Continued From Page 14
when redoffing a previously worn FFR. A study evaluating
the persistence of SARS-CoV-2 on plastic, stainless steel, and
carboard surfaces showed that the virus is able to survive for
up to 72-hours. One strategy to mitigate the contact transfer
of pathogens from the FFR to the wearer during reuse is to
issue five respirators to each healthcare worker who may
care for patients with suspected or confirmed COVID-19.
The healthcare worker will wear one respirator each day and
store it in a breathable paper bag at the end of each shift. The
order of FFR use should be repeated with a minimum of five
days between each FFR use. This will result in each worker
requiring a minimum of five FFRs, providing that they put on,
take off, care for them, and store them properly each day.
Healthcare workers should treat the FFRs as though they are
still contaminated and follow the precautions outlined in our
reuse recommendations. If supplies are even more constrained
and five respirators are not available for each worker who
needs them, FFR decontamination may be necessary.”
Pre-pandemic, the CDC guidance indicated that decontam-
ination and subsequent reuse of FFRs should only be practiced
as a crisis-capacity strategy. But in late March, the FDA issued
an Emergency Use Authorization (EUA) permitting the Battelle
Decontamination System at Battelle Memorial Institute to
be authorized for use in decontaminating “compatible N95
respirators.” The CDC emphasizes that “Only respirator
manufacturers can reliably provide guidance on how to
decontaminate their specific models of FFRs. In absence of
manufacturer’s recommendations, third parties may also
provide guidance or procedures on how to decontaminate
respirators without impacting respirator performance.
Decontamination might cause poorer fit, filtration efficiency,
and breathability of disposable FFRs as a result of changes to
the filtering material, straps, nose bridge material, or strap
attachments of the FFR. CDC and NIOSH do not recommend
that FFRs be decontaminated and then reused as standard
care. This practice would be inconsistent with their approved
use, but we understand in times of crisis, this option may need
to be considered when FFR shortages exist.”
Continued on Page 18
New Guidelines Outline COVID-19 Infection Prevention and Control Evidence
To
guide facilities and healthcare personnel in manage-
ment of suspected or confirmed COVID-19 patients
amid ongoing critical shortages of personal protective
equipment, the Society for Healthcare Epidemiology of America
(SHEA) joined with the Infectious Diseases Society of America
(IDSA) and the Pediatric Infectious Diseases Society (PIDS) in
releasing the infection prevention and control portion of a
three-part guideline based on the best evidence available.
“There is still much to learn about this virus, but these
recommendations give hospitals an evidence-based reference.
This guideline can assist in creating policies to prevent the
transmission of COVID-19 and to help keep healthcare
personnel and patients safe,” says Judith Guzman-Cottrill,
DO, the SHEA representative on the author panel
The societies developed the guideline under a rapid
process to complete it in a matter of weeks to respond quickly
to the pandemic, where guideline development generally
takes well over a year. The guideline was developed by a
committee of frontline clinicians, healthcare epidemiologists,
and other infectious diseases specialists with expertise in
infection control. The writing panel applied the rigorous
Grading of Recommendations Assessment, Development,
and Evaluation (GRADE) approach to assess the certainty of
evidence and make eight recommendations:
1
Masks: Healthcare personnel caring for patients with
suspected or known COVID-19 use either a surgical mask
or N95 (or N99 or PAPR) respirator as part of appropriate
personal protective equipment (PPE) (Strong recommenda-
tion, moderate certainty of evidence)
2
Masks in shortage scenarios: In contingency or crisis set-
tings with a shortage of respirators, healthcare personnel
caring for patients with suspected or known COVID-19 use a
surgical mask or re-processed respirator instead of no mask
as part of appropriate PPE.
16
3
Gloves: Citing a lack of evidence, the panel did not
make a recommendation to support the use of double
gloves vs. single gloves.
4
Shoe covers: Citing a lack of evidence, the panel did
not make a recommendation to support the use of
shoe covers.
Recommendations for Aerosol-Generating Procedures:
5
N95 masks: Healthcare personnel involved with
aerosol-generating procedures on suspected or known
COVID-19 patients should use an N95 (or N99 or PAPR)
respirator instead of a surgical mask, as part of appropriate
PPE.
Reprocessed N95 masks: If respirators are in shortage,
re-processed N95 respirators should be reused instead
of surgical masks as part of appropriate PPE during
aerosol-generating procedures on suspected or known
COVID-19 patients.
6
7
Extended use of N95s through face shields and surgical
masks: If due to shortages re-processed respirators are
being used for aerosol-generating procedures, the panel
recommends healthcare personnel use a face shield or surgical
mask over the reused respirator to aid extended use, instead
of using a surgical mask alone. This recommendation assumes
correct PPE donning and doffing techniques.
8
Reuse of N95s with face shields and surgical masks:
To allow for reuse of re-processed respirators during
contingency or crisis settings, healthcare personnel involved
with aerosol-generating procedures on suspected or known
COVID-19 patients should add a face shield or surgical mask
as a cover for the N95 respirator instead of a using a surgical
mask alone, as part of appropriate PPE.
Source: Society for Healthcare Epidemiology of America (SHEA)
may 2020 • www.healthcarehygienemagazine.com