Author: Ethan Covey
As concern over shortages of personal protective equipment (PPE) at U.S. hospitals grows, the CDC has updated interim recommendations for health care professionals (HCPs) managing the COVID-19 outbreak.
The information highlights recommendations for HCPs working in health care facilities, as well as providing strategies to address shortages of key supplies.
Although U.S. organizations are actively pursuing strategies to increase production of PPE, relief will likely take a number of weeks.
“It’s incumbent upon all of us to save PPE because the manufacturing shortfall in China is not going to be fixed in the next month,” commented Stephen M. Parodi, MD, the executive vice president at Kaiser Permanente, in Oakland, Calif. Dr. Parodi noted that hospitals should be prepared for existing stock to last four to six weeks.
Face Masks and Respirators
Due to potential shortages of respirators, the CDC noted that “face masks are an acceptable alternative when the supply chain of respirators cannot meet the demand.” During this time, respirators should be prioritized only for procedures that are likely to generate respiratory aerosols, which would pose a high risk to HCPs.
Once supply chain issues are resolved, the agency recommended that facilities with a respiratory protection program should return to using respirators for patients with known or suspected COVID-19. Meanwhile, facilities without a current respiratory protection program should implement one.
Regarding face mask shortages, the CDC recommended that HCPs use masks beyond the manufacturer-designated shelf life. Additionally, face mask use should be prioritized for activities in which prolonged close contact with a potentially infectious patient is unavoidable, during care activities when splashes and sprays are anticipated, and for essential surgeries and procedures.
If supplies become completely exhausted, the CDC has approved the use of homemade masks (e.g., a bandana or scarf) as a last resort.
Other Types of PPE
Eye protection, gowns and gloves should be used by all HCPs attending to patients with confirmed or possible COVID-19 infection. If shortages occur, for instance with gowns, the recommendations state that they should be prioritized for aerosol-generating procedures, care activities when splashes and sprays are anticipated, and high-contact patient care activities in which there is a high risk for pathogen transfer to the clothing and/or hands of the HCP.
Dr. Parodi added that institutions should begin to reuse and extend the use of PPE, as well as attempt to reduce the amount of PPE use and associated burn rate, and reiterated that all elective surgery procedures should be cancelled. Using these approaches, Dr. Parodi said his institution has been able to extend five to 10 days’ worth of PPE supplies into a stock that should last a month.
While all patients with known or suspected COVID-19 infection should be cared for in single-person rooms with the door closed, if possible, airborne infection isolation rooms (AIIRs) should be reserved only for patients undergoing aerosol-generating procedures that stimulate coughing. Additionally, visitor access to, and movement within, health care institutions should be limited and all visitors should be assessed for fever prior to entering the facility.
However, Dr. Parodi observed that increases in the number of patients requiring treatment will make the use of single rooms impossible. To address this, he noted that hospitals can benefit from housing all patients suspected of COVID-19 in a particular ward, and combining patients who are known positives and who don’t have other contagious diseases that would pose a risk into a single room.
Cleaning and Infection Prevention
The CDC has noted that increased emphasis should be placed on the early identification and implementation of source control. This includes efficiently putting face masks on patients who present with symptoms of respiratory infection.
Hand hygiene and disinfection procedures remain highly important, as does consistent and correct implementation of environmental cleaning and disinfection procedures.
Andy Pekosz, PhD, a professor of molecular microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health, in Baltimore, commented that while it has become clear that the COVID-19 virus can live on surfaces for a few hours up to 24 hours, the virus is very sensitive to typical disinfectants.
“Anything that says ‘microcidal’ will kill this virus quickly,” he said.
Caitlin Rivers, PhD, a senior scholar at the Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, noted that there are additional steps HCPs can take to ensure proper sterilization in their facilities, such as providing alcohol-based sanitizer and masks in waiting rooms.
Generally, according to Thomas File Jr., MD, president of the Infectious Diseases Society of America, “we are all dealing with potential contingency plans” regarding how to manage the flow of potential COVID-19 patients.
“It is extremely important that all HCPs having interaction with patients are protected and safe,” said Dr. File, who is also a member of the Infectious Disease Special Edition editorial advisory board. “We have to have an effective workforce to take care of patients.”
The IDSA urged the president to invoke the Defense Production Act to ensure that health care personnel are protected. (His public statements as to whether he has or has not invoked the act are contradictory.)
“Infectious disease and HIV physicians, healthcare epidemiologists and other medical professionals on the frontlines defending our country from COVID-19 urgently need equipment and supplies to protect themselves, identify infections, treat patients, and save lives. In health settings across the country, we are confronting shortages of essential equipment—including viral culture swabs, gloves, masks, eye protection, gowns and ventilators—that we need now to diagnose and treat patients and to maintain a healthy and sufficient workforce in the face of this fast-moving and destructive virus,” the IDSA wrote the president.
The Defense Production Act was created to maintain the nation’s security by ensuring sufficient supply and distribution of critical resources during times of crisis.