Advice please - PPE's for a patient who is a contact of Covid 19

[haveyourbowelsmoved]

HI ALL,

I am badly looking for advice. I am a nurse in a medical ward. we received a patient who had been screened for COVID 19 in the Hospital they were coming from. We received patient. So patient was a/w test results for COVID 19, we were told as nurses we only needed white plastic apron , gloves and surgical mask to receive this patient. we disagreed and demanded we get the full protective gear. Ambulance crew transferring patient to us were wearing the same. Now patient tested neg for swab.

So for next day all staff were using no precautions. Now we have discovered that she is a contact of a pt who has a confirmed covid 19 case. We are being told monitor her and again being told it is OK to wear a white plastic apron, surgical mask and gloves. Can somebody please please guide me on same. I am trying to find accurate guidelines for exactly what we should be wearing in all types of scenarios. Does anyone know?

[Susie2310]

On the CDC web site, for Coronavirus (COVID-19) there is "Information for Healthcare Professionals" which gives information on Infection Control, PPE, etc.

[Keli Jones, BSN]

CDC has approved droplet and contact precautions so gown, gloves, mask, and eye protection unless the patient is intubated, on bipap or HFNC (which should be avoided and simply intubated), or is having an aresolizing procedure such as a bronch, intubation, or even Neb treatments (which are worthless for these patients and not with the risk) where N95 or PAPRs are required. Granted this conveniently came out after concerns of supply shortages so I have reasonable concerns. Our facility is following CDC guidelines but as an ICU RN I have been fitted for and assigned my own PAPR hood.

[Sadala, ADN, RN]

12 minutes ago, Keli Jones said:

CDC has approved droplet and contact precautions so gown, gloves, mask, and eye protection unless the patient is intubated, on bipap or HFNC (which should be avoided and simply intubated), or is having an aresolizing procedure such as a bronch, intubation, or even Neb treatments (which are worthless for these patients and not with the risk) where N95 or PAPRs are required. Granted this conveniently came out after concerns of supply shortages so I have reasonable concerns. Our facility is following CDC guidelines but as an ICU RN I have been fitted for and assigned my own PAPR hood.

I'm guessing they've approved that grudgingly since we're short on N95s. Not really on what we SHOULD be wearing to protect ourselves, our patients, and our families. I base this on the fact that we were first told that N95s were essential. But hey, we only recently started testing here so we've probably already been exposed to a lot.

[MunoRN, RN]

10 minutes ago, Keli Jones said:

CDC has approved droplet and contact precautions so gown, gloves, mask, and eye protection unless the patient is intubated, on bipap or HFNC (which should be avoided and simply intubated), or is having an aresolizing procedure such as a bronch, intubation, or even Neb treatments (which are worthless for these patients and not with the risk) where N95 or PAPRs are required. Granted this conveniently came out after concerns of supply shortages so I have reasonable concerns. Our facility is following CDC guidelines but as an ICU RN I have been fitted for and assigned my own PAPR hood.

You're wearing N95s for patients who are already intubated, but not for non-intubated patients with a cough?

[Sadala, ADN, RN]

Truly, our preparedness for this has been the worst roll out since Windows 95.

[Keli Jones, BSN]

7 minutes ago, Sadala said:

I'm guessing they've approved that grudgingly since we're short on N95s. Not really on what we SHOULD be wearing to protect ourselves, our patients, and our families. I base this on the fact that we were first told that N95s were essential. But hey, we only recently started testing here so we've probably already been exposed to a lot.

There's lots of research and findings coming in daily that offer new insights so a change in PPE in and of itself could make sense but it'sthe timing with supply shortages that adds to the suspicion. You'd have to read them yourself and make your own judgements on that one but I encourage following EddyJoeMD on Instagram. He's had a lot of great up and coming evidence based articles and crisis preparation ideas that I've found very helpful.

[Keli Jones, BSN]

9 minutes ago, MunoRN said:

You're wearing N95s for patients who are already intubated, but not for non-intubated patients with a cough?

That is correct. New evidence is showing a lower likelihood that the virus is airborne except during aerosol producing procedures as listed above. Several of the MDs that contracted the virus likely did so during bronchoscopies which as a result are now contraindicated. Lower likelihood doesn't mean no chance so here in lies the gray area.

For transport, the patient wears a mask in the hallways just like a TB pt but no other PPE is required while the patient is masked. Their mode of transmission (droplets) is stopped by their mask but obviously it is imperative that the patient wears said mask when others are not protected with PPE.

[Keli Jones, BSN]

13 minutes ago, Sadala said:

Truly, our preparedness for this has been the worst roll out since Windows 95.

LOL probably the most accurate comment on the internet!

[MunoRN, RN]

11 minutes ago, Keli Jones said:

That is correct. New evidence is showing a lower likelihood that the virus is airborne except during aerosol producing procedures as listed above. Several of the MDs that contracted the virus likely did so during bronchoscopies which as a result are now contraindicated. Lower likelihood doesn't mean no chance so here in lies the gray area.

For transport, the patient wears a mask in the hallways just like a TB pt but no other PPE is required while the patient is masked. Their mode of transmission (droplets) is stopped by their mask but obviously it is imperative that the patient wears said mask when others are not protected with PPE.

A coughing COVID positive patient causes far more aerosol exposure to staff than any of the procedures designated as aerosol generating. An aerosol generating procedure refers to a procedure that is more likely to produce aerosolized droplets than just regular breathing. But there's never been any reason to believe these procedures are more aerosol generating than a coughing patient, particularly a patient who is already tubed. If you've got enough N95s for staff caring for vented patients to wear as well as non-intubated but coughing patients (I've yet to see a COVID patient that doesn't cough at least a fair amount) then the priority would be for the non-vented patients.

There's never actually been any evidence that COVID has airborne transmission, components of airborne precautions have been recommended because the procedure / surgical masks commonly used for droplet precautions offer less protection against droplet transmission than N95s or PAPRS since those masks are intended to catch exhaled droplets, not inhaled droplets.

[Keli Jones, BSN]

1 minute ago, MunoRN said:

A coughing COVID positive patient causes far more aerosol exposure to staff than any of the procedures designated as aerosol generating. An aerosol generating procedure refers to a procedure that is more likely to produce aerosolized droplets than just regular breathing. But there's never been any reason to believe these procedures are more aerosol generating than a coughing patient, particularly a patient who is already tubed. If you've got enough N95s for staff caring for vented patients to wear as well as non-intubated but coughing patients (I've yet to see a COVID patient that doesn't cough at least a fair amount) then the priority would be for the non-vented patients.

There's never actually been any evidence that COVID has airborne transmission, components of airborne precautions have been recommended because the procedure / surgical masks commonly used for droplet precautions offer less protection against droplet transmission than N95s or PAPRS since those masks are intended to catch exhaled droplets, not inhaled droplets.

I'm not disagreeing with this one bit. Just regurgitating what they're telling us to support less PPE. That's why it's such a debated topic and a HUGE source of distrust from all of us!

I wear a reusable PAPR because I have that luxury. I won't be downgrading my PPE based on this marginal research.

[MunoRN, RN]

10 minutes ago, Keli Jones said:

I'm not disagreeing with this one bit. Just regurgitating what they're telling us to support less PPE. That's why it's such a debated topic and a HUGE source of distrust from all of us!

I wear a reusable PAPR because I have that luxury. I won't be downgrading my PPE based on this marginal research.

I should clarify that I'm not suggesting you downgrade your protection if you have the option not to, but if having a higher level of respiratory protection available to care for intubated patients means that it's not available for non-intubated patients, then the clear priority would be to make it available for those caring for positive and coughing patients.