Attachment 1 - PPE Guidance - COVID19.pdf

MVAHCS PPE Guidance During COVID-19 Pandemic

April 21, 2020

Employee1 Patient Visitors

Non-clinical Areas2

OR

Non-Medical Mask Medical Facemask

Non-Medical

Mask

All patient Transport Medical Facemask Face shield

Clinical areas3 – HCW who do not provide direct patient care

Medical Facemask Face shield4

Clinical areas – HCW provide direct patient care to patients who are NOT suspect/confirmed COVID-19 patients5

Medical Facemask Face shield

Direct Patient Care of COVID-19 PUI and confirmed cases including NP/OP collection

Medical Facemask Face shield Gown Gloves

Before and after NP/OP collection

Aerosol Generating Procedures6

N95 or PAPR Face shield Gown Gloves

Mask Before and After Procedure

N/A

Footnotes:

1. For the purposes of this document employee encompasses all healthcare workers including support personnel

2. Non-clinical areas: Areas where no direct patient care is provided (e.g. offices, tele-medicine, etc.)

3. Clinical areas: Areas/units where direct patient care is provided (e.g. acute care, triage, CLC, etc.)

4. Face shield should be worn if not working behind a physical barrier (e.g. plexiglass panel)

5. This includes patients who tested for COVID-19 and negative in the past 7 days

6. List of Aerosol Generating Procedures is included in Inpatient Care Guidelines for COVID-19 Patients (posted on Coronavirus SharePoint)

Gown and/or gloves per isolation precautions https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/SitePages/Home.aspx

MVAHCS PPE Guidance During COVID-19 Pandemic

Minneapolis VA Health Care System Effective Date:

April 21, 2020

Date Updates since previous version 4/21/2020 • Expanded masking guidance

• Incorporation of Non-Medical Masks and Employee-Provided Protection SOP into this document

• Emphasis on PPE use based on areas where work is being performed

4/16/2020 • Addition of Home-Based Primary Care (new table in Section 9.)

• All staff providing face-to-face care will be provided a medical facemask daily

• Clarification regarding when medical facemask/face shield should be used by MSA

• Change to limited reuse of N95 (not reused after intubation/bronchoscopy) and thrown away at the end of the day

• Deletion of SOP Appendices A, B, C and replaced with links to detailed competencies

4/10/2020 17:00

• Clarification of Aerosol Generating Procedures performed among suspect/confirmed COVID-19 vs patients not currently suspect or confirmed

1. PURPOSE: During the COVID-19 pandemic, hospital-provided personal protective equipment (PPE) is in short supply and must be used judiciously while providing needed protection for staff in the context of patient care day to day operations. This document provides guidance for the appropriate use of PPE for all clinical and non-clinical areas of MVAHCS.

2. RISK ASSESSMENT: MVAHCS continues to evaluate increasing numbers of patients under investigation (PUI) and confirmed COVID-19 patients. PUI and COVID-19 patients are being roomed on designated units throughout our facility and staff are being retrained across our facility to work on these wards. The frequency of COVID-19 in the surrounding communities continues to increase, affecting Veterans served by the MVAHCS as well as staff. We have had multiple instances of staff who have not been working on wards with PUI or confirmed COVID- 19 cases but have tested positive for COVID-19. This has led to potential exposures among outpatients and inpatients hospitalized for non-COVID-19 related illness. As access to test supplies increases in the future, additional testing among inpatients will assist in more accurate cohorting and clinical care.

3. DEFINTIONS

a. Hospital-Provided Personal Protective Equipment (PPE): PPE provided by MVAHCS which meets NIOSH/OSHA standards as supplies to be used in the context of patient care. This PPE includes, but is not limited to, medical facemasks, face shields, goggles, N95 respirators, PAPRs, gowns and gloves.

b. Non-Medical Masks: Masks provided by MVAHCS that includes, but is not limited to, donated supplies, cloth masks, home-made masks or other items that have not been tested and determined to meet NIOSH/OSHA standards to be used as PPE in the context of patient care.

c. Employee-Provided Protection: For the purposes of this document, employee encompasses all healthcare workers (HCW) including support personnel. Employee-owned/purchased items are those brought into MVAHCS by an employee. Employee- Provided Protection includes, but is not limited to, cloth masks, home-made masks, non-medical facemasks, medical facemasks, face shields, respirators or other items which are not provided by MVAHCS as PPE. These items may / may not have been tested and determined to meet NIOSH/OSHA standards. Employee-Provided Protection is NOT considered PPE to be worn in the context of patient care at MVAHCS.

d. Clinical areas: Areas/units where direct patient care is provided (e.g. acute care, triage, CLC, etc.)

e. Non-clinical areas: Areas where no direct patient care is provided (e.g. offices, tele-medicine, phone counseling, etc.).

f. Extended use is wearing the same medical facemask, (or N95 respirator) and face shield for an extended period and for repeated close contact encounters with several different patients without removing the medical facemask (N95 respirator) between patients.

4. PROCEDURES

a. PPE Use

(1) Employees are expected to wear medical facemasks or non-medical masks in non-clinical areas unless workspace/office is not shared with anyone else.

(2) The use of MVAHCS-provided PPE outside of recommended or permitted settings is not allowed.

(3) Each employee who enters areas/units where direct patient care will receive one medical facemask per day.

(4) If the medical facemask becomes visibly soiled or wet, unable to maintain appropriate fit, or difficult to breathe through, the employee can request a replacement from their supervisor.

(5) Each employee who enters areas/units where direct patient care is provided will receive one face shield for use until it becomes degraded (foggy or scratched).

(6) Employees who are performing aerosol-generating procedures will be provided an N95 respirator for extended use.

(a) N95 respirator should be thrown away after endotracheal intubation or bronchoscopy.

(b) N95 respirator should be thrown away at the end of the day or if the internal surface becomes contaminated.

(7) Employees will be provided paper bags for medical facemask, N95 respirator, and face shield storage.

(8) Do not wear a medical facemask over N95 respirator.

(9) Extended use competencies for medical facemask and face shield, N95 respirator and face shield, and PAPR are posted on Coronavirus SharePoint.

(10) Do not take PPE home. When appropriate, according to extended use competencies, dispose of PPE at MVAHCS.

(11) To prevent self-contamination, do not drape mask or N95 around your neck.

(12) The outside/front of PPE is contaminated; do not touch these surfaces and perform hand hygiene immediately if you inadvertently do.

(13) If you need to remove PPE, place in a paper bag for storage.

b. Employee-Provided Protection use

(1) These items are not allowed in the context of patient care.

(2) These items will be allowed by employees in non-patient care areas but must comply with Dress Code/Professional Appearance for Minneapolis VA Health Care System (MVAHCS) Policy HR-22. “Good customer service starts with the first impressions given from how an employee is dressed. It is the policy of the MVAHCS that employees wear appropriate clothing suitable to the professional health care environment”.

(3) The outside/front of PPE is contaminated; do not touch these surfaces and perform hand hygiene immediately if you inadvertently do.

(4) To prevent self-contamination, do not drape mask or N95 around your neck.

(5) If you need to remove PPE, place in a paper bag for storage.

(6) Employee is responsible for properly maintaining these items. Remove if it becomes wet and/or soiled or unable to achieve an appropriate fit.

(7) If made of cloth material, launder at home between use in hot water with regular detergent. Dry on hot setting.

5. SEE COMPETENCES FOR DETAILED PROCEDURES TO PUT ON AND TAKE OFF PPE

a. Competency Extended Use Medical Facemask for Contact Droplet Precautions -https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID- 19/COVID19%20Competencies/Forms/AllItems.aspx

b. Competency Extended Use N95 Respirators for Aerosol Generating Procedures https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID- 19/COVID19%20Competencies/Forms/AllItems.aspx

c. Competency Extended Use of PAPR 3M Air-Mate and Versaflo for Aerosol Generating Procedures https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID- 19/COVID19%20Competencies/Forms/AllItems.aspx (revise – now written as 2 separate competencies) https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx https://dvagov.sharepoint.com/sites/min/SiteDirectory/COVID-19/COVID19%20Competencies/Forms/AllItems.aspx

6. PERSONAL PROTECTIVE EQUIPMENT FOR ALL INPATIENT AREAS

Setting Target Personnel/ Patient

Activity Type of PPE or Procedure

Patient Room

Employee

Direct patient care of patients who are NOT suspect/confirmed COVID-19 patients

• Medical facemask

• Face shield

Direct patient care of COVID- 19 PUI and confirmed cases.

Includes NP/OP collection

• Medical facemask

• Face shield

• Gown

• Gloves

Aerosol-generating procedures

• N95 respirator + face shield or PAPR

• Gown

• Gloves

• Negative pressure room, if available1, 2

Patient Any • Non-medical mask

EMS personnel Routine cleaning / disinfection services

• Medical facemask

• Face shield

• Follow routine practices

Visitors Per visitor policy

• Non-medical facemask

• Goggles

• Gown

• Gloves

Patient Care Unit

Employee (e.g. Food / Nutrition Service, Pharmacy Tech, MSA)

Enters patient care unit

• Medical facemask

• Face shield

Other areas of patient transport (e.g., hallways, Imaging)

Employee Transport patient to / from patient care areas

• Medical facemask

• Face shield

Patient Being transported

• Non-medical facemask

• Wear clean gown, clothing or cover with clean sheet

Triage Screening or Reception

Employee

• Maintain spatial distance of at least 3.5 feet (1 m)

• Physical barrier (plexiglass panel) recommended

• Medical facemask

• Face shield - if not working behind plexiglass panel

Patient Any • Non-medical mask

1Keep door closed and use N95 respirator or PAPR for 30min after procedure in a negative pressure room 2Keep door closed and use N95 respirator or PAPR for 60min after procedure in a standard private room

7. PERSONAL PROTECTIVE EQUIPMENT FOR ALL OUTPATIENT SETTINGS, CBOCs

Setting Target Personnel/ Patient

Activity Type of PPE or Procedure

Exam Room

Employee

Direct patient care of patients who are NOT suspect/confirmed COVID-19 patients

• Medical facemask

• Face shield

Direct patient care of COVID-19 PUI and confirmed cases.

Includes NP/OP collection

• Medical facemask

• Face shield

• Gown

• Gloves

Aerosol-generating procedures

• N95 respirator + face shield or PAPR

• Gown

• Gloves

• Negative pressure room, if available2

Patient Any • Non-medical mask

Accompanying family/ caregiver

Any • Non-medical mask

EMS personnel Cleaning / disinfection services

• Medical facemask

• Face shield

• Follow routine practices

Patient Care Unit

Employee (e.g.

Pharmacy Tech, MSA)

Enters patient care unit

• Medical facemask

• Face shield

Patient transport

Employee Transport of a patient within the healthcare facility

• Medical facemask

• Face shield

Patient Transport within the healthcare facility

• Non-medical facemask

Triage Screening or

Reception

Employee

• Maintain spatial distance of at least 3.5 feet (1 m)

• Physical barrier (plexiglass panel) recommended

• Medical facemask

• Face shield (if not working behind plexiglass panel)

Patient Any • Non-medical facemask

Accompanying family/ caregiver

Any • Non-medical facemask

1Keep door closed and use N95 respirator or PAPR for 30min after procedure in a negative pressure room 2Keep door closed and use N95 respirator or PAPR for 60min after procedure in a standard private room

8. PERSONAL PROTECTIVE EQUIPMENT FOR ALL ED AND ARC

Setting

Target Personnel/ Patient

Activity

Type of PPE or Procedure

Exam Room

Employee

Direct patient care of patients who are NOT suspect/confirmed COVID-19 patients

• Medical facemask

• Face shield

• Gown

• Gloves

Direct patient care of COVID-19 PUI and confirmed cases.

Includes NP/OP collection

• Medical facemask

• Face shield

• Gown

• Gloves

Aerosol-generating procedures

• N95 respirator + face shield or PAPR

• Gown

• Gloves

• Negative pressure room, if available1, 2

Patient Any • Non-medical facemask

Accompanying family/ caregiver Any • Non-medical facemask

EMS personnel Cleaning / disinfection services

• Medical facemask

• Face shield

• Additional PPE per routine practices

Patient Care Unit

Employee (e.g.

Pharmacy Tech, MSA)

Enters the patient care unit

• Medical facemask

• Face shield

Patient transport

Employee Transport of a patient within the healthcare facility

• Medical facemask

• Face shield

Patient Any • Non-medical mask

Triage Screening Or Reception

Employee

• Maintain spatial distance of at least 3.5 feet (1 m)

• Physical barrier (plexiglass panel) recommended

• Medical facemask

• Face shield (if not working behind plexiglass barrier)

Patient Any • Non-medical facemask

Accompanying family/ caregiver

Any • Non-medical facemask

1Keep door closed and use N95 respirator or PAPR for 30min after procedure in a negative pressure room 2Keep door closed and use N95 respirator or PAPR for 60min after procedure in a standard private room

9. PROCEDURES FOR HOME BASED PRIMARY CARE

Target Personnel/ Patient

Activity Type of PPE or Procedure

Patient’s Home

Employee Physical examination of a patient with no symptoms consistent with

COVID-19

• Medical facemask

• Face shield

Patient Any • Non-medical facemask, if available

Accompanying family/ caregiver Any • Non-medical facemask, if available

10. PROCEDURES FOR DRIVE THROUGH TESTING

Target Personnel/Pts

Activity

Type of PPE or Procedure

Curbside

Employee

Collection of nasopharyngeal/oropharyngeal swab specimen for suspected COVID-19 patients

• Medical facemask

• Face shield

• Gown

• Gloves

EMS Personnel Cleaning and disinfection services

• Medical facemask

• Face shield

• Additional PPE per routine practices

11. REFERENCES

a. VISN23 Memorandum – “Appropriate and Rationale Use of Personal Protective Equipment” 3/30/2020, updated 4/1/2020, 4/6/2020, 4/10/2020, and 4/16/2020 https://dvagov.sharepoint.com/:f:/r/sites/vhav23/PatSafety/VISN%2023%20COVID19/VI SN%2023%20PPE%20Guidance?csf=1&web=1&e=CelCbI

b. CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings April 1, 2020, updated 4/13/2020 https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

c. CDC: Healthcare Infection Prevention and Control FAQs for COVID-19 Updated April 19, 2020 https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html

d. Minneapolis VA HCS Policy HR-22: Dress Code/Professional Appearance for MVAHCS Employees. Updated 3/22/2018.

https://dvagov.sharepoint.com/sites/min/SiteDirectory/Policies/_layouts/15/listform.aspx?

PageType=4&ListId=%7B9770FCDD%2D3C4D%2D45E2%2DAFF3%2DA58DF92A674 7%7D&ID=798&ContentTypeID=0x0100DF15D66627FE804D9B567D0CF96CAE3A

e. CDC Coronavirus Disease 2019 (COVID-19) Cloth Face Covers. 4/4/2020:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

f. CDC Coronavirus Disease 2019 (COVID-19) Recommendations for Cloth Face Covers.

4/13/2020: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

g. MN Dept of Health - Interim Guidance on Facemasks as a Source Control Measure.

3/27/2020. https://www.health.state.mn.us/diseases/coronavirus/hcp/maskssource.pdf https://dvagov.sharepoint.com/:f:/r/sites/vhav23/PatSafety/VISN%2023%20COVID19/VISN%2023%20PPE%20Guidance?csf=1&web=1&e=CelCbI https://dvagov.sharepoint.com/:f:/r/sites/vhav23/PatSafety/VISN%2023%20COVID19/VISN%2023%20PPE%20Guidance?csf=1&web=1&e=CelCbI https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html https://dvagov.sharepoint.com/sites/min/SiteDirectory/Policies/_layouts/15/listform.aspx?PageType=4&ListId=%7B9770FCDD%2D3C4D%2D45E2%2DAFF3%2DA58DF92A6747%7D&ID=798&ContentTypeID=0x0100DF15D66627FE804D9B567D0CF96CAE3A https://dvagov.sharepoint.com/sites/min/SiteDirectory/Policies/_layouts/15/listform.aspx?PageType=4&ListId=%7B9770FCDD%2D3C4D%2D45E2%2DAFF3%2DA58DF92A6747%7D&ID=798&ContentTypeID=0x0100DF15D66627FE804D9B567D0CF96CAE3A https://dvagov.sharepoint.com/sites/min/SiteDirectory/Policies/_layouts/15/listform.aspx?PageType=4&ListId=%7B9770FCDD%2D3C4D%2D45E2%2DAFF3%2DA58DF92A6747%7D&ID=798&ContentTypeID=0x0100DF15D66627FE804D9B567D0CF96CAE3A https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html https://www.health.state.mn.us/diseases/coronavirus/hcp/maskssource.pdf

h. MN Dept of Health - Interim Guidance on Alternative Facemasks. 3/27/2020 https://www.health.state.mn.us/diseases/coronavirus/hcp/masksalt.pdf https://www.health.state.mn.us/diseases/coronavirus/hcp/masksalt.pdf