Changes to medical examinations and health monitoring due to COVID-19

Background

Spirometry is a non-invasive common test to assess how well the lungs work, by measuring the volume of air that is inhaled and then exhaled, and the rate at which this occurs.

It is one of the most frequently performed tests carried out by medical practitioners as part of workplace medical examinations and employee health monitoring, particularly for industries that involve work with hazardous substances (such as crystalline silica and isocyanates) and asbestos removal.

Due to the impact of COVID-19, in April 2020 the Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science Ltd (ANZSRS) recommended postponing the spirometry component of medical examinations and health monitoring, unless clinically essential.

In October 2020, this recommendation was updated to advise that lung function testing, which includes spirometry testing, can resume for employees who do not have a fever or any other symptoms of COVID-19.

TSANZ and ANZSRS have made recommendations to medical practitioners about measures to put in place to reduce the risk of exposure to COVID-19. Before lung function tests are performed, employees who undergo health monitoring will need to participate in screening, including temperature testing, to identify any COVID-19 symptoms, whether they have been in contact with any confirmed cases of COVID-19, are awaiting a COVID-19 test result or are subject to any pandemic orders issued by the Victorian Minister for Health, such as isolation, quarantine or in relation to travel.

Health monitoring should not be conducted for any employee who has a fever or any other symptoms of COVID-19, or who has an escalating acute respiratory condition.

Information on lung function testing is available from the TSANZ and ANZSRS

Staff performing the spirometry component of medical examinations should continue to be guided by the TSANZ and ANZSRS and Victorian Respiratory Protection Guidelines for respiratory protective equipment and procedures guidance for lung function tests to reduce the risk of exposure to COVID-19.

Legal duties

Note: Anyone with symptoms of COVID-19, however mild, should self-isolate immediately, seek medical advice from their GP or the Victorian Coronavirus Hotline on 1800 675 398, and get tested.

In some circumstances health monitoring or medical examinations are required under the Occupational Health and Safety Regulations 2017 (OHS Regulations). Where necessary, this includes spirometry testing.

WorkSafe Victoria acknowledges that the recommendation not to conduct testing on patients with COVID-19 symptoms may impact on the tests that can be completed when undertaking health monitoring or medical examinations. In addition, health monitoring providers in some areas may not be resuming services for some time.

However, employers must continue to meet their duties to monitor the health of their employees and arrange for medical examinations under the following OHS Regulations:

• Regulation 169: Employers must ensure health monitoring is carried out for employees who are exposed to a scheduled hazardous substance (e.g. respirable crystalline silica and isocyanates).
• Regulations 262, 282 and 311: Employers must arrange for medical examinations for employees engaged in ongoing asbestos removal work (or asbestos related activities where the risk requires a medical examination) before the asbestos removal work commences for the first time, at intervals of not more than 2 years and within 30 days after the employee has ceased asbestos removal work.

Recommendations

Employers should contact their medical examinations or health monitoring provider to confirm spirometry testing has recommenced and ensure that any tests that were postponed due to COVID-19 restrictions are undertaken by their employees as soon as possible.

WorkSafe Victoria will continue to monitor information provided by the Victorian Minister for Health, TSANZ and ANZSRS and will update duty holders and employees as the situation develops.

Infection prevention and control measures

1. Patient risk assessment

• Assess if patient/client has tested positive for COVID-19 in the past 14 days, is a close contact of someone confirmed to have COVID-19, is awaiting COVID-19 test results, or has been instructed by the Department of Health (DH) to self-isolate/quarantine for other reasons
• Assess if patient/client has had any international travel in the past 14 days
• Assess if patient/client has any COVID-19 symptoms: fever, chills or sweats, cough, sore throat, shortness of breath, runny nose and loss or change in sense of smell or taste. Some people may also experience headache, muscle soreness, stuffy nose, nausea, vomiting and diarrhoea

2. Personal protective equipment (PPE)

• Ensure availability of PPE and use of PPE follows the DH guidance COVID-19 – A guide to the conventional use of PPE

3. Maintain physical distancing of 1.5 metres

Maintain physical distancing of 1.5 metres to avoid crowding in examination/assessment room and waiting room areas. Consider the need to stagger appointments. Under Pandemic Orders from the Victorian Minister for Health, workplaces may also be required to comply with particular density quotient rules.

4. Spirometry device

• Ensure single use disposable inline bacteria/viral filters with proven efficiency are available
• Use single use disposable mouthpieces, nose clips and flow sensors if practical. If using reusable items, ensure they are reprocessed according to AS/NZS 4187:2014 Reprocessing of reusable medical devices in health service organisations
• Ensure device is safely stored to prevent device damage
• Use spirometry device according to the manufacturer’s instructions for use (IFU)
• Training is necessary and required for competency in using these devices
• Device cleaning should follow manufacturer’s instructions

5. Practise good hand hygiene

• Follow the World Health Organization’s 5 moments of hand hygiene guidance.

6. Have a dedicated and well-ventilated spirometry room. If possible, open windows to outside air

• Reduce clutter and limit consumables to those needed for the procedure.
• Only essential staff should be in the room

7. The procedure may promote deposition and contamination of surfaces

• Clean and disinfect device surfaces and replace single use consumables
• Clean and disinfect frequently touched surfaces and workstations between each patient/client
• For environmental cleaning and disinfection, see the DH Infection Prevention and Control Guideline