Ensuring Healthcare Systems Preparedness

Staying knowledgeable about the Coronavirus Disease 19 can save lives. The COVID-19 is spreading and it's critical to provide the proper respiratory protection to our healthcare workers to keep them safe on the job while treating patients. To help you sift through all of the information that is currently being reported by the media and Center for Disease Control (CDC) about the virus, here’s a quick reference guide to understanding the role personal protective equipment (PPE) plays in keeping healthcare workers safe. 

The First Case of the Virus in the United States
The CDC recognized the quick actions of Providence St. Joseph Health in Everett, WA, whose Bio-containment Evaluation and Specialty Treatment (BEST) team treated the first case of the Coronavirus Disease 19 in the Unites States on January 20, 2020. BEST's response to providing medical treatment to the coronavirus-infected patient helped prevent the spread of the virus and is a best practice for all healthcare providers to mirror. Powered Air Purifying Respirators (PAPRs) played a critical role in the BEST team's response by maximizing respiratory protection with up to 1,000 APF (assigned protection factor). PAPRs utilize loose-fitting hoods that don't require fit testing and provide full respirator, head, and face protection in one easy-to-use system. The BEST team equipped themselves with the following respiratory protection:     

  • A PAPR
  • Impervious boot cover
  • AAMI 4 level gown 
  • Hospital scrubs and shoes
  • Double gloves (extended cuff)

Best Practices for Managing the Spread of the Coronavirus Disease 19
Providence St. Joseph Health asked two simple questions to determine next steps for treating the coronavirus-infected patient:

  1. Have you traveled to China in the last 30 days?  
  2. Have you been in contact with someone who has traveled to China in the last 30 days who is now ill? 

If a patient answers yes to either question, immediately provide him/her with an N95 mask. In the clinic-based setting, escort the patient to a room for quarantine or to a negative pressure room, if available. Whether in a clinic-based setting or hospital, immediately contact clinical resources designated for your area to proceed with a symptom screen and triage. If the patient is already at the hospital, the clinical resources should don the patient with droplet Personal Protective Equipment (PPE) including gloves, gown, and mask for screening. Below are two critical symptom screen questions:

  1. Does the patient have a fever above 100.4F?
  2. Is the patient experiencing cough, shortness of breath, or other lower respiratory symptoms? 

If yes to either question, use contact and airborne PPE with eye protection. Isolate the patient in a room or a negative pressure room, if available. Then notify the nursing supervisor immediately, followed by your local health authority and regional lead.  

Strategies for Optimizing the Supply of Respirators
The CDC offers guidance on how to optimize the supplies of respirators in the healthcare setting for the potential ongoing Coronavirus Disease 19 transmission. Controlling exposures to occupational hazards is fundamental to protecting healthcare personnel. Elimination, substitution, engineering controls, administrative controls, and PPE. recommendations from the CDC are below:  

Engineering Controls 

  • Place the patient in a private room, preferably a negative pressure room 

Administrative Controls 

  • Limit number of patients going to hospitals     
  • Exclude HCP not directly involved in patient care
  • Limit face-to-face HCP encounters with patient
  • Exclude visitors
  • Provide facemasks for patients with symptoms                                                              
  • Cohort patients
  • Cohort healthcare personnel
  • Practice telemedicine
  • Limit respirators during training

PPE Control 

  • Use respirators after their extended life only if supplies are limited.
  • Only wear the same N95 or PAPR hood for repeated close contact encounters with several different patients without removing the respirator between encounters if supplies are limited; otherwise, its best practice to replace respirators and PAPR hoods between patient encounters.
  • Be sure not to use the same N95 or PAPR hood by one healthcare personnel for multiple encounters with different patients and remove it after each encounter. This is only appropriate for diseases in which contact spread is not a concern.