Presented in collaboration with Nebraska ICAP, Nebraska DHHS HAI Team, Nebraska Medicine, and The University of Nebraska Medical Center Presented by Kate Tyner Moderated by Mounica Soma Dr. Salman Ashraf, MBBS Dr. Maureen Tierney, MD,MSc Angie Vasa, RN, BSN Kate Tyner, RN, BSN, CIC Ishrat Kamal-Ahmed, M.Sc., Ph.D Margaret Drake, MT(ASCP),CIC Teri Fitzgerald RN, BSN, CIC Panelists Guidance and responses were provided based on information known on 4/14/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and jurisdictional guidance for updates.
Transcript
Presented in collaboration with Nebraska ICAP, Nebraska DHHS HAI Team, Nebraska Medicine, and
CDC national COVID-19 Infection Control Guidance for Healthcare • When supplies are available, facemasks are generally preferred for
healthcare providers to wear while they are in a healthcare facility as it offers both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.
• Cloth face coverings should not be considered PPE and should NOT be worn instead of a respirator or facemask if more than source control is required.
• Healthcare providers should consider continuing to wear their respirator or facemask while in the healthcare facility instead of intermittently switching back to their cloth face covering, which could cause self-contamination.
• Healthcare providers should remove their respirator or facemask and put on their cloth face covering when leaving the facility at the end of their shift.
CDC national COVID-19 Infection Control Guidance for Healthcare (cont’d)• Visitors and patients should be wearing their own cloth face covering upon arrival
to the facility per CDC recommendations to the general public.
• If they are not, they should be offered a facemask or cloth face covering, as supplies allow, and instructed to wear it while in the facility. This recommendation does not change CDC’s guidance to use N-95 or equivalent respirators when providing care for patients with suspected or known COVID-19.
• Facilities that do not have sufficient supplies of N-95s and equivalent respirators for all patient care should prioritize their use for activities and procedures that pose high risks of generating infectious aerosols, using facemasks for care that does not involve those activities or procedures. Once availability of supplies is reestablished, N-95s and equivalent respirators use should resume for all workers caring for these patients.
• Facilities should consider utilizing CDC’s PPE optimization guidance [cdc.gov] and PPE Burn Rate Calculator [cdc.gov] in order to preserve PPE supplies and keep workers safe
• Conduct a physical inventory - every unit, common area, supply closet
• Immediately take control – under lock and key – of PPE supplies, no matter how well-sourced you feel you are
• Immediately explain why –
• In order to ensure that supplies are available when needed
• Initiate a system for responsible dispensing
• who is on isolation, why; use Omnicell/Pyxis or manual log sheets for record of where inventory goes
Adapted from The NETEC COVID-19 PPE Webinar - Extended use, reuse, and innovative decontamination strategies https://repository.netecweb.org/items/show/861
PPE Steps you must takeConsider a PPE calculator, example:
• 3 masks per patient bed (if reused per staff member one day only)
• 8 disposable isolation gowns/floor patient/day
• Make estimates for the largest number of beds you could possibly have occupied with COVID-19
• Plan now for the next phase, communicate what might come next
• Extended Use
• Reuse for multiple days
• Equipment disinfection
• Cloth and patient gowns as PPE
• Educate: do not want people putting themselves in danger
Adapted from The NETEC COVID-19 PPE Webinar - Extended use, reuse, and innovative decontamination strategies https://repository.netecweb.org/items/show/861
PPE Steps you must takeStrategize for minimizing entry into patient rooms
• Telemedicine
• Tele-everything! Food and nutrition, social work, discharge planning
• Cluster tasks and meal-times
• Limit specimen collection times
• Reduce hospitality and housekeeping events, weekly and PRN linen change
• Pharmacist to review MAR’s to cluster meds in sequence (single access)
Adapted from The NETEC COVID-19 PPE Webinar - Extended use, reuse, and innovative decontamination strategies https://repository.netecweb.org/items/show/861
Selected Options for Reprocessing Eye Protection• Adhere to recommended manufacturer instructions for cleaning and
disinfection.
• When manufacturer instructions for cleaning and disinfection are unavailable, such as for single use disposable face shields, consider:• While wearing gloves, carefully wipe the inside, followed by the outside of the
face shield or goggles using a clean cloth saturated with neutral detergent solution or cleaner wipe.
• Carefully wipe the outside of the face shield or goggles using a wipe or clean cloth saturated with EPA-registered hospital disinfectant solution.
• Wipe the outside of face shield or goggles with clean water or alcohol to remove residue.
• Fully dry (air dry or use clean absorbent towels).
• Remove gloves and perform hand hygiene.
Extended use of isolation gowns-crisis capacity strategy• Consideration can be made to extend the use of isolation gowns
(disposable or cloth) such that the same gown is worn by the same HCP when interacting with more than one patient known to be infected with the same infectious disease when these patients housed in the same location (i.e., COVID-19 patients residing in an isolation cohort).
• This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridioides difficile, CPE or other highly resistant MDRO) among patients. If the gown becomes visibly soiled, it must be removed and discarded.
Prioritize gownscrisis capacity strategy• Gowns should be prioritized for the following activities:
• During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures
• During the following high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of healthcare providers, such as: • Dressing, bathing/showering, transferring, providing hygiene, changing linens,
changing briefs or assisting with toileting, device care or use, wound care
• Surgical gowns should be prioritized for surgical and other sterile procedures.
• Facilities may consider suspending use of gowns for endemic multidrug resistant organisms (e.g., MRSA, VRE, ESBL-producing organisms).
Re-use of cloth isolation gowns-crisis capacity strategy
• Disposable gowns are not typically amenable to being doffed and re-used because the ties and fasteners typically break during doffing.
• Cloth isolation gowns could potentially be untied and retied and could be considered for re-use without laundering in between.
• In a situation where the gown is being used as part of standard precautions to protect HCP from a splash, the risk of re-using a non-visibly soiled cloth isolation gown may be lower.
• However, for care of patients with suspected or confirmed COVID-19, HCP risk from re-use of cloth isolation gowns without laundering among• single HCP caring for multiple patients using one gown or• among multiple HCP sharing one gown is unclear.
• The goal of this strategy is to minimize exposures to HCP and not necessarily prevent transmission between patients.
• Any gown that becomes visibly soiled during patient care should be disposed of and cleaned.
In situation of severely limited or no available isolation gowns, the following pieces of clothing can be considered as a last resort for care of COVID-19 patients as single use. However, none of these options can be considered PPE, since their capability to protect HCP is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.
Combinations of clothing: Combinations of pieces of clothing can be considered for activities that may involve body fluids and when there are no gowns available:
• Long sleeve aprons in combination with long sleeve patient gowns or laboratory coats
• Open back gowns with long sleeve patient gowns or laboratory coats
• Sleeve covers in combination with aprons and long sleeve patient gowns or laboratory coats
Implement limited re-use of facemasks. Limited re-use of facemasks is the practice of using the same facemask by one HCP for multiple encounters with different patients but removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, care should be taken to ensure that HCP do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner.
• The facemask should be removed and discarded if soiled, damaged, or hard to breathe through.
• Not all facemasks can be re-used. • Facemasks that fasten to the provider via ties may not be able to be undone without
tearing and should be considered only for extended use, rather than re-use.• Facemasks with elastic ear hooks may be more suitable for re-use.
• HCP should leave patient care area if they need to remove the facemask.
• Short term storage-e.g. lunch or break• Facemasks may be put down on a barrier such as a paper towel with clean
side up (user side) and dirty side down (outside of mask).
• Long term storage-e.g. for use the next day• Facemasks should be carefully folded so that the outer surface is held inward
and against itself to reduce contact with the outer surface during storage.• The folded mask can be stored between uses in a clean sealable paper bag or
breathable container.• Hung by ear straps to handle of brown paper bag
Guidance for Universal Masking andExtended UseUniversal Mask Policy and FAQ: this one from Nebraska Medicine and includes extended wear of mask
Proper Donning & Doffing of Procedural and Surgical Masks- Nebraska Medicine (Video) in the time of extended mask use. This one includes removal of the masks for breaks and the best way to do that.
https://www.youtube.com/watch?v=z-5RYKLYvaw
COVID-19: Conserving PPE Emory University School of Medicine for putting on and removing PPE- with conservation strategies
