COVID-19: Staying Safe in General Practice – Air Circulation

General Practitioners (GP) in the private sector plays an important role in the delivery of healthcare for the public. It supplements the primary healthcare services offered in the public sector.

Most of the GP practices in Malaysia, either group or individual are located in shop lots. The usual practice in these clinics is to use split airconditioning units for climate control. The problem with the use of the split airconditioning units is that the air is recirculated as there are no fresh air intake vents. The recirculation of air within the consultation room will increase the risk of transmission of infectious diseases from patients to the GP and from one patient to the next patient.

There are some simple measures that the GP can take to reduce the risk of transmission. Besides wearing proper and appropriate personal protective equipment when attending to the patient. They can also rearrange their practice so that the airflow will be optimised to reduce transmission. Installing a portable air purifier with a HEPA filter will also improve the air quality in the room. The efficiency of the HEPA filter needs to be able to remove at least 99.97% of dust (Class H14), pollen, mold, bacteria, and any airborne particles with a size of 0.3 microns (µm).

Arrangement in a GP Clinic

The figures below show some recommendations on how to arrange the furniture in the consultation room in the GP clinic to reduce the chances of transmission of infectious diseases. The arrangement of furniture as shown in Figures 1 and 2 are NOT RECOMMENDED as it will increase the chances of exposure from the direction the air from the aircon is blowing. In both figures, the aircon is blowing from the patient towards the doctor.

Figure 1
Figure 2

Instead, the furniture should be arranged in such a manner that the aircon should be blowing from the doctor towards the patient (Figures 3 and 4). This will reduce the risk of exposure. Further, it is also recommended that the doctor attending to a patient in a GP practice should wear surgical masks and a face shield. This is because in the GP practice, there is usually no triage counter and all patients should be treated as suspected COVID19 patients. If the doctor is performing an Aerosol Generating Procedure, then an N95 mask should be worn instead of the surgical mask.

If the GP decide to install a protable air purifier with a HEPA filter, it should be located at the other end of room, where the direction of air is flowing. This will capture the most amount of contaminants.

Figure 3 – Doctor sitting with his back towards the aircon blower. The HEPA filter is located at the other end of the consultation room.
Figure 4 – Doctor standing with her back towards the aircon blower. The HEPA filter is located at the other end of the consultation room.

The above are simple measures that the GP can take to reduce the risk of infection.

Prepared by
Dr Victor Hoe, Professor of Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.
10 May 2020

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