Practice Management Alert

Taking inventory of PPE may be a state or local mandate.

Some aspects of infection control are old hat for people who are well-versed in science and healthcare, but are you following all of the best practices for reducing the chance of infection for the SARS-CoV-2 virus, which causes COVID-19? Infection control is crucial to keeping staff and patients safe; managing personal protective equipment (PPE) is one critical component of effective infection control.

The dearth of sufficient PPE has been in the news since the pandemic hit U.S. shores, as leaders of state and local governments, hospitals, nursing homes, and laypeople have scrambled to source supplies necessary for protecting themselves and others from COVID-19 infection. Many states have issued mandates requiring entities, including healthcare providers, to keep a running inventory of PPE supply and usage — and to report supply numbers to various agencies.

Prioritize Universal PPE Usage

Even though PPE is tough to come by, it’s one of the most effective tools for reducing the spread of COVID-19 and keeping staff and patients safe. While you should implement certain distancing protocols if or when possible, from utilizing telemedicine to nurse-triage, wanting or needing to conduct in-person patient visits is understandable. Make sure your practice is doing everything it can to keep everyone safe. Don’t forget to budget PPE needs for other workers under your direct management who may have incidental exposure, like janitorial or security staff, too.

Know What PPE You Really Need

Since COVID-19 is thought to be spread by aerosols, face masks and respirators are some of the main defenses against infection. But healthcare personnel (HCP), regardless of whether they’re caring for suspected or confirmed COVID-19 patients, need additional PPE.

The Centers for Disease Control and Prevention (CDC) cautions that cloth face masks are not PPE and should not be used by staff who need to interact with suspected or confirmed COVID-19 cases. Respirators, like the N95 style, should be used in such instances. Note that the CDC does not recommend respirators with an exhalation valve, because they allow unfiltered air to escape, potentially putting others at risk.

Although the general public is advised to wear cloth face masks, including patients, the CDC advises HCP to wear surgical masks and respirators, and to keep the respective face covering on for their entire shift, to cut down on the times they’ll need to touch their face. HCP should also wear the face covering throughout their shift, including in break rooms, to keep colleagues safe, too. However, when staff are leaving for the day, they should remove their work shift face covering, wash their hands, and put on their “civilian” cloth face mask.

Eye protection should be used too, including either goggles or face shields, especially if community transmission is considered moderate to substantial.

Although there has been some discrepancy between different health agencies’ views about which HCP need aprons or gowns, respectively, there is not sufficient research to suggest one style over another, say Briana Coles, University of Leicester; Chris Burton, University of Sheffield; Kamlesh Khunti, University of Leicester; Trisha Greenhalgh and Xin Hui Chan, University of Oxford; and Lawrence Ross, Children’s Hospital, Los Angeles; in a review conducted for the Centre for Evidence-Based Medicine at the University of Oxford.

However, the World Health Organization (WHO) recommends long-sleeved gowns for all HCP, regardless of whether they’re performing aerosol-generating procedures, and the CDC recommends HCP use both aprons and gowns during aerosol-generating procedures. With the shortage of PPE, many primary care and other nonhospital workers were advised to wear only aprons, but the possibility that aprons do not provide sufficient protection has made some HCP nervous, the review authors note.

Frequent and thorough hand hygiene is, of course, paramount, but note that the Food and Drug Administration (FDA) is continually adding more brands to their list of hand sanitizers to avoid. Find out more here: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use.

Reconfigure Public-Facing Areas, but Breakrooms, too

You already know that you need to temporarily redesign your waiting rooms so patients aren’t within 6 feet of each other when waiting for an appointment (or, better yet, establish a system to call people in from their vehicles or a designated outdoor waiting area), but make sure you’ve adjusted your backroom resting places as well. Keep reminding staff that patients aren’t the only potential sources for infection, and so they must maintain vigilant distancing precautions around one another as well.

Measures designed to keep HCP (and all workers, regardless of occupation) safe are mandated by various entities, from local ordinances to multiple federal agencies. Know that the Occupational Safety and Health Administration (OSHA) is accepting whistleblower complaints in situations where employees believe they have been retaliated against for reporting unsafe working conditions during the pandemic.