While it is critical that every nursing home and assisted living facility community receive the necessary PPE to fight off this virus and other co-infections, I realize that too often this is just not the reality of the situation. We have gone from using PPE in a conventional capacity, to contingency capacities, and now at crisis capacity usage. According to the U.S. PIRG (Public Interest Research Group), Forty-six percent of all nursing homes nationwide reported they didn’t have a one-week supply of at least one type of PPE at some point from May through August. Facing these facts, we turn to the scary idea of re-using PPE. There is good news: When done properly, the re-use of PPE can be done safely enough to sufficiently mitigate the spread of the virus and other infections. The bad news? It can get very confusing, so here are some key points on the safe re-use of PPE.
It is always important to know and follow your county and state regulations regarding the re-use of PPE. A resident admitted to a facility in one county may require contact and droplet precautions, while not required in a different county. Make sure to follow protocols correctly.
More confusion lies around what PPE should be worn on the COVID units or the quarantine units, where the resident’s status is unknown. For contact and droplet precautions, make sure the staff wear gown, gloves, mask, and eye protection (Goggles or face shield. Both is not needed, but some form of eye protection is critical). When it comes to masks, follow your policy that should line up with current CDC guidelines. N95 masks are more than adequate, but OSHA requires proper fit-testing for their effectiveness to be utilized.
As you know, the quarantine wards, sometimes referred to as step-down wards or warm units, is where our residents of unknown COVID-19 status reside. Here, gowns must be doffed between every resident room. If you are reusing gowns, you can hang hooks inside each room, labeled “Nurse #1” and “CNA #1”. Those gowns are for that specific person in that room only. Do not re-use the same gown from resident to resident, not only does this increase the risk for cross-contamination, it can also be cited as an Immediate Jeopardy.
When working in the actual COVID positive ward, PPE can be optimized by reusing the same gown unless it is visibly dirty. (This re-use can only occur if the resident does not have a co-infection such as C. Diff that requires specific contact precautions.)
When it comes to N-95 in short supply, consider rotating the mask back into use after several days. For example, five masks, five paper bags. After the mask is used on Monday, it goes into a bag that gets date-labeled, then you can wait and use that mask again after five days.
I understand that we all have shortages and low supplies right now. If you are not already using it, the CDC has a Burn Rate Calculator that helps plan use and optimize supply. While re-use isn’t ideal, I hope these tips helped your facility. Thank you to all our healthcare worker superheroes out there, be safe and be well.