Researchers have warned that community pharmacy could “unwittingly become a hub for COVID-19 transmission” without strict preventative measures in place, as it is often a first point of contact for people who are sick
During the COVID-19 pandemic, there have been issues with some pharmacies securing enough personal protective equipment (PPE) to distribute among staff.
PPE that pharmacists have been advised to use in the presence of unwell patients includes masks, gloves, gowns, aprons and eye protection.
Since February, PHNs have been authorised to provide masks that had been released from the National Medical Stockpile upon request to pharmacists, for use when in contact with potentially at-risk customers.
However some pharmacists have reported difficulties accessing these as well as other PPE.
“We don’t have gowns for staff. We don’t have any masks available – they sold out weeks ago,” one pharmacist reader told AJP.
“None for us, none for customers. Eye protection? Are we all going to be sent kits with these items in them?”
Meanwhile pharmacy researchers from the Universities of Huddersfield and Leeds, and International Medical University in Malaysia, have investigated the importance of wearing PPE and social distancing in community pharmacies.
They found inconsistencies upon reviewing the recommendations of 15 selected countries across five continents (Asia, Europe, Oceania, North America, and Africa).
More than half (n = 9) of the countries adopted a social distance of 1 m in their community pharmacies.
United Kingdom, New Zealand, and Canada recommended a social distance of 2 m, while Australia and the United States advised social distances of 1.5 m and 1.8 m, respectively.
Recommendations on PPE use also widely varied among countries, write the authors in Research in Social and Administrative Pharmacy.
Australian recommendations are that PPE such as surgical mask should be considered when providing essential services requiring direct patient contact, dispensing and handling prescriptions, cash and other paperwork. Additional PPE (gowns, gloves, protective eye wears) are recommended when dealing with a confirmed or suspected COVID-19 patient.
The US said pharmacy personnel should always wear a facemask while they are in the pharmacy; meanwhile the UK recommended face masks only if pharmacy personnel cannot maintain a social distance of 2 metres at all times from patients and other staff.
UK pharmacists were only recommended to use aprons and gloves when in direct contact with suspected patients.
However evidence from preliminary studies and field reports has indicated the possibility for SARS-CoV-2 to spread in aerosols, say the researchers.
This includes evidence from Wuhan in China where aerosol traps set up in various public spaces reported findings of viral RNA from SARS-CoV-2.
Meanwhile a case study investigated an outbreak of COVID-19 involving three non-associated families sitting at three neighbouring tables in a restaurant in Guangzhou, China.
Ten individuals from these families were found to be infected although no significant close contact or fomite contact was observed.
“Though the observation from such case study cannot be regarded as conclusive, the assumption, for now, should be that airborne transmission of SARS-CoV-2 is possible unless being discredited in the future,” say the researchers.
“Therefore we opine that the wearing of appropriate PPE is of utmost importance for healthcare workers, including community pharmacy personnel dealing with individuals [who] may or may not be infected on a day-to-day basis, regardless if they manage to observe social distancing in their workplace or if they perform close contact activities.”
They say a universal PPE approach such as that adopted by the US and Turkey should be strongly considered by other countries.
Wearing appropriate PPE is of utmost importance for … community pharmacy personnel dealing with individuals [who] may or may not be infected on a day-to-day basis, regardless if they manage to observe social distancing in their workplace or if they perform close contact activities.
In addition, a case study from Singapore reported that among healthcare workers (85% wearing a surgical mask and 15% wearing an N95 mask) identified to have had exposure for ≥10 min at a distance of <2 m from patients with SARS-CoV-2 undergoing aerosol-generating procedures, none became SARS-CoV-2 positive by nasopharyngeal swab within 14 days of exposure.
“Relevant health authorities when issuing the preventative measure directives for community pharmacies may consider the availability of local resources due to a worldwide shortage of PPE, but we feel that recommendations should be made based on current science and not based solely on the supply of PPE,” the authors add.
“In cases where a continuous supply of PPE to community pharmacies cannot be confidently maintained, consideration should be given to recommending a further social distance specific to community pharmacy settings to avoid the transmission of SARS-CoV-2 viruses in infectious amount.
“Else, innovations such as the installation of the Perspex or plexiglass barrier at the customer contact area to provide barrier protection could also be promoted if feasible.”
They warn that community pharmacy “could unwittingly become a hub for COVID-19 transmission without strict preventative measures in place” as it is often a first point of contact for people who are sick, as well as those at high risk of being infected with COVID-19 attending to get their routine medicine supply.
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