American Nurses Association Discusses PPE Equipment During COVID-19 Pandemic

In a webinar hosted by the American Nurses Association (ANA) titled, “Be Confident Protecting Yourself and Providing the Best Care to Your Patients during this COVID-19 Pandemic,” Terri Rebmann, PhD, RN, CIC, FAPIC, from Saint Louis University, spoke about how nurses can protect themselves and their patients during the coronavirus disease 2019 (COVID-19) pandemic. 

After conducting a pre-webinar survey, the ANA found that 14% of nurses are not concerned or afraid to come to work due to the COVID-19 pandemic, 48% are somewhat concerned or afraid, and 38% are very concerned or afraid. 

According to Rebmann, healthcare workers are often at-risk during emerging infectious disease outbreaks. Healthcare workers can therefore inadvertently contribute to the disease if they are not protecting themselves and their patients properly. 

“It’s important that we have PPE available for our healthcare staff, and also that it is used correctly,” said Rebmann, “because, minor mistakes in PPE can put healthcare workers at risk of occupational exposure.”

Before human to human spread was suspected in COVID-19, improper infection prevention most likely contributed to the spread of disease early on. Additionally, lack of access to proper PPE and delays in patient isolation led to the pandemic becoming what it is currently. 

Rebmann noted that nurses do not need a physician to order a patient a patient into isolation and should immediately isolate patients who are suspected of having COVID-19. According to Rebmann, previous outbreaks have indicated that it is better to over-isolate, rather than risk the chance of increased spread. 

“Correct and rapid patient isolation plays the largest role in controlling outbreaks when the disease has a basic reproductive rate or an R₀ between 1 and 5, which is exactly what we’re seeing with COVID-19” said Rebmann. “So, if you are dealing with a patient who is symptomatic and you believe that they might have COVID-19, you have the right to put that person into isolation.”

For nurses providing care to hospitalized patients with COVID-19, Rebmann indicated that PPE used should include an N96, isolation gown, eye protection, and gloves. Conservation techniques should be employed to conserve the supply of these resources, especially N95s and masks. This can be done by reducing the number of staff who need N95s or masks, such as restricting visitors in facilities to only known or suspected COVID-19 cases.

If facilities begin to experience shortages in isolation gowns, gowns should then be prioritized for aerosol-generating procedures and high contact activities. Moreover, should there be shortages in N95s due to supply chain issues, the CDC recommends that that respirators be worn for extended periods of time without removal if possible, rather than re-used, and should be disposed of if soiled or damaged. Proper hand hygiene should be performed following removal though, and there should be less touching of the N95.  

Further, should respirators need to be reused, they should be reused in accordance with the manufacturer’s guidelines or no more than 5 times. Additionally, staff should be sure to only re-use their own respirator, placing it in a plastic bag labeled with their own name between uses. A cleanable face shield should also be worn over the N95 if possible and should be discarded or cleaned between uses as to protect the N95. 

NIOSH tested 11 expired N95 models from 10 stockpiles that were manufactured from 2003 to 2013, and many still met NIOSH standards. Though it is preferred that these expired N95s are used in training or fit testing, those that were deemed as okay to use included:

• 3M 1860          Gerson 1730

• 3M 1870          Medline/Alpha Protech

• 3M 8210          NON27501

• 3M 9010          Moldex 1512

• 3M 8000          Moldex 2201

However, expired N95s should not be used for staff in ORs. Additionally, should expired N95s be utilized, they should be visually inspected before use and the user should perform a seal check. 

Should respirators be depleted altogether, high-risk staff should be excluded from caring for patients with COVID-19, including those who are elderly, have chronic medical conditionals, or who are pregnant. Moreover, healthcare workers who have already recovered from COVID-19 should be assigned to these patient cohorts and surgical mask procedure should be employed.

In regard to the general public, masks are not recommended for individuals unless they are sick. Not only can masks create a false sense of security in the general public, but Rebmann also indicated that individuals could auto-inoculate themselves. Overall though, masks should be conserved for healthcare personnel. 

“The general public is not trained on how to wear a mask or a respirator,” Rebmann explained. “We need to conserve our masks and respirators for our high-risk medical personnel, so we don’t want the general public to be taking away from the possibility of healthcare personnel having access to those supplies.”

Healthcare workers should be prepared to wear respirators for long-term periods of time. Rebmann and her colleagues performed a study looking at the ability of healthcare workers to wear respirators long-term, finding that though many were highly uncomfortable, there were no physiological issues reported with long-term use. However, Rebmann highlighted that obese staff may need more frequent respirator breaks. 

“It is important to remember… anytime we are using crisis standards of care, it’s not the absolute best, but it’s the best that we can do and we used an evidence based ethical approach to deciding who is going to get those limited resources,” said Rebmann.