So I mentioned the PPE optimization, you know, because of this critical shortage
of PPE that we've been experiencing throughout this pandemic. The interim
guidances were developed. And they include that available respirators
should be prioritized for procedures that are likely to generate respiratory
aerosols which would pose the highest exposure risk to health care healthcare
personnel. And to, you know, remember that a facemask does protect the wearer from
splashes and sprays. So if you're not using aerosol generating procedures you
may be able to wear a face mask or the face shield, instead. Respirators, of
course, filter inspired air and so, therefore, offer the higher level
respiratory protection that you'd need for aerosol producing procedures. In,
again, in hospital settings they talk about sputum induction and opening
suctioning of airways. So you can kind of see from that that the respiratory
aerosols they're talking about contain almost exclusively respiratory
secretions or sputum. Whereas in dentistry, its saliva that may
contain some respiratory secretions and, therefore, virus if you're treating a
person who is, indeed, infected. The CDC guidance on optimization of PPE cautions
that we should not extend the use or reuse disposable PPE until we've done
everything else that we possibly can to prevent ourselves from not having to do
that. And some of the work practice and administrative controls that they
mention and their guidance is that [...] you do this when
you're providing only urgent care, that you would not take the risk of reusing
disposable PPE if you're doing routine procedures, that you'd limit the number
of people in the facility so that you know there's less risk of exposure and
there's fewer people that need the PPE, that you provide telemedicine or
teledentistry, that you limit your procedures in the length and in the spread of oral
fluids, so again, you can reduce the risk of exposure. aAnd if you
want to look at the guidelines there's strategies to optimize the supply of PPE
and equipment. It is available online. And there's a full list of the
administrative controls that they are suggesting. So what is the
optimization of PPE, what kind of strategies are they talking about? Well
they're talking about things like wearing a surgical mask for more than
one patient encounter. So that would be you know extended use. You put a mask on,
and maybe you're doing very quick procedures. The mask doesn't get wet or
contaminated, and so you continue to wear that same mask for more than one patient.
Same thing for respirators. As long as they maintain their fit and function,
that you might practice an extended use, where you put it on and you just leave
it on and not take it off. And when you're using PPE optimization strategies,
the training on the PPE use, including proper donning and doffing procedures,
which may be different — and I'll talk about that in just a moment — have to be
provided to healthcare personnel before they start carrying out these patient
care activities. And, of course, this is not for when adequate supplies are
available and not for routine procedures, but when there's an emergency critical
need situation, such as we've seen, you know, over these past couple of months. So
extended use is one thing. Reuse is another. Of course, reuse carries a
higher risk, because you're dealing with a contaminated —potentially contaminated —
piece of PPE that now you're going to handle again. So the recommendations from
NIOSH are that you discard the N95 respirator if you've used it during
aerosol generating procedures, because it's going to be contaminated, and that
you also just discard it if it has become contaminated with blood or other
body fluids from the patient. Always consider using a cleanable face shield,
which is preferred over goggles, because it helps protect the N95
respirator, and it reduces the surface contamination. So you can, maybe, use it a
little bit more safely if it hasn't been exposed to as much splatter and spray. If
you're going to the respirator they make a couple of
suggestions. One would be that you hang the used respirator in a designated
storage area. So you set aside a place, and you put a hook on it on the wall. And
that's where you put your respirator. Or you could put them in a clean, breathable
container, like a paper bag between uses. And then also to ensure that you don't
cross contaminate respirators — if there's more than people using one — that you
store them, so they don't touch each other. And the person who's using each
respirator should clearly be identified. So you don't want to write on the
respirator, itself. You should never put any markings or stickers or anything
like that on the surface of the respirator. But you could put your name
on the bag or the storage container that you're putting it in, or you could put
names over the hooks where you're hanging it, so that you don't
accidentally use somebody else's respirator. Also, if you're going to reuse
the respirator, you would clean your hands with soap and water or an
alcohol-based hand sanitizer, both before and after touching or adjusting the
respirator. Because sometimes you need to do that to maintain the fit, or because
it's become uncomfortable you need to shift it around a little bit.
Avoid touching the inside of the respirator. If you do inadvertently touch
it [...] — touch the inside — then you need to discard of it, and then perform hand
hygiene. Because you don't want to have contaminated the inside of your
respirator and then put that right up against the mucous membranes of your
nose and mouth. That's certainly introducing a risk. And then when you're
donning a used N95 respirator, use a pair of clean gloves, [...] because when
you do the seal check you have to put your hand over the respirator and hold
it against your face and blow out to see if any air escapes. And so, you'd want to
wear a glove to do that if the respirator may be contaminated. And then
you don't want to use that same glove in treating the patients. You need to
discard that glove, perform hand hygiene put on new gloves, and then provide
care.
[...]