patient safety & quality
By Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC, PLNC, AS-BC, IP-BC, VA-BC™, CFER, CPPS, NREMT,
FACDONA, FAAPM, FNAP
A New Era in Personal Protective Equipment:
Strategies for the Future
W
ith the ongoing COVID-19 pandemic, healthcare
professionals and facilities have struggled to maintain
adequate supplies of personal protective equipment (PPE).
In normal circumstances, healthcare professionals would
dispose of single-use PPE after a single use, but this practice
has been impossible to maintain during a large-scale outbreak
or pandemic. PPE includes commonly used supplies such
as gloves, gowns, and masks, but in today’s times it also
includes respirators and enhanced eye protection. To help
healthcare facilities prepare for potential PPE challenges,
the Centers for Disease Control and Prevention (CDC) has
developed extensive guidance to guide decisions related to
PPE. This new guidance categorizes PPE prioritization into
three basic capacities: Conventional Capacity, Contingency
Capacity, and Crisis Capacity.
Conventional capacities include common measures that
consist of providing patient care without any change in daily
contemporary practices. This capacity includes measures
such as engineering, administrative, and PPE controls
that should be already implemented as a standard part of
infection prevention and control plans in healthcare settings.
Contingency capacity, on the other hand, include measures
that change daily standard practices but may not have any
significant impact on the care delivered to the patient or
the safety of healthcare personnel. Contingency capacities
and strategies are used during periods of known shortages.
Lastly, the crisis capacity category includes those strategies
that are not commensurate with the normal standards of
care in the United States. The crisis category during extended
PPE shortages.
The CDC has offered several general strategies that
healthcare facilities can implement across the healthcare
continuum of care to reduce PPE challenges. First, healthcare
facilities should attempt to purchase PPE that can be safely
reprocessed if available. Non-urgent procedures and elective
cases can also be rescheduled to minimize the demand of
PPE. Next, PPE may be used beyond its normal shelf live
in these dire circumstances. Healthcare facilities should
attempt to maximize the use of engineering controls which
includes well-maintained ventilation systems, administrative
controls, and barriers. These interventions will minimize the
unprotected patient contacts that can be very risky to the
healthcare team.
Certain procedures, such as surgeries or aerosol-gener-
ating procedures may require specific PPE depending upon
the pathogen of concern. One critical aspect of proper PPE
usage is to ensure that all staff using PPE have received
both adequate training and have been fit tested for any
PPE which requires this, most notably a respirator. The
Occupational Safety and Health Administration (OSHA)
and the CDC National Institute for Occupational Safety
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and Health (NIOSH) regulate respirator masks and relevant
fit testing recommendations which are designed to protect
the user during use. Recently, the CDC and others have
released new tools and resources including a comprehensive
Personal Protective Equipment Burn Rate Calculator. These
tools assist healthcare leaders in forecasting the breakdown
of different types of PPE and quantities needed to care for
patients requiring isolation precautions in an outbreak and
pandemic scenario. The CDC tool is an important component
of healthcare facilities partnering with their medical supplier
partners so that proper inventory levels can be maintained
and adjusted as needed. Healthcare leaders have an
important responsibility and obligation to ensure that all
healthcare workers that are performing clinical care. Under
no circumstances should healthcare providers be asked by
leadership to perform clinical care without the appropriate
PPE available to them for their protection.
In some circumstances, such as what occurred when the
World Health Organization and CDC declared COVID-19 a
pandemic, available off PPE was immediately impacted and
global supply chains for PPE came to a screeching halt. In
many instances during supply chain shortages, healthcare
facilities may be provided with alternate PPE products from
numerous sources. This can create anxiety for the healthcare
provider team as they may not be familiar with substituted
equipment nor be properly fit tested for items such as
respirator masks. During difficult times, PPE can become
scarce, and the supplies available must be used deliberately
to prevent waste. If PPE is reprocessed due to shortages,
it should be done in accordance with CDC Guidance to
prevent potential occupational exposure. Finally, PPE, is the
last element of protecting healthcare workers from potential
infectious diseases threats. Measures such as Engineering
and Administrative Controls are much more effective and
sustainable at reducing risk for occupational exposure. PPE,
while a critical element, is one component of a comprehensive
approach to infection control, patient safety, and occupational
safety. Healthcare facilities must heed the lessons learned
from pandemics such as COVID-19 and ensure a constant
state of readiness for future threats.
Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC, PLNC,
AS-BC, IP-BC, VA-BC™, CFER, CPPS, NREMT, FACDONA,
FAAPM, FNAP, is president and CEO of Community Health
Associates, LLC. He also is an adjunct assistant professor of
medicine in the Division of Infectious Diseases at the University
of Louisville School of Medicine. Garrett is a frequent lecturer
globally on patient safety, infectious diseases, and medical
device reprocessing and safety. He may be reached at:
[email protected]
may 2020 • www.healthcarehygienemagazine.com