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March 27, 2020

The following recommendations are culled from CDC and other expert resources as healthcare organizations struggle to cope with shortages of personal protective equipment (PPE). These recommendations will vary over time and will be based on the health of the supply chain.

The following measures are aimed at ensuring the organization employs evidenced-based practice while fostering safety for its patients, visitors, and staff.

General Recommendations:

  • Conduct Inventory of PPE (know what you have on hand (days on hand) and what you may need for future use. Daily reports from central supply/supply chain delivery are recommended
  • Review engineering controls (what can be done to the environment to protect/lessen exposure to workers) and implement as appropriate
  • Review administrative controls (what can be done administratively to reduce staff exposure – e.g., reducing work schedules) and implement as appropriate
  • Evaluate minimal or foregoing of PPE use for colonized patients (on a case by case basis). Obtain approval from both Infectious Disease Physician and Infection Prevention staff.
  • Temporarily remove respiratory care stations throughout the organization (preserving face masks) – Restrict the use of face masks to healthcare workers if possible. Patient use of face masks should occur only to prevent the spread of microorganisms.
  • Determine use of isolation gowns
    • Consider elimination of isolation gowns when clinically appropriate
    • Consider use of cloth gowns and laundering of same
    • Paper isolation gowns should not be re-used
  • Determine use of protective eyewear
    • Outline when to follow extended use guidelines and when to follow reuse guidelines and all cleaning/sanitation recommendations
  • Determine use of face masks
    • Outline when to follow extended use guidelines and when to follow reuse guidelines and all cleaning/sanitation recommendations
  • Determine use of N95 Respirator masks
    • Outline when to follow extended use guidelines and when to follow reuse guidelines and all cleaning/sanitation recommendations. Regardless of which type of use (extended or reuse) the following CDC recommendations apply:
      • Discard N95 respirators following use during aerosol generating procedures
      • Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients
      • Discard N95 respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions
      • Use a cleanable face shield over a N95 respirator to reduce surface contamination
      • Perform hand hygiene with soap and water or alcohol-based hand sanitizer before and after touching or adjusting the respirator (when necessary to adjust the respirator)
      • Discard any respirator that is obviously damaged or becomes hard to breathe through
      • Seal check the N95 each time it is donned to assure proper functioning of the device
      • Healthcare workers need to be fit-tested if another brand of N95 is deployed within the organization
    • Determine when use of powered air purifying respirators (PAPRs) is necessary (example for individuals who cannot be fit-tested, for use during aerolizing procedures such as endoscopic endo-nasal procedures).

References outlining best practice recommendations for preservation of PPE include:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/contingency-capacity-strategies.html

https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

https://www.apic.org


Greeley’s core mission is to help hospitals deliver high-quality, cost-effective patient care. For more information on how Greeley can partner with your organization during this challenging time, please email info@greeley.com or call 888.749.3054. 

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