Ontario Health - North Principles and Practical Applications for PPE use in COVID-19 for Home and Community Care - Service Provider Organizations ...
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Ontario Health – North Principles and Practical Applications for PPE use in COVID-19 for Home and Community Care - Service Provider Organizations Health Protection Portfolio, Public Health Ontario: LaurieDawn Boyer & Lori Schatzler, Regional IPAC Specialists, Regional IPAC Support Team – North April 23, 2020
Disclosure
• None of the presenters at this session have received financial support or
in-kind support from a commercial sponsor;
• None of the presenters have potential conflicts of interest to declare.
PublicHealthOntario.ca 2
Overview
• Discuss hierarchy of controls for the prevention of transmission of
infection in the home and community care context;
• Review Infection Prevention and Control (IPAC) Guidance for Personal
Protective Equipment (PPE) use in healthcare;
• Provide examples of practical application of PPE management;
• Provide opportunity for discussion of current challenges;
• Identify outstanding issues that require clarification or resolution.
PublicHealthOntario.ca 3
Public Health Ontario-Regional IPAC Support-Team North
Vicky Willet Lori Schatzler LaurieDawn Boyer Amanda Brizard Brandy Oldale
Team Lead Regional IPAC Specialist Regional IPAC Specialist Regional IPAC Specialist Administrative Assistant
• https://www.publichealthontario.ca/en/contact/ipac-regional-contact
PublicHealthOntario.ca 4
Controlling Health Care Workers (HCW) Exposure to COVID-19
Image: https://www.cdc.gov/niosh/topics/hierarchy/
PublicHealthOntario.ca 5
Controlling HCW Exposure to COVID-19
Image: https://www.cdc.gov/niosh/topics/hierarchy/
PublicHealthOntario.ca 6Reasons for Using PPE
Personal Protective Equipment Source Control
• HCW wears surgical mask to • HCW wears surgical mask to protect
protect oneself clients/others from his/her
respiratory droplets to protect
others
• Client wears mask to contain
his/her respiratory droplets to
protect others
PublicHealthOntario.ca 7Current relevant documents
• PHO documents
• Technical Brief: Updated IPAC recommendations for use of PPE for Care of
Individuals with Suspected or Confirmed COVID-19 (updated April 6);
• Ministry of Health
• COVID-19 Guidance: Home and Community Care Providers (Version 3 -March 18);
• Directive #1 for Health Care Providers and Health Care Entities (March 30)
• COVID-19 Guidance: Occupational Health and Safety and Infection Prevention &
Control (March 20).
PublicHealthOntario.ca 8Current relevant documents – LTCH & Retirement Homes
Ministry of Health
• Guidance for LTC homes
* Updates re: Long Term Care Homes
• Screening checklist (& Retirement Homes) regarding testing
• Outbreak Guidance for LTCH received April 21, please check for updates often
• Directive #3 for LTCH
PublicHealthOntario.ca 9Public Health Ontario Technical Brief
https://www.publichealthontario.ca/-/media/documents/ncov/updated-ipac-measures-covid-19.pdf?la=en
PublicHealthOntario.ca 10PHO Technical Brief – Key Findings
• Given updated information on COVID-19, Droplet and Contact precautions are
recommended for the routine care of patients with suspected or confirmed COVID-
19.
• Airborne precautions should be used when aerosol generating medical procedures
(AGMPs) are planned or anticipated to be performed on patients with suspected or
confirmed COVID-19.
https://www.publichealthontario.ca/-/media/documents/ncov/updated-ipac-measures-covid-19.pdf?la=en
PublicHealthOntario.ca 11http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx 14 April, 2020 PublicHealthOntario.ca 12
Directive #1 –
Health Care providers and
Health Care Entities
Revised 30 March, 2020
http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/directives/health_care_providers_HPPA.pdf
PublicHealthOntario.ca 13Ontario Health
• Recommendations for Use and Conservation of PPE (March 25);
• Optimizing the Supply of PPE During the COVID -19 Pandemic (April 11, 2020).
PublicHealthOntario.ca 14Point of Care Risk assessment examples
Routine Practice and Suspect or Confirmed
Additional Precautions COVID-19
• Am I providing care within 2m for a patient • Am I providing care within 2m for a
with symptoms of a respiratory illness probable/confirmed COVID -19 patient?
(fever, new cough e.g. influenza )?
• Gloves, gown (based upon risk assessment), • Gloves, gown,
• eye protection (goggles or face shield), • eye protection (goggles or face shield),
• surgical/procedure mask. • surgical/procedure mask
• Am I providing care including an AGMP to • Am I providing care including an AGMP to
a patient? a probable/confirmed COVID-19 patient?
• Conduct a risk assessment and consider gloves, • Gloves, gown, N95 respirator, eye protection
gowns, surgical/procedure mask, eye protection.
PublicHealthOntario.ca 15When Should I Put ON PPE – examples
Routine Practice and Suspect or Confirmed COVID-19
Additional Precautions
• Screen prior to visit to conduct
• Screen prior to visit to conduct assessment;
assessment; • Upon entry to the home:
• Upon entry to the home; • Ask client/family to maintain two
• At point of care; meter distance.
-e.g.-providing direct care to a client who has an
ARO or diarrhea:
• Conduct a risk assessment;
• Put on PPE.
PublicHealthOntario.ca 16When Should I Take OFF PPE – examples
Suspect or Confirmed COVID-19
Routine Practice and
Additional Precautions
• Upon completion of task • Upon completion of task
(e.g., glove removal); (e.g., glove removal);
• Prior to leaving the space or home; • Prior to leaving the space or home:
• Ask client/family to maintain two meter
distance.
• Hand hygiene.
• Hand hygiene.
PublicHealthOntario.ca 17Aerosol Generating Medical Procedures (AGMPs)
PHO Current list of procedures that are NOT AGMP
• Endotracheal intubation, including during cardio- • Collection of nasopharyngeal or throat swab
pulmonary resuscitation (CPR) • Chest compressions
• CPR during airway management • Coughing, expectorated sputum
• Open airway suctioning • Oral suctioning
• Bronchoscopy (Diagnostic or Therapeutic) • Oral hygiene
• Autopsy • Nasogastric/nasojejunal
• Sputum induction (Diagnostic or Therapeutic) tube/gastrostomy/gastrojejunostomy/jejunostomy
• Non-invasive positive pressure ventilation for acute tube insertion
respiratory failure (CPAP, BiPAP3-5) • Chest physiotherapy (outside of breath stacking)
• High flow oxygen therapy • Oxygen delivered at less than or equal to 6 liters per
minute by nasal prongs and less than or equal to 15
liters per minute by Venturi masks and non-
rebreather masks
PublicHealthOntario.ca 18Indications for surgical/procedure masks for COVID-19
• Masks are required:
• When providing direct care within 2m of a patient with suspect or confirmed COVID
-19;
• When within two meters of a patient with suspect or confirmed COVID -19;
• When entering the room a patient with suspect or confirmed COVID-19;
• Based upon a risk assessment for interactions with patients that are not suspected
or confirmed COVID -19.
PublicHealthOntario.ca 19Indications for surgical/procedure masks for COVID-19
• HCW who in consultation with Occupational Health department:
• Traveled outside of Canada in previous 14 days;
• Unprotected exposure to a suspect/confirmed COVID -19 case;
• Are critical to organization operations.
PublicHealthOntario.ca 20PPE for COVID -19
• Droplet/contact precautions:
• Surgical/procedure mask;
• Isolation gown;
• Gloves;
• Eye Protection (goggles or face shield).
• NOT REQUIRED:
• Booties;
• Hair covering;
• Double gloves.
https://www.publichealthontario.ca/-/media/documents/ncov/updated-ipac-measures-covid-19.pdf?la=en
PublicHealthOntario.ca 21Scenario
You are contacted by one of your staff who has several different homes to go
to today. Two of the staff members’ clients reported no COVID-19
symptoms and are alone in their homes. A third client reports they went to
an assessment center the previous day and were tested for COVID-19. Their
partner is also unwell and has an appointment at an assessment center later
in the evening.
• How should the worker organize their visits?
• Assess purpose of visit
• What PPE is required by the health care worker for each client visit?
PublicHealthOntario.ca 22Can I conserve PPE by wearing the same gown/mask to different
clients homes
If reusable equipment, clean and disinfect between visits.
To reuse PPE consider, what protocols have been developed by your
organization and have staff been trained?
• Can staff safely remove PPE and store (how?) for transport in the vehicle
to another client?
• Can staff safely put on contaminated PPE?
• Can staff safely provide care to another client in another setting while
wearing potentially contaminated PPE?
PublicHealthOntario.ca 23Questions
I am a HCW who is going into a retirement home to provide care.
• Do I need to wear a mask?
• What other PPE should I wear?
• Can I see more than 1 client in the home during that visit?
PublicHealthOntario.ca 24Questions
• How should PPE be disposed?
• No special requirements- follow usual process
• How do we clean and disinfect items between uses:
• Same as usual process;
• Depends on the product –is it a clean/disinfect all in one;
• DIN;
• Contact time;
• Amount of wipes to use will depend on the size of the equipment and soil level.
PublicHealthOntario.ca 25Questions?
• Staff Self monitoring / self screening.
• How to Self-monitor
• How to Self-isolate
• What We Know So Far About series, masks, COVID in children, etc.
PublicHealthOntario.ca 26For More Information About This Presentation, Contact:
ipacnorth@oahpp.ca or call 1-888-378-4916
Public Health Ontario keeps Ontarians safe and healthy. Find out more at
PublicHealthOntario.ca
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