Special Edition on Infection Prevention & Control | Page 10

●Healthcare personnel should wear filtering facepiece
respirators (e.g., N95 respirators) or higher-level respirators
during all aerosol generating procedures or surgical procedures
involving anatomic regions where viral loads might be
higher, such as the nose and throat, oropharynx, respiratory
tract even if the patient has tested negative for COVID-19.
Healthcare organizations will need to identify all aerosol
generating procedures to which their employees could be
exposed, determine the risk, and, if risk is identified, either
provide them a respirator or prevent entry into the room until
sufficient air changes have occurred to remove infectious
particles. Employers must comply with Occupational Safety
and Health Administration (OSHA)’s Respiratory Protection
Standard if their employees wear respirators that fall under
the standard. In order to prevent entry prior to allowing a
sufficient time to elapse, organizations will need to identify
the number of air changes per hour in the room(s) where the
aerosol generating procedure(s) will take place. For some
organizations (e.g., hospitals and ambulatory surgery centers)
information regarding air changes is relatively easy to obtain
from their facilities staff. For other healthcare providers,
such as homecare agencies, it may be easier to require
staff to wear a respirator whenever entering the home of
a patient who is having aerosol-generating procedures (e.g.,
nebulizer treatment) because it is not possible to identify
air changes of each private residence. Finally, organizations
that identify aerosol generating procedures that create risk
for their employees should review their procedure schedules
and ensure sufficient time has passed to remove infectious
particles before the next patients in line are placed in that
area. . Informing patients about processes to decrease
their risk of exposure, such as spacing aerosol generating
procedures and explaining how rooms are cleaned between
patients to ensure their protection is another way to show
an organization’s commitment to preventing transmission
of COVID-19.
●If an organization has resumed elective procedures and
ambulatory care, it should no longer be operating under crisis
standards of care and should have sufficient gowns, eye
protection, and facemasks to follow conventional practices
for the elective procedures and care that they are providing.
One way that organizations are doing this is by reviewing what
PPE is needed based on anticipated exposure. For example,
if the facility was using a Level 4 surgical gown for all surgical
procedures and these are in short supply, they might review the
types of elective procedures and determine that some minimally
invasive surgical procedures could be safely performed using
a Level 2 gown. Another example would be to switch from
disposable eye protection to reusable eye protection and
implement a process for cleaning and disinfection.
●During times of respirator shortages, it is acceptable for
health care organizations to use contingency conservation
strategies for filtering facepiece respirators (e.g., N95
respirators) to ensure an adequate supply of respirators is
available for all aerosol generating procedures. CDC has
recommended extended use, the practice of wearing the
same N95 respirator for repeated close-contact encounters
with several different patients without removing the respirator
between patient encounters over reuse of respirators, the
practice of removing and reapplying the respirator between
patients. When organizations approaching crisis surge
capacity and anticipate an inability to provide sufficient
number of respirators to protect staff involved in aerosol
generating procedures, the disinfection of single use
respirators is an option when organizations have been
in communication with local public health partners (e.g.,
public health emergency preparedness and response staff)
and are still unable to obtain replacement supplies to match
anticipated need. Decontamination of disposable respirators
as a means of extending use is an option that has been
addressed by states, the CDC, FDA and other stakeholders,
including safety organizations.
●Organizations should check with state and local health
departments for more information about area specific risks
and requirements.
How organizations approach emerging infectious diseases
and their preparedness has most likely changed forever.
Similar to the paradigm shift of healthcare workers always
of wearing gloves that happened during the late 1980’s
and early 1990s -- social distancing and wearing masks
in healthcare facilities and use of respirators for aerosol
generating and high-risk procedures to prevent transmission
of respiratory viruses, including COVID-19, will likely become
the new normal to keep everyone safe. Organizations will
need to stay alert for updated information about transmission,
evaluate the credibility and applicability to their care settings,
and use the information implement effective strategies to
protect their staff and patients.
Sylvia Garcia, MBA, RN, CIC, is director of infection
prevention and control for the Joint Commission.
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ncov/faq.html#:~:text=COVID%2D19%20is%20a,way%20the%20virus%20
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