View source for WLAVA:COVID-19 PPE

'''Last Updated 4/26/20'''

===Mask Guidance===
** 1860 and 1870 N95 respirators are being distributed only to the OR and Procedure Center. 
** ED is receiving only 3M 8000 N95 respirators.
** We have very very few 1860/1870 left for the entire ED (MDs, RNs, ICTs, etc). 
*** We will not be resupplied with 1860/1870s.
** Remind consultants that 8000s are N95 respirators and this is an ID guideline. 
*** They can request an 1860s/1870s is if they failed formal fit test for 8000s.
 
====What Mask Should I Wear?====
*'''PAPR:'''
** Provider intubating. Nursing as per their leadership recommendations.
* '''3M 8000 N95 Respirator:'''
** All providers working in the ED who passed fit testing.
*** Airway buddy.
*** Personnel seeing PUIs. 
*** Nurse performing NP swab.
*** CODES or intubations.
** No need to wear a surgical mask over these.
*** Can discard with every PUI. Can continue to wear between non-PUI to non-PUI.
* '''3M 1860/1870 N95 Respirator:''' 
** Providers that failed formal 8000 N95 fit testing.
** Wear a surgical mask over this and discard surgical mask with every PUI.
** If used for a CODE or Intubation, discard the N95.
** If used daily because you failed 8000 N95 fit test, consider saving these using paper bag method.

====3M 8000 N95 Fit Testing====
* EVERYONE needs to be fit tested for the N95 8000s as these will be the ones handed out. Next fit test dates are:
** Monday 4/27/20 6:30-11:30, building 500 Rm 3232
*** Please complete questionnaire online if you have not done it within the past year. 
*** URL: http://respiratormedicalevaluation.com

====Mask Decontamination Suspended====
* SPS is no longer collecting masks.
* Discard the 8000 N95 respirators.
* Save 1860s/1870s for future use as long as they weren't used for code/intubation.
** Use paper bag method x wait 5 days, 5x max.

====♦♦♦UV Sterilization Technique 4/24/20====
* Not institutionally advised and use at your own risk. 
* The UVC machine on the top shelf in the med room would require '''9 min 30 secs''' to sterilize anything that is put inside if you choose to use it. (Thanks to Miguel for figuring this out)

====♦♦♦PAPR Cleaning 4/24/20====
* After an intubation or CODE with PAPR use, '''remind the charge nurse to call SPS to pick it up for cleaning.'''
* Placing PAPR in the dirty utility room, on the cart instead of the floor. It may be assumed to be trash if on the ground.
* If SPS is not called, PAPR may not be cleaned for days  and has a high chance of getting lost.
* If restocking Airway carts and there are no more PAPRs left in the Med Room, notify the ED Nurse Managers or COVID Team.]

===Guidance On Donning & Doffing For Ed Patient Encounters===
====Patient Encounter Scenarios & Detailed PPPE====
[[File:06B68CDD-1AD2-4390-8044-22D7FC1A4DEB.jpg|thumb|center|Patient Encounter Scenarios and Detailed PPE]]

====For Patients '''W/ COVID''' Isolation Precautions ====
[[File:DBB5C750-02D7-4CA3-B085-80ECD361D51C.png|thumb|center|Donning and Doffing Guidance for Patients w/COVID-19 Isolation Precautions]]

====For Patients '''W/O COVID''' Isolation Precautions====
[[File:ABDFBBCB-FADB-4295-9CA0-3A5BD6EC916D.png|thumb|center|Donning and Doffing Guidance for Patients w/o COVID-19 Isolation Precautions]]

==Airway/Code Donning & Doffing Checklist==
* Latest laminated version included in the Airway Cart (PAPR Drawer)
'''N95'''
* '''CODE Scenario:''' N95 Donning & Doffing ([[:File:PPE Donning Checklist ER 2020 N95 for CODE - 4.4.pdf]])
* '''Airway Buddy:''' N95 Donning & Doffing ([[:File:PPE Donning Checklist ER 2020 N95 buddy - 4.4.pdf]])
'''PAPR'''
* '''PAPR Donning & Doffing''' ([[:File:PPE Checklist ER 2020 airway PAPR 4.4.pdf]])


====PPE PAPR DONNING VIDEO ====
{{#widget:YouTube|id=w253AxiuFzk}}

====PPE PAPR DOFFING VIDEO====
{{#widget:YouTube|id=vKnZaTdhRQs}}

====PPE BUDDY DOFFING VIDEO====
{{#widget:YouTube|id=sl78L2DtloY}}

===UPDATES ON GLA ED SUPPLY OF PPE===
====3D PRINTED FACE SHIELDS====
* These are not completely splash proof because of the holes in the front. 
* It's best to use goggles to protect your eyes. Please keep the headbands. 
* You may discard the clear plastic sheets but they can also be cleaned and reused.

====THE LENGHT OF TIME FOR FACE SHIELD USAGE====
* CDC stated, "Eye protection should be discarded if damaged (e.g., face shield can no longer fasten securely to the provider, if visibility is obscured and reprocessing does not restore visibility)." 
** A way to optimize the face shield and minimize staff exposure is to have one or two designated person each shift for PUI.

====PAPR HOODS====
*'''PAPR hoods are reusable, please send to SPS for decontamination.'''
* Please do not mark PAPR hoods with your name. We are going to be using them indiscriminately based on your size. 
* We secured a limited supply of Inner Hoods with neck covering for use with PAPR. 
[[File:Inner hood.jpg|thumb|center|Inner Hood for PAPR]]
* We secured a limited supply of special PAPRS with Hood with neck covering.
** There is only one in the airway cart and one in the Med Room.
[[File:PAPR Hood.jpg|thumb|center|PAPR w/Hood]]

====BUNNY SUIT====
* We are not re-using these, discard after each use. 
* Come in 3 sizes (located in Med Room).

====GOGGLES====
* ED staff will given safety googles 
** Come see Jonie/Kian/Manny/TBlair to get one if you need it

====REUSING PPE====
* '''PAPR hoods''' - Used PAPR hoods are now community property amongst ED staff since they are being cleaned by SPS (will be labeled ER). 
*'''Cleaning Eye Protection:'''
** Perform hand hygiene
** Put on gloves
** Use an alcohol wipe across the entire INNER surface
**Use a hospital disinfectant (SaniWipe AF3) to wipe the entire OUTER surface
** Allow to air dry
** Place in brown paper bag till next use
** Remove gloves and perform hand hygiene
** GLA Infection Control Reference file:
***[[:File:APPROVED_20200330.1030.Interim GLA guidance for Eye Protection Cleaning.pdf]]

====GLA MAIN CONTACT FOR OFFICIAL PPE PURCHASING (NOT DONATIONS)====
* Terry Wolgamott: Terry.Wolgamott@va.gov

====GLA CONTACTS FOR PPE DONATIONS====
* If you know someone who is interested in donating masks, or other items, to our medical center please have them contact our Voluntary Service dept.
**Alexia Lunningham, Chief of Voluntary Service: Alexia.Lunningham@va.gov or 310-286-3994
**Shirley Bearden, Voluntary Service Specialist: Shirley.Bearden@va.gov or 310-268-3194

==OTHER WLA VA PAGES==
* [[WLAVA:COVID19_ED_Operational_Updates|WLAVA: COVID19 ED Operational Updates]]
* [[WLAVA:COVID19_ED_Airway|WLAVA: COVID-19 ED Airway Main]]
* [[WLAVA:Enhanced_Screening_Tent|WLAVA: Enhanced Screening Tent]]
* [[WLAVA:Enhanced_Screening_Tent_LIP_Orientation|EST Provider Orientation]]
* [[WLAVA:Enhanced Screening Tent Telehealth]]

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