Agenda Hospital Based HCP Protection Task Force Selecting Minimum Levels of Protection Expanding Minimal PPE Upgrading to Airborne Contaminant Protection Ensuring Adequate Supply of Personal Protective Equipment Healthcare Personnel PPE Training Disposal of PPE Healthcare Personnel Decontamination Cleaning Powered Air Purifying Respirator Assemblies 1

HCP Protection Task Force Responsibilities: Inventory available PPE Inspect available PPE Maintains PPE Address Supply Chain Issues Train HCPs on PPE Use Restock PPE for HCPs Decontaminate Reusable PPE Discard Contaminated PPE Provide Assistance to HCPs when donning/doffing Task Force Members: Hospital Emergency Manager Infection Control Materials Management Environmental Services (housekeeping) Facility/Engineering Personnel Decontamination Team Industrial Hygiene Volunteers 2

Selecting Minimum Levels of PPE 3 Standard, Contact, Droplet Precaution PPE  Gloves  Gown (fluid resistant or impermeable)  Eye Protection  Facemask

Expanded Minimal PPE Additional PPE might be required in certain situations…  Copious amounts of blood  Other bodily fluids Double gloving Disposable shoe covers Leg coverings 4

Upgrading PPE-Airborne Contaminant N95 Respirator NIOSH N95 Filtering Facepiece Respirator Filters out include dusts, fumes, mists an microbial agents such as tuberculosis bacteria & flu virus. N95 respirators do not protect you from: chemical vapors, gases, oxygen deficient atmosphere 5

Powered Air Purifying Respirator (PAPR) Recommended for Aerosol Generating Procedures High level of Assigned Protection Factor (APF) Reduces heart, lung & heat stress Loose fitting facepieces do not require fit testing Improved communication 6

PAPR- Challenges PAPRs must be routinely be inspected and deemed serviceable Requires additional training Reusable components to the PAPR should be decontaminated not discarded Use of PAPRs during high demand periods may create supply shortages for new orders 7

Texas Presbyterian PPE Burn Rate The hospital assigned (1) Charge Nurse and (4) Attending Nurses per shift Due to the condition of the patient + preference and comfort of staff members, THR-P decided to upgrade the level of PPE from the recommended CDC standard, contact and droplet precautions to a Level C posture which includes protection against airborne aerosolized contaminants.CDC standard, contact and droplet precautionsLevel C posture The staff burned through 48 sets of PPE per day, averaging (5) sets of PPE per person, per shift. How long can your hospital sustain supply of this amount of PPE?

Decision Points for Upgrading Level of PPE 9 Does your hospital have on hand or can easily acquire a higher level of PPE that could be sustainable throughout the treatment of an Ebola case? Does your hospital’s front line clinical and support staff trained on higher levels of PPE? Does your hospital have a system in place to continuously restock, recover and reposition higher levels of PPE? Does your hospital have a designated area to clean reusable PPE components? Does your hospital have staff trained on how to safely recover, transport and decontaminate PPE components in designated areas?

Ensuring Adequate Supply of PPE If your PPE Storage Area looks like this…

Ensuring Adequate Supply of PPE Now is the time to inventory facility PPE cache Now is the time to inspect PPE for serviceability Now is the time to organize PPE into a deployable system Now is the time to reach out to distributors to inquire about current & forecasted availability of PPE Now is the time to engage state, county and healthcare coalition partners to identify sources of PPE Now is the time to institute PPE use monitoring to ensure supplies are not unnecessarily consumed and improperly stored 11

Ensuring Adequate Supply of PPE Awardees should survey healthcare coalitions to determine type, amount and availability of PPE in caches stored for use at member facilities. Healthcare Coalitions should survey member facilities to determine anticipated PPE needs Partner with manufacturers and distributors of personal protective equipment to determine what actions can be taken to secure adequate availability of PPE in the supply chain Discuss and determine “rationing” models if there is a supply chain disruption and PPE placement needs to be carefully restricted

HCP PPE Training Utilize online documents and videos to provide quick just-in-time training Re-engage contractors to provide PPE training Train all types of HCP including those in support roles Consider designating a 24/7 PPE Donning/Doffing self- paced PPE training area at your facility Train internal PPE SME’s available 24/7 at your facility Work with healthcare coalitions and Awardees to identify training opportunities

Online PPE Training 14 University of Nebraska Medical Center Donning Biological PPE Ebola EbolaPatients-8.5x11-CC-v1.02.pdf Doffing Biological PPE Ebola EbolaPatients-8.5x11-CC-v1.01.pdf Biological Level C PPE Donning Video (Put On) Biological Level C PPE Doffing Video (Take Off)

Disposal of PPE Dispose of PPE as clinical waste Double bag Reusable PPE components should be sealed in a container to be decontaminated in designated area Create and monitor a waste collection log from source to offsite waste removal 15

Healthcare Personnel Decontamination After Doffing and discarding PPE remove scrubs/undergarments Place undergarments in plastic bag Double bag all clothing and label accordingly Proceed to shower Redress in normal work attire Report for medical surveillance

Cleaning Powered Air Purifying Respirator Assemblies Clean according to manufacturers recommendations Follow hygiene/infection control practices established in hospital policy Use mild hospital detergents Do not steam sterilize components Use inspection logs to annotate cleaning cycles