Novel Coronavirus Update- February 12, 2020
The Centers for Disease Control (CDC) has put forth a document offering guidance on how to optimize supplies of N95 filtering facepiece respirators (commonly called “N95 respirators”) in healthcare settings in the face of potential ongoing 2019 Novel Coronavirus (2019-nCoV) transmission in the United States.
Exposures to transmissible respiratory pathogens in healthcare facilities can often be reduced or possibly avoided through engineering (physical barriers such as windows and negative air flow patient care rooms) and administrative (work practices and policies) controls and Personal Protective Equipment (PPE). Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, Health Care Providers (HCP), and visitors at the facility.
N95 respirators are the PPE most often used to control exposures to infections transmitted via the airborne route, though their effectiveness is highly dependent upon proper fit and use. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding HCP in such circumstances. These existing guidelines recommend that healthcare facilities:
- Minimize the number of HCP who need to use respiratory protection through the preferential use of engineering and administrative controls;
- Use alternatives to N95 respirators (e.g., powered air-purifying respirators or PAPRs) where feasible;
- Implement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
- Limit the number of HCP who enter the patient’s room to only those providing direct patient care and bundling care activities to minimize room entries
- Restrict visitors from entering the room of known or suspected 2019-nCoV patients. Alternative mechanisms for patient and visitor interactions, such as video-call applications on cell phones or tablets should be explored.
Identify and assess patients who may be ill with or who may have been exposed to a patient with known 2019-nCoV. Patients with symptoms of suspected 2019-nCoV or other respiratory infection (e.g., fever, cough) presenting to care should use facemasks for source control until they can be placed in an airborne infection isolation room or a private room. Instructions should include how to use facemasks. Patients with these symptoms should not use N95 respirators. If these patients need to leave their room for services in other areas of the hospital (e.g., radiology), they should also wear facemasks for source control.
Prior to use of N95 respirators, the HCP should inspect the respirator and perform a seal check.
Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several different patients, without removing the respirator between patient encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. Extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission.
Reuse refers to the practice of using the same N95 respirator by one HCP for multiple encounters with different patients but removing it (i.e. doffing) after each encounter. N95 and other disposable respirators should not be shared by multiple workers. The respirator is stored in between encounters to be put on again (i.e. donned) prior to the next encounter with a patient. To maintain the integrity of the respirator, it is important for HCP to hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses.
Staff should take the following steps to reduce mask contamination after donning:
- Discard N95 respirators following use during aerosol generating procedures.
- Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
- Discard N95 respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions (e.g., methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, norovirus, etc.).
- Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary, for comfort or to maintain fit).
- Discard any respirator that is obviously damaged or becomes hard to breathe through.
- Avoid touching the inside of the respirator.
