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EMERGENCY PPE CONSERVATION. GLOBAL SHORTAGE
One mask/One N95 per shift in patient care areas
Change only if wet or contaminated
N95 for aerosol generating procedures including Testing (some of the biggest coughing episodes happen when you do an MT swab)
Re-Use & Clean:
Gowns: Use washable fluid resistant Level 2
Face shields: find a way to clean them if possible.Check with Infection prevention and Control for Ideas. Face shields are superior to goggles or glasses as they cover the mask, and your face. Add a disposable bouffant and you have pretty good head coverage.
Glasses: Soak and wash with soap and water. Be careful about using any strong corrosive cleaning solutions-they will etch the surface and render them useless.TRY not to combine face shields with goggles/added glasses as they will fog, it is hot and you will touch to adjust…plus it consumes PPE.
Work Quarantine: Start this now. As long as someone is asymptomatic , they should be able to work with a mask on. 2 weeks home quarantine will deplete your staff when things really start.
Self Screening BID
Screen Positive , self isolate and call occupational health.Screen Neg=Work quarantine.
5 Hot Beds of PPE activity:
Manufacturers retooling to make PPE: e.g. Bauer Hockey Equipment to make Face shields for Health Care Providers:https://globalnews.ca/news/6734828/coronavirus-bauer-face-shields/
Possible ways to Re-Use N95s:
There is data out of Stanford that putting an N95 in a conventional oven at 70C (158F) for 30 minutes should be effective in killing SARS CoV2 and does not degrade the mask itself. There is a nice summary here: https://www.dropbox.com/s/dyiy0z1cb15xgk1/mask-ppe-EBM-v1.1-3-22-20.pdf.pdf?dl=0
ASK your IPAC to look at this and see what they say.
Using Industrial Protective Equipment:
Respirators are gone from the shelves, but cleanable and re-useable face shields may be available at the big box hardware type stores. the face shield is turning out to be an excellent line of defence, protecting the “Critical Areas” : Portals of entry eyes, mask and your face in general which you tend to touch and transfer.
DIY Masks: It’s all over the place. Thankfully we aren’t there and maybe won’t get there if production can be ramped up fast enough.
Here a Cambridge University look at what materials filter viruses.
I spoke to a military PPE expert (off the record) who suggested quilted materials may be best as they are breathable and the mesh of fibres, is better than one layer.Maybe the scientists out there will come up with something soon.
Extended use of N95s.
I left his last because it is a lengthy read from CDC. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
Next week maybe we can find some simple tips for this.
Post 2003 SARS the world began to wonder if a 1918 level pandemic would be possible and if so what would modern medicine be able to do? In 2006 , a group of Canadian Critical Care specialists wrote and article: “Development of a triage protocol for critical care during an influenza pandemic” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635763/ . In 2019, it was looked at again in the “Progress Study” https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2316-x.
Do you think you can use the SOFA Score to decide you who benefit most, and survive as a result