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Hospitals restricting access to N95 masks

Workers in 'lower-risk' areas are being given normal surgical masks to wear

New rules which restrict hospital workers' access to tight-fitting N95 face masks are fuelling fears that health-care staff are being put at risk of Sars infection.

The guidelines took effect at seven public hospitals in New Territories East on Thursday, on the week in which a public hospital doctor and a health-care assistant died of the deadly virus.

The seven hospitals' wards have been separated into high-risk areas, where Sars patients are treated, and lower-risk areas. Staff in designated high-risk wards must wear N95 masks while those in other areas will get standard, flat-face surgical masks.

A nurse, Miss Lam, who works in one of the hospitals in the New Territories East cluster, told a radio programme yesterday that the new guidelines put staff at risk of catching Sars. 'My colleagues and I are now at a loss as to what we should do next. I have complained too many times, but it is totally futile ... you know just two days ago, the new internal guidelines issued by the New Territories East cluster management further limited the supplies of protective gear to us,' she said.

One of three new confirmed cases of Sars yesterday was a health-care assistant at Prince of Wales Hospital, one of the hospitals affected by the policy. The woman was believed to have been infected by a patient who was not suspected as a Sars case at the time, and therefore would have been cared for in a ward designated as lower-risk under the new rules.

The assistant is believed to have worn an N95.

As of yesterday, Hong Kong has 1,706 confirmed Sars cases, with 238 deaths. Of those infected, 377 were health-care workers.

The New Territories East cluster is led by Prince of Wales Hospital, the health facility which has been worst hit by the Sars outbreak. The cluster has at least 6,000 staff.

According to a memo sent to staff on Wednesday: 'N95 will be used for the high-risk area. It can be re-used for up to one day (as the N95 will be protected to a certain extent with the regular use of face-shield). For the other areas, the routine use of surgical mask is adequate but N95 should be used for high-risk procedures.' The infection-control measures took effect the next day.

Sydney Chung Sheung-chee, dean of the faculty of medicine at the Chinese University, which teaches out of Prince of Wales Hospital, said New Territories East was the only cluster to have revised its mask guidelines. There are six other clusters.

He said it was not only protective gear that was important in preventing Sars. 'There are many different factors - one is the hidden cases, when Sars is not initially suspected in patients,' he said.

He added that wearing N95 masks for long periods put workers at risk of taking safety for granted. The masks were also uncomfortable in hot weather.

'I cannot stand them. When it becomes uncomfortable you start to adjust it, and that is very risky,' he said.

Professor Chung said he did not think that cost was a consideration in changing the guidelines. N95s costs about $10, compared to 50 cents for surgical masks.

A statement from the New Territories East Cluster said the new guidelines were aimed 'to more effectively prevent infection of staff'.

A spokeswoman from the hospital authority said there was enough protective gear available to workers but admitted it was having difficulty locating enough small-size N95 masks.

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