There are dire shortages of several kinds of coronavirus-related personal protective equipment across the country.
During the coronavirus pandemic, there are ways that healthcare organizations can reuse or extend the life of some personal protection equipment (PPE), an infection prevention expert says.
PPE is a crucial element of protecting healthcare workers from the virus that causes coronavirus disease 2019 (COVID-19). In China, Italy, and Spain, thousands of healthcare workers have been infected with the coronavirus. One-third of U.S. doctors are at high risk of serious illness from the coronavirus because they are over 60 years old, new research shows.
Last week, the Association of Professionals in Infection Control and Epidemiology (APIC) released national survey results that show severe PPE shortages at many U.S. healthcare facilities, including lack of respirators, surgical masks, face shields, and goggles. This week, HealthLeaders spoke with APIC President Connie Steed, MSN, RN, about how healthcare organizations can reuse or extend the life of PPE.
N95 respirator masks, face shields, goggles, and surgical masks
At this point in the U.S. COVID-19 pandemic, maintaining adequate supplies of N95 respirator masks is the primary PPE supply chain challenge, says Steed, who is director of infection prevention and control at Prisma Health-Upstate in South Carolina.
"Where most facilities are having trouble is with the N95; so, we are trying as much as possible to limit its use; and when it is used, we extend its life when it is acceptable," she says.
At Prisma Health, supplies of N95 respirators are being maximized through prioritization of use in the treatment of COVID-19 patients, Steed says. "It should be prioritized for aerosol generating procedures—that's when you have droplets during the intubation or extubation of a patient, for example. You can put people in surgical masks and face shields for other care."
Another option to conserve N95 respirators when treating COVID-19 patients is to use powered, air-purifying respirators (PAPRs), she says. "One of the things that some hospitals are doing is the use of the PAPR, which is a hood; and there has been discussion about the reuse of those hoods and using them instead of N95s. The PAPR's level of protection is the same or higher than the N95."
N95 respirators, face shields, and goggles are sturdy enough to reprocess after use with COVID-19 patients or patients suspected of coronavirus infection, Steed says.
Reprocessing requires a room designated for disinfection of PPE and other equipment. For N95 respirators, face shields, and goggles, she says two disinfection methods are currently being used across the country: hydrogen peroxide mist and/or ultraviolet light.
N95 respirators go through a four-step disinfection process, Steed says:
- After use, the respirators are placed in a container
- The respirators are carefully transported to the disinfection room
- Inspectors make sure the respirators are intact and not visibly soiled
- The respirators are suspended on "basically a clothesline," then they go through a disinfection process with either hydrogen peroxide mist or UV light, or both
Surgical masks can also be conserved, she says.
For example, Prisma Health started universal masking this week at its hospitals, which requires all employees to wear surgical masks except when they are eating, drinking, or working in a private room. When employees come to a hospital to start a shift, they are screened for fever and other COVID-19 symptoms; and if they screen negative, they are given a surgical mask and a bag, Steed says.
"When a healthcare provider gets ready to go into a room with a suspected or confirmed COVID-19 patient, they would take the regular mask off and put it in their bag. Then they put on an N95 mask, face shield, and other protective gear, go into the room, take care of the patient, come back out, doff safely, and clean their hands. Then they put their daily mask back on their face."
The Centers for Disease Control and Prevention has established guidance for maximizing the supply of N95 respirators.
Gloves and gowns
The options for conserving gloves and gowns in COVID-19 treatment are limited, with gloves only appropriate for single use, Steed says.
Plastic gowns also are single-use PPE in COVID-19 treatment, but some cloth gowns can be reused, she said. "There are some hospitals that use cloth gowns that have fluid repellency. If that's the case, they can be doffed and laundered through a routine process, then reused."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
At this point in the coronavirus pandemic, maintaining supplies of N95 respirator masks is the primary supply chain challenge, an infection prevention expert says.
Powered, air-purifying respirators are an alternative to using N95 respirators.
After treatment of coronavirus patients or those suspected of coronavirus infection, N95 respirators, face shields, and goggles can be disinfected for reuse.