individuals with the same condition or same laboratory-confirmed infection in the same location (a room, ward section or building).
Contact	A person at increased risk of contracting a transmissible disease due to exposure to an infected person. Contacts may be 'close contacts' which are also known as 'household contacts'; social contacts include workplace and education contacts.
COVID-19	The disease caused by SARS-CoV-2.
Dead spot	In an enclosed space, an area where there is very little or no air movement. In these areas, any virus-laden aerosols could remain suspended in the air for prolonged periods of time.
the department	The Victorian Government Department of Health.
Fomite	An inanimate object that has been contaminated with an infectious agent.
HVAC (heating, ventilation, and air conditioning) systems	Centralised conventional ventilation systems that maintain thermal comfort by heating or cooling and introduce fresh air from the outside. The fresh air dilutes or replaces potentially contaminated indoor air.
Negative pressure isolation room (Class N)	A room in a hospital or other facility used for patients requiring airborne isolation. In addition to being at negative pressure, the room may have additional barriers such as an anteroom.
Patient	The term ‘patient’ is used inclusively to refer to all consumers of health care services, including patients, residents, customers, clients and guests in healthcare, residential aged care homes, supported residential settings, primary and community care settings and clinics.
Personal ventilation hood	A hood over a patient’s bed providing a negative pressure environment that reduces the risk of aerosol transmission to healthcare workers. It consists of a plastic canopy over a frame, a HEPA filter, and an exhaust fan.
Residential care facility	Any public or private accommodation facility where residents sleep, eat and live either temporarily or on an ongoing basis. This includes residential aged care facilities (including nursing homes and hostels), residential care facilities for people with physical and cognitive or behavioural disabilities, and other similar accommodation settings.
SARS-CoV-2	The causative virus for COVID-19.
Self-isolation	Separation from other people, including those in the same household, to stop the spread of a transmissible disease.
Source control	A preventative strategy for reducing airborne contaminant levels in the air, for example, by using a mask to prevent the release of respiratory particles from an infected person.
Ventilation rate	The amount of outdoor air that is introduced into a space. It is measured in m3/hr (cubic metres per hour), l/s/p (litres per second per person) or ACH (air changes per hour).
Viral emission rate	The number of viral particles expelled by an infected person over a particular unit of time.
Whirlybird	A wind-driven turbine located on a roof to improve extraction of air from a building.
Zones (also see cohorting)	Zoning means designating a room, wing, ward, floor or building to accommodate single and cohorted groups of patients who have the same transmissible disease.

8.3. TGA listed respirators

To check if a respirator is suitable for HCW use, search the TGA list at Guidance on medical/surgical face masks and respirator standards - key performance aspects.

Follow these steps:

Identify the ARTG number. This number may be listed on the product package, in the product information, or on the company website. You can also request the manufacturer or supplier to provide the ARTG number or a copy of the ARTG summary.
Use the ARTG number to search the ARTG list TGA ARTG search function. Key words can also be searched, including product name, manufacturer, or sponsor, although this method may be less accurate than using the ARTG number as registration may be under different names.
Review the ARTG summary to find the Global Medical Device Nomenclature (GMDN) code.
Use the table below to confirm whether the mask or respirator is recommended for use by health care workers (HCWs) when a P2/N95 respirator is required.

Global Medical Device Nomenclature (GMDN) codes, descriptions and recommended use

GMDN code	Description of mask or respirator	Recommended use
35177	Surgical mask – single use For use by medical personnel during surgery	Recommended for HCWs Not recommended for HCWs in contact with COVID-19 patients
57794	Surgical respirator – single use For use by healthcare workers during medical, surgical, dental, and isolation procedures	Recommended for HCWs Recommended for HCWs in contact with COVID-19 patients
57792	Antimicrobial surgical respirator (has an antimicrobial/antiviral agent to destroy specified pathogens) For use by healthcare worker during medical, surgical, dental, and isolation procedures	Recommended for HCWs Recommended for HCWs in contact with COVID-19 patients
57793	Public respirator – single use Note: Not all respirators in this category are equivalent to a P2/N95. Check the product information to confirm classification.	Respirators classified as a P2, FFP2 or N95: Recommended for HCWs Recommended for HCWs in contact with COVID-19 patients Respirators not classified as a P2, FFP2 or N95: Recommended for use by the general public Not recommended for use by HCWs Not recommended for use by HCWs in contact with COVID-19 patients
64821 64822	Public respirator (64821) – single use Public face mask (64822) – reusable For use by the general public. Suitable for community settings and industries and as an alternative to a surgical mask.	Recommended for use by the general public Not recommended for use by HCWs Not recommended for use by HCWs in contact with COVID-19 patients

Respirators that cannot be identified through a TGA search should not be used as a P2/N95 until the ARTG listing has been confirmed.

KN95 standard respirators, are different from P2/N95, and are not recommended as a P2/N95 alternative for healthcare workers or in healthcare settings.

Respirators with ear loops are not recommended by Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health COVID-19: International Respirator Purchase | CDC or the Australian Institute of Occupational Hygienists Guide to Buying P2, or Equivalent, Respirators for use in the Work Environment (2020) – AIOH.

Source: Guidance on Personal Protective Equipment for Health Professionals.

8.4. COVID-19 and IPC education

For a summary of IPC education available to healthcare workers, see VICNISS – Educational Opportunities.

Training for health care workers in all settings covering the fundamentals of IPC for COVID-19 is available from the Australian Government Department of Health.

IPC training suitable for non-clinical staff is available from VICNISS - Infection Prevention and Control eLearning Modules.

Training to support organisations in meeting the requirements of the National Safety and Quality Health Service Standards, the National Safety and Quality Primary and Community Healthcare Standards and to assist in implementing effective IPC practices is available from the Australian Commission for Safety and Quality in Healthcare (ACSQH): National Hand Hygiene Initiative Learning Management System (southrock.com).

Ventilation in residential care – an education package is available at VICNISS – Ventilation in Residential Care.

8.5. Purchasing an air cleaner

An air cleaner needs to be appropriate to the size of the room and must be positioned correctly within the room. Follow manufacturer’s recommendations and seek advice from an occupational physician or IPC or ventilation professional when purchasing and positioning air cleaners.

Air cleaning device - purchasing factors

Factor	Considerations and recommendations
Filter requirement	Air cleaners equipped with H13 HEPA filters are recommended. Air cleaners with a lower grade filter may not be as efficient in removing airborne viral particles.
Filter maintenance	All parts of the air cleaner will require maintenance and replacement as per the manufacturer’s instructions. Emphasis should be placed on the cleaning and maintenance of the pre-filter and HEPA filter. A HEPA-filtered vacuum cleaner should be used if manual cleaning of the pre-filter is required. Effectiveness of the air purifier could be reduced if you replace the filter with a lower quality filter. Filter changes should be undertaken outdoors where possible. Where required, appropriate Personal Protective Equipment (PPE) should be worn as per the manufacturer’s instructions.
Surface cleaning and disinfection	The surface of air cleaner should be treated as a frequently touched surface and cleaned as per the department’s cleaning guidelines to prevent it from becoming a source of infection. Follow the manufacturer’s instructions on how to appropriately clean device surfaces.
Noise levels (dB) and fan speed	Noise levels generated will depend on the fan speed and distance from the device. Each air purifier operates at a different noise level depending on the fan. Maximum recommended air purifier noise level (dB) for different environments: quiet for sleeping at night = 35-40 dB quiet areas, for example, quiet restaurants, classrooms or office = 40-45 dB loud office and childcare = 40-45 dB noisy environment, for example, cafe or gym = >50 dB loud environments = >60 dB For reference, a whisper is about 30 decibels (dB), normal conversation is about 60 dB, and a motorcycle engine running is about 95 dB. Two quiet air purifiers instead of one large unit is an option.
Costs	Costs relating to outright purchase or rental, filter replacement, energy and regular maintenance. Portable air cleaners are cost-effective, flexible solutions to reduce the risk of airborne infectious disease transmission in spaces where other ventilation and filtration modifications are impossible, or where building occupants seek additional reassurance about air quality.
Size	Size of the air cleaner should be appropriate to the space it will be used in. Properly sized portable air cleaners with HEPA filters can reduce in-room concentrations of airborne particles, including those carrying viral material. It may be appropriate to use more than one air purifier in a room.
Electrical	Measured in watts and amps. Overseas models need to be checked for compatibility with the Australian standard voltage and frequency.
Add-ons	Additional disinfection features such as UV, air ionisations, ozone are not required for infection prevention and control purposes. Some air purifiers use ionisers, plasma/ozone/photocatalytic oxidation/precipitators and UV technology. These are currently unproven technologies, and in some cases dangerous technologies. These chemicals and technologies can significantly degrade air quality by producing ions, ozone and oxidation. This can cause irritation, trigger asthma and/or degrade materials.

For more information, see the University of Melbourne Guide to Air Cleaner Purchasing.

8.6. Posters

PPE

How to put on and take off your PPE - gown and gloves together

How to put on and take off your PPE - gown and gloves separately

How to put on and take off PPE - using plastic apron

How to put on and take off PPE - using coveralls

See, How to put on (don) and take off (doff) your PPE.

Caring for your skin when wearing PPE

Caring for Facial Skin Applying Dressings Under PPE

Caring for Facial Skin When Wearing a Surgical Face Mask

Caring for Facial Skin When Wearing a P2/N95 Respirator and Eye Protection

See, Caring for your skin when wearing PPE.

Face masks

See, Face masks do's and don'ts.

How to clean your personal items used at work

How to safely clean your mobile phone

How to safely clean your laptop and tablet

How to safely clean your reusable face shield

How to safely handle your drink bottle

See, How to clean your personal items used at work.

PPE for different zones

Zoning—Red zone

Zoning—Amber zone

Zoning—Blue zone

Zoning—Green zone

See, PPE for different zones - posters.

8.7 Self-assessment tools

These tools are designed as checklists and should be used as a prompt to evaluate items that need to be in place to reduce the transmission of COVID-19.

The checklists are not meant to replace detailed, site-specific policies, protocols and procedures that every service should have in place. Instead, they are intended to assist in the assessment of COVID-19 infection prevention and control policies and practices to mitigate the risk of COVID-19 transmission among staff, visitors and where applicable residents.

The tools do not provide links to financial assistance, grants, supplies procurement or other assistance schemes.

Services are responsible for understanding their eligibility and accessing these resources: