Early Infection Control Assessment and Response Visits:
Lessons Learned
Topic 2: PPE Use and Optimization
In early April 2020, the DPH Healthcare-Associated Infections (HAI) Prevention Program began performing telephone-based, COVID-19-focused infection control assessment and response visits (ICARs) with long-term care facilities (LTCF) around the state.
ICARs are educational discussions that cover a range of infection prevention and control topics that can impact the spread of COVID-19 within a facility. ICARs provide opportunities for questions and discussion, a review of policies and practices, and "just in time" education.
The HAI program and its partners in this effort, including the Superior Health Quality Alliance and local health departments, have conducted more than 165 ICARs to date.
This "Early ICAR Lessons Learned" series of messages will highlight common recommendations and clarifications our team of infection preventionists are making during these calls, as they promote best practices and alignment with CDC and DHS guidance.
PPE Use and Optimization
LTCFs frequently seek clarification on a variety of issues surrounding PPE use and optimization. Here are a few reminders and recommendations based on those discussions:
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LTCFs should operate under conventional PPE capacity as often as possible, using contingency and crisis strategies only as needed until conventional status can be restored. PPE is used to prevent exposures, which prevent infections, which in turn prevent outbreaks. Facilities should understand their supply chain, assess their PPE utilization, optimize supplies before they have shortages, and reach out to their local health department or county emergency manager to determine whether local supplies are available. Facilities can use the CDC PPE burn rate calculator to help manage supplies. Facilities should try to have enough PPE on hand for at least a few weeks’ typical utilization, while still providing appropriate PPE to staff in the present time (i.e., don’t stockpile PPE in anticipation of a future outbreak while not wearing recommended PPE now).
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Provide clean PPE to external resident care staff (e.g., hospice, lab, providers) entering the building whenever possible. This helps prevent the use of potentially contaminated PPE within the facility. Alternatively, outside providers could bring in new PPE (e.g., N95s) and store it at the facility in a paper bag labeled with their name.
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Educate and audit staff PPE donning and doffing practices. These practices should be assessed to ensure all staff can safely don and doff necessary PPE for their role, and avoid self-contamination. These practices should also be revisited whenever different PPE is purchased, to ensure the current ensemble is understood. Facilities may want to consider “PPE buddies” who can check each other for proper doffing technique, particularly in outbreak situations.
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Cloth masks are not PPE and should not be worn by health care personnel (HCP) providing resident care. Cloth masks are for universal source control for residents and should be worn by residents whenever residents leave their rooms. HCP should wear surgical/procedure masks or respirators, as well as other recommended PPE depending on the type of work they do and the conditions within the building at the start of their shift. HCP should be wearing cloth masks on the way to and from work, as part of their community-level source control efforts.
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Staff should be in full PPE when caring for residents on 14-day quarantine. CDC advises a 14-day quarantine of all new skilled nursing facility (SNF) admissions and readmissions, to observe those potentially exposed to COVID-19 for signs and symptoms of infection. Current evidence suggests the incubation period for COVID-19 can be up to 14 days. During this time, all staff entering a quarantine room should be in full PPE, which includes a gown, gloves, eye protection (goggles or face shield), and a respirator or procedure mask if a respirator is unavailable. The same gown should not be worn by staff for different residents in quarantine to prevent possible exposure to others under observation for COVID-19. As discussed in Topic 1 of this series, residents leaving the facility for non-COVID medical appointments (e.g., clinic visit, dialysis) do not need to be quarantined upon return to the facility.
Note that the recommendations highlighted here do not replace the value of a facility having its own ICAR, or the need to stay current on CDC and DHS guidelines. ICARs are non-regulatory and complement infection control surveys, with a focus on education and infection prevention.
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