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PPE Summary and Rationale for Change 03-13-2020V3

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PPE Summary and Rationale for Change 03-13-2020V3 The safety of all members of our healthcare team is a top priority for UCSF Health as we manage the rapidly evolving situation around COVID-19. As we gain experience and learn more about this infection, we recognize that using airborne isolation in all clinical situations is not necessary. As a result, UCSF Health is now recommending droplet (including eye protection) plus contact isolation for most ambulatory, acute care, and ED patients with known or suspected COVID-19 disease. Patients who may have or are known to have COVID-19 who requiring continuous aerosol generating interventions like mechanical ventilation, non-invasive ventilation, or use of high-flow nasal cannula will continue to cared for in airborne plus contact isolation with eye protection (Novel Respiratory Isolation). This change is in line with the World Health Organization (WHO) use of personal protective equipment for coronavirus disease 2019 (COVID-19) recommendations, recently revised CDC guidance, and in keeping with the revised practices across all of the UC medical centers and in most other academic centers throughout the U.S. Based on available evidence and expert opinion, the COVID-19 virus, similar to other coronaviruses and influenza, is primarily transmitted through close contact and large droplets. This change will enable us to optimize protection of our healthcare staff and patients by being able to appropriately isolate and test the large number of patients who we care for with symptoms that could be consistent with COVID-19 while also ensuring that healthcare staff are able to use personal protective equipment (PPE) that will keep them safe. The CDC currently recommends contact plus airborne isolation with eye protection for patients receiving therapies that are potentially aerosol-generating, and we will continue to support this approach. With expanded laboratory testing capabilities, we will also make testing available to a broader group of patients with fever or respiratory symptoms. Why are we changing to contact + droplet isolation? • Droplet + contact isolation (Respiratory Illness sign) is clinically appropriate for care of patients who are not requiring continuous aerosol generating interventions and is consistent with guidelines from WHO and other countries. • Similar practices are being adopted across all of the UC health centers. • Ensures that we are able to maintain appropriate PPE for the highest risk patients • Simplifies PPE use in most settings. The current process is more complicated and may lead to increased risk while removing PPE. • Streamlines care for these patients • Allows all sites to get patients into precautions more consistently What about patients who test positive? Patients who are not requiring continuous aerosol generating interventions will remain in droplet + contact isolation (Respiratory Illness sign). This approach will facilitate testing among patients entering our system while keeping our workforce safe and ensuring the most rational use of PPE for the highest risk scenarios. Which patients should remain in airborne isolation (i.e., on Novel Respiratory Isolation)? • Patients with suspected or confirmed COVID-19 requiring mechanical ventilation, high-flow nasal cannula, non-invasive ventilation, or tracheostomy • When administering discrete aerosol-generating procedures, such as nebulizers, for patients on Respiratory Illness isolation, all staff in the room should wear an N95 respirator with eye protection or PAPR in addition to a gown and gloves during and for one hour following the procedure. Preferentially using metered dose inhalers (MDIs) instead of nebulizers for any person being tested for or diagnosed with COVID-19 is strongly recommended since administration of MDIs is not aerosol-generating. What precautions are required for specimen collection? • Nasopharyngeal swabs often generate a strong cough reflex. Personnel obtaining an NP swab should wear an N95 respirator, eye protection, a gown and gloves. • The room where a nasopharyngeal swab is obtained does NOT need to remain empty for one hour after specimen collection. Where can I find the most recent version of our screening and testing protocols? • Up to date information can be found here https://infectioncontrol.ucsfmedicalcenter.org/coronavirus Thank you for everything you do for the safety of our patients, yourselves, your families and your communities. .
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