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Learn MoreHail to the Americans who are at the front lines fighting SARS-CoV-2! The healthcare providers and public servants continue to do their work despite the threats that come their way.
Following the guidelines for infection control is a little more challenging though, in light of this pandemic. Because the infection is world-wide, it has affected the supply chain of necessary personal protective equipment (PPE). The demand has exceeded the supply.
What may have been habit, simply donning and doffing PPE for both standard and transmission-based precautions, now requires more thought and some commonsense application. Healthcare workers must be conservative while protecting themselves and preventing transmission. Fortunately, the Centers for Disease Control and Prevention (CDC), provides some commonsense guidance. This is especially important regarding the use of respirators.
N95 respirators are the PPE most often used to control exposures to infections transmitted via the airborne route. N99, N100, P95, P99, P100, R95, R99, and R100 are at least as protective as the N95. Viral loads in the upper respiratory tract of patients infected with the SARS COV-2 are high, so patients are likely to secrete aerosolized particles, those less than 5 micrometers and droplets, particles larger than 5 micrometers.
During the short supply of respirators, infection control specialists and leaders at individual facilities should consider a combination of measures to protect their employees and prevent infection transmission. For instance, engineering controls function without a healthcare provider having to take action. Airborne infection isolation rooms (AIIR) should be constructed and maintained so that air from these rooms is exhausted to the outside or is first filtered with a HEPA filter and before recirculation. Aerosol-generating procedures should be performed in an AIIR.
Other measures include the use of physical barriers in intake, triage, triage and at information booths.
Administrative controls include limiting face-to-face encounters with patients and qualitative fit-testing of N95 respirators.
Under guidance from the CDC, one of the first strategies is to use respirators that are beyond the manufacturer-designated shelf-life for patients with COVID-19, measles, tuberculosis, and varicella. Be mindful that straps and nose bridges may degrade, affecting the quality of the fit and seal, so an inspection and seal-check is always necessary. If the integrity is compromised, users should discard it and try another.
The National Institute for Occupational Safety and Health (NIOSH), is in the process of studying stockpiled N95s and have determined that many brands and models will provide their expected level of protection even though they exceed the beyond use date. If these products have been stored according to the manufacturers’ recommendations, the following models may be protective:
These respirators should only be used as outlined in the Strategies for Optimizing the Supply of N95 Respirators. In other words, they should not be used if NIOSH approved, in date respirators are available.
A second strategy is to use respirators which are approved under standards used in other countries. They are expected to be suitable alternatives to NIOSH approved respirators when supplies are short. A list of these are located on the CDC website: Respirators approved under NIOSH similar standards. “They should not be used during aerosol-generating medical procedures unless the alternative is a loose-fitting surgical mask or improvised device. On April 3, 2020, FDA issued an update to the Non-NIOSH Approved Respirator Emergency Use Authorization (EUA) concerning non-NIOSH-approved respirators that have been approved in other countries.” (CDC, 2020) This memo informs staff and manufacturers of requirements if this strategy is necessary.
Thirdly, respirators may have to be re-used. This practice carries the risk of contact transmission when touching or removing the respirator between uses and should be limited. NIOSH recommends using a cleanable face shield or disposable face mask over the respirator to prevent its contamination. They can be stored in a paper bag between uses. Ensure protection against damage and disfigurement during storage. Wear a pair of clean non-sterile gloves when re-applying the respirator. If the manufacturer provides information on the maximum number of donnings and doffings, then follow those instruction. Otherwise, don’t use an N95 more than five times.
Extended use is another option, but the wearer must make sure that the respirator maintains a good fit and seal during use. When practicing extended use of N95 respirators, they should not be used beyond 8-12 hours or for multiple shifts. They should not be re-used after extended use. Always remove and discard them before activities such as meals and restroom breaks.
The CDC informs us that N95 respirators beyond their manufacture-designated shelf life, when available, are preferable to use of facemasks.
Applying a combination of controls can provide an additional degree of protection, even if one intervention fails or is not available.
For instance, controlling the source by masking a symptomatic patient and keeping a distance of six feet is recommended when N95s are in short supply. Keeping a distance of six feet or more is just good sense. Viral loads in the upper respiratory tract of patients infected with the SARS COV-2 virus are high so patients are likely to secrete aerosolized particles, those less than 5 micrometers and droplets, particles larger than 5 micrometers.
If care requires that a healthcare worker be closer to the patient, that is, between three and six feet, then both the patient and the healthcare worker should wear a facemask. This is the case for distances closer than three feet too. However, if a healthcare worker needs to be very close, within three feet of the patient, and a symptomatic patient cannot wear a face mask, then the health care worker must don an N95, elastomeric or powered air purifying respirators (PAPRs), based on what is available.
During aerosol generating procedures, performed on symptomatic patients, the available respirator must be worn, whether or not the patient is masked. It should always be discarded after use.
Since certain individuals are at higher risk of severe illness from COVID-19, these workers should be excluded from working with COVID-19 patients. This includes those HCP who are:
Those who are recovered from COVID-19 may have developed some immunity to the virus. These healthcare providers are preferred to provide care to COVID-19 patients.
Create an expedient patient isolation room by using portable fan devices with high-efficiency particulate air (HEPA) filtration. In this environment, face masks can be used.
Use a ventilated headboard that draws exhaled air from a patient into a HEPA filter. Using this along with HCP and patient masking may decrease exposure.
As a last resort, masks that have not ever been approved by NIOSH or homemade masks may afford some protection. Use caution when considering this option.
It is still uncertain how individuals who do not have symptoms can spread the virus throughout the course of their day. So, researchers have been curious about just how long SARS-CoV-2 remains on surfaces.
According to a new study by Neeltje van Doremalen, PhD, of the Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, in Hamilton, Montana, and colleagues, SARS-CoV-2 remains viable in aerosols for hours and on surfaces for days.
They looked at plastic, air, stainless steel, paper and copper and this is what they discovered:
Surface type |
Survival Time |
Plastic |
2-3 days |
Stainless Steel |
2-3 days |
Air |
>3 hours |
Copper |
4 hours |
Cardboard |
24 hours |
Knowing how long the SARS-CoV-2 remains on surfaces helps us understand that contact transmission is possible and probable.
Learn more by reading similar blogs:
What Healthcare Officials Need to Know About the Coronavirus COVID-19 (Part 1)
What Healthcare Professionals Need to Know About the Coronavirus COVID-19 (Part 2)
What Healthcare Professionals Need to Know About the Coronavirus COVID-19 (Part 3)
Preventing Viruses: Strategies of Containment, Protection, & Prevention
Benefits & Challenges of Working Remotely in Times of Crisis
PLEASE NOTE: The information in this blog post was considered current at the time of its publishing, 03/24/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
View All Products