infection prevention
By Phenelle Segal RN, CIC, FAPIC
Navigating Ongoing COVID-19 Challenges:
A Perspective From the Front Lines of Infection Prevention
In
a pre-COVID 19 world, August is the height of summer
vacation for millions of Americans. People enjoy backyard
barbeques, swimming parties, fun at the beach, traveling and
organizing family reunions as the nation enjoys a much-needed
reprieve from cold temperatures and long work hours. The
summer of 2020 is very different as it continues to reveal a
tumultuous and unprecedented pandemic. COVID-19 continues
to follow the trajectory of an out-of-control respiratory-spread
virus that has the power to sicken and kill many Americans
within a short period of time. Besides the tragic toll on human
lives, COVID-19 continues to affect the economy and threatens
healthcare facilities and workers with no end in sight. The
ongoing challenges we face is evident including severe shortages
of personal protective equipment (PPE) and disinfectant products,
among many others.
Ongoing Challenges in Healthcare Facilities
Over the course of five months, infection preventionists
— after planning and preparing as best as possible — were
unaware of the impact this out-of-control, highly transmissible
respiratory virus could have on a systemwide basis. Prior
pandemics, including SARS, H1N1, MERS and Ebola, revealed
the need to stay on top of surge capacity plans in the event of
a “COVID-19 catastrophe. However, in line with other natural
disasters, we had no idea when it would strike, what type of
disease would attack and how much of an impact it would
have. We were always aware that our efforts to plan for the
“big one” may fall short of the needs as the unknown would
deliver its punches. Decades of developing, implementing
and educating on “best practices” have abruptly halted as
infection preventionists and healthcare educators scramble to
prioritize and use best judgment, while guiding facilities across
the continuum of care. The frustration in having to let go of
routine practices is daunting, but infection preventionists must
be flexible in an everchanging environment. This article will
address two ongoing critical challenges as we continue striving
in a nontraditional fashion for staff and patient safety.
Personal Protective Equipment (PPE) Shortage
Filtering face-piece respirators (FFRs), including but not limited
to N95 respirator masks, are critical items in the prevention of
COVID-19 spread and other aerosol transmissible diseases. They
remain in ongoing short supply throughout the nation. FFRs
protect the user by filtering particles out of the air that is being
breathed by the users. The National Institute for Occupational
Safety and Health (NIOSH) the federal agency responsible for
conducting research and making recommendations for
the prevention of work-related injury and illness has seven
classes of FFRs approved with a 95 percent minimum level of
filtration (95 percent). Masks that filter less than 95 percent
of particles are not guaranteed to be as
effective as those that filter 95 percent
or more. NIOSH works in conjunction
with the Occupational Health and Safety
(OSHA) agency that regulates respiratory
programs for healthcare workers.
N95 masks are the traditional FFR
used in hospitals for healthcare personnel
taking care of patients requiring airborne
isolation. The most common use has been
for patients with aerosol transmissible
diseases including pulmonary tuberculosis
(TB). They are manufactured and sold as
“single use only,” and until COVID-19,
there was no shortage of these items.
In response to the increased demand
for use as thousands of cases were occurring
in the hot zones in March and April,
the Food and Drug Administration (FDA)
released Emergency Use Authorizations
(EUAs) for companies that had developed
a “mask reprocessing” system to decontaminate
N95s for reuse. Only N95 masks
can be decontaminated but is dependent
on the manufacturer and products used.
Some N95 masks are not compatible
with reprocessing such as those made
•
Decades of
developing,
implementing,
and educating
on “best
practices” have
abruptly halted
as infection
preventionists
and healthcare
educators
scramble
to prioritize
and use best
judgment, while
guiding facilities
across the
continuum of
care.
with cellulose. In addition, the Centers for Disease Control and
Prevention (CDC) issued guidance for reuse and extended use of
single use FFRs. To date, facilities are reprocessing N95 masks via
authorized methods and strictly follow the manufacturer of the
mask as well as the decontamination equipment’s instructions
for use. These methods are primarily using hydrogen peroxide
in various forms, but with limited numbers of reprocessing
cycles (based on the type of equipment) before having to
discard them. Infection preventionists continue to work with
facilities that cannot reprocess masks and one of the CDC
recommendations for extending the “life of the mask” is to
place them in a brown paper bag or other breathable container
for at least 72 hours before wearing them again. Facilities
are providing a limited number of N95 masks to employees
at most risk. That includes healthcare workers caring directly
for COVID-19 positive and those providing aerosol generating
procedures (AGPs) such as anesthesiology personnel. Staff are
wearing surgical masks over their N95 masks to prevent them
from becoming decontaminated. Face shields are thought to
provide some protection from becoming contaminated too.
Reuse and disinfection techniques are neither simple, nor ideal,
but at this juncture, the choices are limited. It is important to note
10 august 2020 • www.healthcarehygienemagazine.com