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Agenda

• Hospital Based HCP Protection Task Force• Selecting Minimum Levels of Protection• Expanding Minimal PPE• Upgrading to Airborne Contaminant Protection• Ensuring Adequate Supply of Personal Protective

Equipment• Healthcare Personnel PPE Training• Disposal of PPE• Healthcare Personnel Decontamination• Cleaning Powered Air Purifying Respirator Assemblies

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HCP Protection Task Force Responsibilities:

• Inventory available PPE• Inspect available PPE• Maintains PPE• Address Supply Chain Issues• Train HCPs on PPE Use• Restock PPE for HCPs• Decontaminate Reusable PPE• Discard Contaminated PPE• Provide Assistance to HCPs when

donning/doffing

Task Force Members:

• Hospital Emergency Manager• Infection Control• Materials Management• Environmental Services

(housekeeping)• Facility/Engineering Personnel• Decontamination Team• Industrial Hygiene• Volunteers

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Selecting Minimum Levels of PPE

Standard, Contact, Droplet Precaution PPE

Gloves Gown (fluid resistant

or impermeable) Eye Protection Facemask

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Expanded Minimal PPE

Additional PPE might be required in certain situations…

Copious amounts of bloodOther bodily fluids

• Double gloving• Disposable shoe covers• Leg coverings

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Upgrading PPE-Airborne ContaminantN95 Respirator

NIOSH N95 Filtering Facepiece Respirator

• Filters out include dusts, fumes, mists an microbial agents such as tuberculosis bacteria & flu virus.

• N95 respirators do not protect you from: chemical vapors, gases, oxygen deficient atmosphere

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Powered Air Purifying Respirator (PAPR)

• Recommended for Aerosol Generating Procedures

• High level of Assigned Protection Factor (APF)

• Reduces heart, lung & heat stress

• Loose fitting facepieces do not require fit testing

• Improved communication

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PAPR- Challenges

• PAPRs must be routinely be inspected and deemed serviceable

• Requires additional training • Reusable components to the

PAPR should be decontaminated not discarded

• Use of PAPRs during high demand periods may create supply shortages for new orders

Texas Presbyterian PPE Burn Rate

• The hospital assigned (1) Charge Nurse and (4) Attending Nurses per shift

• Due to the condition of the patient + preference and comfort of staff members, THR-P decided to upgrade the level of PPE from the recommended CDC standard, contact and droplet precautions to a Level C posture which includes protection against airborne aerosolized contaminants.

• The staff burned through 48 sets of PPE per day, averaging (5) sets of PPE per person, per shift.

• How long can your hospital sustain supply of this amount of PPE?

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Decision Points for Upgrading Level of PPE

• Does your hospital have on hand or can easily acquire a higher level of PPE that could be sustainable throughout the treatment of an Ebola case?

• Does your hospital’s front line clinical and support staff trained on higher levels of PPE?

• Does your hospital have a system in place to continuously restock, recover and reposition higher levels of PPE?

• Does your hospital have a designated area to clean reusable PPE components?

• Does your hospital have staff trained on how to safely recover, transport and decontaminate PPE components in designated areas?

Ensuring Adequate Supply of PPE

If your PPE Storage Area looks like this…

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Ensuring Adequate Supply of PPE

• Now is the time to inventory facility PPE cache• Now is the time to inspect PPE for serviceability• Now is the time to organize PPE into a deployable system• Now is the time to reach out to distributors to inquire

about current & forecasted availability of PPE• Now is the time to engage state, county and healthcare

coalition partners to identify sources of PPE• Now is the time to institute PPE use monitoring to

ensure supplies are not unnecessarily consumed and improperly stored

Ensuring Adequate Supply of PPE

• Awardees should survey healthcare coalitions to determine type, amount and availability of PPE in caches stored for use at member facilities.

• Healthcare Coalitions should survey member facilities to determine anticipated PPE needs

• Partner with manufacturers and distributors of personal protective equipment to determine what actions can be taken to secure adequate availability of PPE in the supply chain

• Discuss and determine “rationing” models if there is a supply chain disruption and PPE placement needs to be carefully restricted

HCP PPE Training

• Utilize online documents and videos to provide quick just-in-time training

• Re-engage contractors to provide PPE training• Train all types of HCP including those in support roles• Consider designating a 24/7 PPE Donning/Doffing

self-paced PPE training area at your facility• Train internal PPE SME’s available 24/7 at your facility• Work with healthcare coalitions and Awardees to

identify training opportunities

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Online PPE TrainingUniversity of Nebraska Medical Center

Donning Biological PPE Ebolahttp://app1.unmc.edu/nursing/heroes/pdf/vhfppe/donningBiologicalPPE-EbolaPatients-8.5x11-CC-v1.02.pdfDoffing Biological PPE Ebolahttp://app1.unmc.edu/nursing/heroes/pdf/vhfppe/doffingBiologicalPPE-EbolaPatients-8.5x11-CC-v1.01.pdfBiological Level C PPE Donning Video (Put On)https://www.youtube.com/watch?v=T5knZceQ1xABiological Level C PPE Doffing Video (Take Off)https://www.youtube.com/watch?v=ls69Tib1PjU

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Disposal of PPE

• Dispose of PPE as clinical waste

• Double bag• Reusable PPE components

should be sealed in a container to be decontaminated in designated area

• Create and monitor a waste collection log from source to offsite waste removal

Healthcare Personnel Decontamination

• After Doffing and discarding PPE remove scrubs/undergarments

• Place undergarments in plastic bag

• Double bag all clothing and label accordingly

• Proceed to shower• Redress in normal work attire• Report for medical

surveillance

Cleaning Powered Air Purifying Respirator Assemblies

• Clean according to manufacturers recommendations

• Follow hygiene/infection control practices established in hospital policy

• Use mild hospital detergents• Do not steam sterilize

components• Use inspection logs to

annotate cleaning cycles