1. Background

To date, there is no evidence that any disease or virus may be transmitted by use of an alcohol breathalyser device if those devices are used correctly; that is, with single use disposable mouthpieces/straws that are stored and disposed of in a hygienic manner; and disinfected appropriately; that is, with Clinell Universal wipes. These have been shown to not alter the readings by NSW Police. Any traces of rubbing alcohol on units may alter readings.

Nevertheless, to reduce the risk that COVID-19 may be transmitted through the use of breathalysers, it is recommended to minimise the use of breathalysers during the pandemic; and to introduce a new, two-stage process for taking a breath test reading from clients.

Existing breathalyser devices can operate in two modes – passive, or active. Passive mode is when the client speaks closely to the device but does not contact it directly. A device operating in passive mode detects the presence or absence of alcohol, but not alcohol concentration. Active mode requires the client to blow into a disposable mouthpiece. Services may choose to use active mode only, or a combination of passive and active modes as required or available. The two modes for use are described in Section 3.

This document specifies the indications and process for the use of breathalysers by drug and alcohol staff until further notice. The process has been reviewed by the Centre for Alcohol and Other Drugs, NSW Health and the Clinical Excellence Commission.

These procedures have been adapted from the South East Sydney Local Health District Drug and Alcohol Services ‘Indications and process for using breathalysers during the COVID-19 Pandemic’ Interim Procedures. We gratefully acknowledge their original work.

2. Indications

Clinicians are expected to minimise the use of breathalysers as much as possible. Clinicians can and should use their clinical judgement and assessment skills to identify intoxication in many clinical encounters. Regardless of how a clinician determines that a client is intoxicated, clinicians will document consumption of alcohol and use of medications in the clinical notes.

In addition to meeting one of the limited indications for breathalyser use listed below, clinicians must receive approval for breathalyser use from a senior clinician.

1. A clinician intends to start diazepam loading of a client for withdrawal treatment;
2. A clinician has concerns about disulfiram medication dispensing (e.g., the client reports or is assessed as having potentially used alcohol recently);
3. A clinician has significant concerns about the safety of opioid agonist treatment administration;
4. Where a senior clinician determines that obtaining a breathalyser reading is clinically indicated to guide treatment as ordered by a doctor; and/or
5. To assist in assessment of a client where the senior clinician determines that a breathalyser reading will add value. 

3. Process

1. Hand hygiene and standard precautions are to be undertaken when conducting any form of breath testing. Clinicians may choose to wear gloves if they suspect body fluid contact while performing the procedure. (Gloves can hinder hand hygiene and increase surface contamination in people not trained in their use).
2. A breathalyser is assigned to a client. Until (i) that client has finished using the breathalyser during any one service encounter, (ii) the breathalyser has been cleaned consistent with standard infection control procedures. The clinician instructs the client to wash their hands before and after use of the breathalyser, or if hand washing is not practical, to use alcohol-based hand rub.
3. Health workers are to maintain a safe distance while conducting testing.
4. Health workers are to wear a surgical mask and eye protection when within 1.5m of a client. Glove use is optional depending on the risk assessment.
   

Passive mode

5. The clinician demonstrates to the client how to start the breathalyser reading in passive mode (press the arrow button on the R hand side) and passes the BAL machine to the client in the “passive mode”, and steps away to distance of 1.5 metres.
6. The client holds the device themselves, and conducts the passive test according to the clinician’s instructions:
• ask the client to press the start button
• speak / count to 10 directly into the machine
• wait until the BAL machine makes a noise/ bleep once recorded reading
• show the clinician the result.
7. If the result of the passive test indicates:
• alcohol is present; the clinician decides whether the breath alcohol concentration, assessed by breathalyser reading in active mode, is required. Note that for some indications, detecting the presence of alcohol is enough and there will be no need for a second test. For example, the presence of any concentration of alcohol is sufficient to not administer disulfiram.
• alcohol is not present; machine is cleaned as per manufactures directions.
8. If a breath alcohol concentration is required and the breathalyser being used has active (standard) mode (using the mouthpiece), the same breathalyser should be used to obtain that reading.
   

Active mode


9. Where possible, the active test should be conducted outside.
10. The clinician shows the client how to use the breathalyser.
11. The clinician removes themselves from the room, or, if conducting the test outside, moves at least 1.5 metres away from the client, until the client has conducted the active breath test.
12. The clinician, and, if testing is being conducted outside, the client, return to the room and the client shows the clinician the test result.
13. Mouthpieces can be disposed of in normal waste bins, unless the client is a confirmed COVID-19 case,
    in which case the tube should be placed in the medical waste bin.
14. Both the client and the clinician perform hand hygiene after disposing of mouthpieces.
15. The clinician cleans the machine using Clinell Universal wipes.
16. The intervention is documented in the client’s clinical notes.

4. Infection control

Following use of the breathalyser, the device will be cleaned and disinfected using the Clinell Universal wipes and standard infection control process.

Document information

Developed by

Centre for Alcohol and Other Drugs, NSW Ministry of Health.

Consultation

Drug and Alcohol Services, South Eastern Sydney Local Health District.

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW MInistry of Health.

Reviewed by

Infection Prevention and Control, Clinical Excellence Commission.

For use by

NSW drug and alcohol treatment services​.​​