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.]

PPE General Info

Patient Encounter Scenarios & Detailed PPE

Patient Encounter Scenarios and Detailed PPE

For Patients WITH COVID-19 Isolation Precautions

Donning and Doffing Guidance for Patients w/COVID-19 Isolation Precautions

For Patients WITHOUT COVID-19 Isolation Precautions

Donning and Doffing Guidance for Patients w/o COVID-19 Isolation Precautions

GUIDANCE ON DONNING & DOFFING FOR ED PATIENT ENCOUNTERS

PATIENT ENCOUNTER SCENARIOS & DETAILED PPE

Patient Encounter Scenarios and Detailed PPE

FOR PATIENTS W/COVID19 ISOLATION PRECAUTIONS

Donning and Doffing Guidance for Patients w/COVID-19 Isolation Precautions

FOR PATIENTS W/O COVID19 ISOLATION PRECAUTIONS

Donning and Doffing Guidance for Patients w/o COVID-19 Isolation Precautions

GLA AIRWAY/CODE DONNING & DOFFING CHECKLIST

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

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PPE PAPR DOFFING VIDEO

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PPE BUDDY DOFFING VIDEO

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RADIOLOGY COVID19 & PPE

• Very low threshold for placing facemask on patients with respiratory symptoms or symptoms potentially concerning for COVID.
  • All patients with respiratory symptoms are supposed to have this anyway, but we may have to enforce further
• In the current climate, portable CXRs generally preferred (especially for respiratory symptoms)
• Very low threshold for staff wearing face masks whenever interacting directly with patients including when obtaining XRs
• Make sure patients are wearing face mask properly if they are sent down to imaging (Remind transport to check face mask).
• We can do portable CXRs in Fast Track if either the patient is in a bed (Room D only) or the patient is very compliant and able to sit still in our exam chairs without risking dropping the cassette.

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.

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.

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: COVID-19 ED Airway Main
• WLAVA: Enhanced Screening Tent
• EST Provider Orientation
• WLAVA:Enhanced Screening Tent Telehealth