Safety & Personal Protective Equipment (PPE)
Modified on 12/3/2020 at 08:21am

Contact the Program of Hospital Epidemiology at 319-356-1606 or 24-hour pager 3158.

Latest guidance and policies from our Program of Hospital Epidemiology.

View our Safety Policy here.


Chief Medical Officer Theresa Brennan, MD, and the Operations branch of the UI Health Care Hospital Incident Command System (HICS) have reviewed each line of Iowa Governor Kim Reynolds’ order on personal protective equipment (PPE) and has determined that UI Health Care is in compliance with the order.

This site is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. All information is meant for use by health care workers and not the general public. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by this web site or its use. Neither the University of Iowa nor its employees, nor any contributor to this web site, makes any representations or warranties, express or implied, with respect to the information provided herein or to its use.

General safety and infection prevention principles

Best practices

The safety of our staff and patients always comes first. Please take care of yourself and your work spaces as we strive to do our best for each other, our patients, and our community.

In clinical settings:

  • Staff must wear a medical-grade mask and eye protection in clinical settings at all times. Face shields are the preferred PPE for eye protection during most clinical situations, though alternative protection is available, such as eye goggles.
  • Keep arms bare below the elbows in order to avoid sleeve contamination. This means that there should be nothing on your forearms, including wrist jewelry and watches. If you wear a long-sleeved shirt, roll up the sleeves.
  • Neckties, scarves, and long necklaces should not be worn.
  • Tie or clip up long hair.
  • Wipe down your stethoscope after each use.

 Work rooms and commonly shared work spaces:  

  • Wipe down surfaces with disinfectant wipes often.
  • It’s time to declutter. If surfaces are cluttered they are unable to be cleaned.
  • Wipe down shared computer keyboards, phones, door knobs, and other items you frequently touch before using.

Shared food:  

  • Food should not be consumed in areas other than designated break rooms.
  • Limit food sharing. There are potential health risks with communal food sharing, and it is strongly discouraged at this time.

Other best practices:

  • Practice social distancing (6 feet) whenever possible. Consider all opportunities to minimize contact with other employees.
  • Wash your hands often and avoid touching your face.

For staff who wear green scrubs:

  • Green scrubs are not to be worn outside of the hospital. If you currently have green scrubs at home, please bring them back to work as soon as possible so they can be laundered and reused appropriately.


View frequently asked questions about face masks and face coverings here
.

Surface cleaning and disinfection guidance
Updated on 05/07/2020 at 2:52 pm

Virex® II 256 Spray

Download these instructions

For use as a one-step cleaner/disinfectant for environmental surfaces (similar application as the Grey top PDI wipes)

INSTRUCTIONS FOR USE:

  1. Carefully spray Virex® solution away from eyes onto a new disposable
  2. Wet cloth using approximately 12-15 squeezes; cloth should be damp, not

Rationale: When a surface is sprayed then wiped with a dry cloth the disinfectant is wiped away and does not allow the surface to remain wet.

  1. Wipe all hard, non-porous surfaces with damp
  2. All surfaces must be visibly wet and allowed to air

Note: Do not directly spray on electronics.

*DO NOT DISCARD EMPTY SPRAY BOTTLES (Spray bottles will be cleaned and refilled) Virex® II 256 may be used to fill and refill clean, properly labeled containers.

INSTRUCTIONS FOR ORDERING:

  1. Call Stores (6-1784) to request new
    • Virex® Spray Bottle – Reusable (use PS#156332)
    • Wipe Disposable for Virex® Spray (use PS#156334)
  2. Stores will deliver a new supply of Virex® and pick-up empty bottle(s).

Reference:

William A. Rutala, P. M. (n.d.). Frequently Asked Questions. Retrieved from How should readers interpret the recommendation about contact time for disinfectants: http://vtwqt464m234djrhbie88e10- wpengine.netdna-ssl.com/wp-content/uploads/2017/07/FAQ_Contact-time-for-disinfectants- used-on-noncritical-items.pdf

Developed: Program of Hospital Epidemiology and Environmental Services 3/27/2020


Sani-HyPerCideTM Spray

Download these instructions

For use as a one-step cleaner/disinfectant for environmental surfaces

(similar application as the Orange top PDI Bleach wipes)

INSTRUCTIONS FOR USE:

  1. Sani-Hypercide spray is a bleach substitute for environmental cleaning.
  2. Carefully spray Sani-Hypercide solution away from eyes onto a new disposable cloth.
  3. Wet cloth using approximately 12-15 squeezes; cloth should be damp, not dripping.

Rationale: When a surface is sprayed then wiped with a dry cloth the disinfectant is wiped away and does not allow the surface to remain wet.

  1. Wipe all hard, non-porous surfaces with damp cloth.
  2. All surfaces must be visibly wet and allowed to air dry.

Note:

  • Do not directly spray on electronics.
  • Use Sani-Hypercide for environmental cleaning associated with diff and Norovirus infections or when bleach wipes use is specified.

INSTRUCTIONS FOR ORDERING:

  1. Call Stores (6-1784) to request new supply.
  • Sani-HyPerCide Spray Bottle (use PS# 156230)
  • Wipe Disposable for Sani-HyPerCide Spray (use PS#156334)
  1. Stores will deliver a new supply of Sani-HyPerCide.

Reference:

William A. Rutala, P. M. (n.d.). Frequently Asked Questions. Retrieved from How should readers interpret the recommendation about contact time for disinfectants: http://vtwqt464m234djrhbie88e10-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/FAQ_Contact-time-for-disinfectants-used-on-noncritical-items.pdf

Developed: Program of Hospital Epidemiology and Environmental Services 04/09/2020


Oxivir® Ready to Use

Download these instructions

For use as a one-step cleaner/disinfectant for environmental surfaces

(Reserved for Operating Rooms disinfection)

INSTRUCTIONS FOR USE:

  1. Carefully pour Oxivir® solution onto a new disposable cloth.
  2. Wet cloth with disinfectant; cloth should be damp, not dripping.
  3. Wipe all hard, non-porous surfaces with damp cloth.
  4. All surfaces must be visibly wet and allowed to air dry.

Note: Do not directly apply on electronics.

*DO NOT DISCARD EMPTY REFILL BOTTLES (Refill bottles will be cleaned and reused)

Oxivir® may be used to fill and refill clean, properly labeled containers.

*DO NOT POUR SOLUTION IN TUB OR BUCKET FOR MULTIPLE USES

Rationale: Improperly handled disinfectants may be contaminated with organisms that could lead to hospital-acquired infections.

INSTRUCTIONS FOR ORDERING:

  1. Call Stores (6-1784) to request new supply.
  • Oxivir® Ready to Use solution – Reusable (use PS# 139831)
  • Wipe Disposable for Oxivir® Ready to Use solution (use PS#156334)
  1. Stores will deliver a new supply of Oxivir® and pick-up empty bottle(s).

Reference:

William A. Rutala, P. M. (n.d.). Frequently Asked Questions. Retrieved from How should readers interpret the recommendation about contact time for disinfectants: http://vtwqt464m234djrhbie88e10-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/FAQ_Contact-time-for-disinfectants-used-on-noncritical-items.pdf

Keah KC. Et al. Bacterial Contamination of Hospital Disinfectants. http://www.e-mjm.org/1995/v50n4/Hospital_Disinfectants.pdf

Developed: Program of Hospital Epidemiology and Environmental Services 04/29/2020

Showers and hygiene products available for UI Health Care staff
Social distancing

Read more about social distancing here.

Guidance on laundering of scrubs at home
Guidance on green scrubs

For staff who wear green scrubs:

Green scrubs are not to be worn outside of the hospital. If you currently have green scrubs at home, please bring them back to work as soon as possible so they can be laundered and reused appropriately.

General personal protective equipment (PPE) guidance

PPE for treating a suspected or confirmed COVID-19 patient
Updated on 04/24/2020 at 8:51 am

Interim instructions for caring for a patient with COVID-19 (person under investigation* or confirmed)

April 21, 2020

Please send requests for additional guidance to: InfectionPrevention@healthcare.uiowa.edu

Urgent requests: page 3158.

Situation Guidance
Isolation Precautions

PPE* in all clinical settings (Inpatient and Outpatient)

Droplet    +  Contact Precautions  +   Eye Protection

face mask  +      gown and gloves         +   face shield, goggles or mask with fluid shield

Avoid aerosol generating procedures (AGP)*.

If AGPs necessary:

Airborne PPE + Contact Precautions + Eye Protection

  N95 or CAPR  +      gown and gloves        +   face shield, goggles

Wear Airborne PPE during the procedure and for 1 hour after procedure completion

Patient transport (procedures or transferring units) Limit transport and movement of the patient outside of the patient room to medically essential purposes.

If procedures or tests are required and not able to be performed in the patient room OR if patient is being transferred to another unit, follow these steps:

  • Notify receiving department/unit of isolation status of patient
  • Wear mask, gown, gloves and eye protection PPE to prepare the patient for transfer (e.g., transfer patient to the wheelchair or cart)
  • Place clean sheet over patient
  • Place a face mask on patient to contain secretions
  • Wipe bed rails/wheelchair handles down with approved disinfectant
  • Transporter wears face mask and face shield.  Clean gloves may be stored in transporter’s pocket.

Receiving personnel should wear PPE for droplet, contact and eye protection (gloves, gown, face mask and eye protection)

After transport, equipment must be cleaned with approved disinfectant

To transport patients who require care during transport (e.g. a critically ill patient) follow the guidance above with the addition of:

  • Persons transporting and caring for the patient wear a surgical face mask (or keep on N95 if one was used for intubation) and eye protection, gown and clean gloves.
  • Other transporters not providing care wear a surgical face mask, eye-protection and do not wear gloves.  This person will clear hallways if needed and open doors, activate elevator buttons, etc.
  • Under no circumstances should anyone wearing gloves touch door handles, doors, elevator buttons, etc.

 

Food and Nutrition Nursing will take food trays into patient room and also remove them from patient room. No special handling of food tray necessary.
Environmental infection control

Inpatients

Daily cleaning:

  • Will be performed with the assistance of EVS

Terminal cleaning (after discharge):

  • Room does NOT need to sit vacant for 1 hour unless an AGP was performed within the last hour.
  • No AGP within last hour EVS staff to clean wearing the following PPE:  gown, gloves, mask and eye protection
  • If AGP within last hour – the room needs to sit vacant for 1 hour after patient discharge. EVS staff to clean wearing the following PPE:  gown, gloves, mask and eye protection.

Procedural Areas (not Operating Room)

  • Room does NOT need to sit vacant for 1 hour unless an AGP was performed within the last hour.
  • No AGP within last hour – Staff to follow normal process and clean all surfaces. Wear the following PPE: gown, gloves, mask and eye protection.
  • If AGP within last hour – the room needs to sit vacant for 1 hour after patient discharge. Staff to follow normal process and clean all surfaces. Wear the following PPE: gown, gloves, mask and eye protection.

Outpatients

  • Room does NOT need to sit vacant for 1 hour unless an AGP was performed within the last hour.
  • No AGP within last hour – Clinic staff to clean all surfaces and equipment touched wearing the following PPE: gown, gloves, mask and eye protection.
  • If AGP within last hour – the room needs to sit vacant for 1 hour after patient discharge. Clinic staff to clean wearing the following PPE:  gown, gloves, mask and eye protection.

*Definitions

  • COVID-19 person under investigation: a person that is going to be or has been tested for COVID-19 and is awaiting results.
  • Droplet precautions PPE: face mask
  • Contact precautions PPE: gown + gloves
  • Airborne PPE: N95 or CAPR
  • Eye protection: face shield, goggles or mask with fluid shield
  • Aerosol generating procedures:
    • nebulized medication administration
    • manual ventilation before intubation
    • endotracheal intubation
    • extubation
    • BiPAP/CPAP
    • high-frequency oscillating ventilation
    • open suctioning
    • sputum induction
    • bronchoscopy
    • CPR
    • autopsy

 

 

 

 

Discontinuation of Isolation Precautions for Patients with COVID-19
Updated on 05/07/2020 at 2:46 pm
COVID-19 Discontinuation of Isolation guidance for Inpatient providers
Updated on 12/11/2020 at 9:18 am

The Program of Hospital Epidemiology (PHE) recommends that the decision to resolve COVID precautions be discussed by the primary care team in rounds.

Discontinuation of COVID-19 Isolation Precautions criteria:        

Asymptomatic, mild, or moderate COVID-19 related symptoms (must meet all criteria):

  1. At least 10 days since symptoms first appeared (or positive test if asymptomatic)
  2. At least 24 hours with no fever (without fever-reducing medication)
  3. Symptoms have improved (e.g., cough, shortness of breath)

Severe to critical COVID-19 illness requiring ICU care or severe immunosuppression (must meet all criteria):

  1. At least 20 days since symptoms first appeared (or positive test if asymptomatic)
  2. At least 24 hours with no fever (without fever-reducing medication)
  3. Respiratory symptoms have improved or stabilized

What is considered a severe COVID-19 illness?

If the patient is in/has been in ICU for a severe COVID pneumonia requiring ventilatory support, then isolate for 20 days. You may make an exception if the ICU stay was brief, no intubation and/or patient condition quickly improved by day 10. We would defer to the clinical judgement of the primary provider/team.

What do you consider severe immunosuppression?

Many conditions and treatments can weaken a person’s immune system (making them “immunocompromised”). Some of these include:

  • Recently received chemotherapy or stem cells for cancer treatment
  • Bone marrow transplant
  • Solid organ transplant
  • Genetic or acquired immune deficiencies
  • Use of Oral or IV corticosteroids or other medicines called immunosuppressants that lower the body’s ability to fight some infections.

How are isolation dates determined?

The date of the test or the onset of symptoms is day 0.  In most cases we use the date of the test as symptoms are subjective.  Day 0 through day 10 (or 20) is the isolation period.  They are eligible to come out of isolation on day 11 or day 21.

How do I get the COVID-19 infection removed (resolved) from my patient’s chart?

  1. If your patient requires 10 day isolation: On day 11 after the first + test there is a Best Practice Advisory (BPA) that will fire to providers and if after review your patient meets the criteria you can choose to “Resolve the COVID-19 infection”. If you select the option “does not meet clinical criteria”, the BPA will not fire for another 5 days.
  2. If your patient requires 20 day isolation: the “does not meet clinical criteria” will need to be selected twice. The third time it fires will be day 21.  At that point you can re-evaluate and potentially resolve.

Do I need to talk with the Program of Hospital Epidemiology (PHE) to resolve an infection on a COVID-19 patient?

It is not a requirement to speak with PHE prior to resolving the COVID-19 infection and removing the patient from isolation.  We defer to the clinical judgement of the provider.  If the timing of the BPA does not allow you to resolve the COVID-19 infection and you have determined that your patient meets criteria to resolve, you can call 356-1606 or page 3158 between 8am-5pm to assist.

If I resolve the COVID-19 infection, what else do I need to do?

Discontinuation of isolation precautions should be the next step.  The patient should be in standard precautions (which currently requires eye shield and medical grade face mask) unless otherwise indicated.  No special placement required.  This should be communicated to the charge nurse or patient’s nurse.

Anesthesia guidelines
Updated on 05/12/2020 at 11:21 am
Resuming use of gowns in all instances of contact precautions
Updated on 05/22/2020 at 9:39 am

Effective immediately, gowns should be worn by faculty and staff in treating all patients in contact precautions. This guidance reverses the previous temporary guidance put into place to conserve our supply of gowns for staff treating patients with confirmed or suspected COVID-19. This reversal resumes normal contact precaution guidance.

The Program of Hospital Epidemiology also strongly recommends a continued focus on hand hygiene before and after all patient contact. As always, gowns should be worn if a splash or spray of blood or body fluids is anticipated.

Please contact Epidemiology (319-356-1606) for any questions.

Doffing tape-tab neck isolation gown
Updated on 11/18/2020 at 3:39 pm

PPE training

Training for all faculty and staff with patient contact

As part of University of Iowa Health Care’s ongoing efforts to protect the health of our community, we want you to be fully prepared should you care for patients with symptoms of COVID-19. We recognize that many of you have already had PPE training. This provides an additional opportunity to reinforce your knowledge with current video examples.

To help contain the 2019 Novel Coronavirus (COVID-19), as well as ongoing flu instances, all employees with patient contact are required to complete these refresher trainings for use of personal protective equipment (PPE). The training courses are available online as compliance issues through Employee Self-Service and need to be completed by March 31.

For areas with a high potential to take suspected or confirmed COVID-19 patients, staff should complete the course as soon as possible. It will take approximately 10-20 minutes to complete.

For those UI employees who wish to take the training—but are not required—please note that it’s available through My Training in Employee Self-Service.

Download a PPE donning and doffing flyer here.

PPE conservation

UI Health Care is implementing centralized strategies to optimize the supply of our personal protective equipment (PPE) and reviewing potential clinical contingency plans.

Securing PPE/ensuring the highest level conservation

Effective immediately, we are following maximum conservation protocols for all critical personal protective equipment (PPE) and testing supplies. Although we presently have enough supplies, our supply chain remains vulnerable and availability changes daily. With everyone’s help, we can do this effectively while maintaining safety for our faculty and staff.

Our Supply Chain/Materials Management department is now centralizing the management of these supplies to ensure conservation and proper use.

Although we presently have enough supplies, our supply chain remains vulnerable and availability changes daily. To continue to keep people safe, we are implementing strategies to optimize the supply of our personal protective equipment (PPE) and are focused on clinical contingency planning.

Health care team members caring for patients in isolation precautions should only include the minimum number of individuals necessary for ensuring proper patient care. Additionally, rounding teams should only have the attending and one house officer enter the rooms of patients in isolation precautions.

Aerosol-generating procedure (AGP) guidance for confirmed or suspected patients with COVID-19

Aerosol-generating procedure (AGP) guidance for confirmed or suspected patients with COVID-19
Updated on 08/19/2020 at 8:34 am

Aerosol-generating procedure (AGP) guidance for patients with COVID-19

May 11, 2020

Aerosol-generating procedures (AGPs) are procedures performed on patients that are more likely to generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or breathing. AGPs should be avoided if possible in patients with suspected or confirmed COVID-19.

Aerosol-generating procedures

Procedures commonly recognized as aerosol-generating:

  • Open suctioning of airway secretions*
  • Sputum induction
  • Cardiopulmonary resuscitation (CPR)
  • Endotracheal intubation and extubation
  • Manual ventilation
  • Nebulized medication administration
  • Non-invasive positive pressure ventilation (e.g., BiPAP, CPAP)
  • Bronchoscopy
  • High-frequency oscillating ventilation
  • Disconnection of ventilator circuit to replace Filters/Heat Moisture Exchangers
  • Cough assist device

Procedures that are not believed to generate aerosols:

  • Coughing through mouth or tracheostomy
  • Oral cares
  • Swabs of OP, NP, or nares
  • Endotracheal cuff leak
  • NJ (nasojejunal)/NG (nasogastric) tube placement
  • Metered dose inhaler (MDI) with spacer
  • MDI-drug delivery into a ventilator circuit
  • Heated High Flow nasal cannula – adults, peds, neonate
  • Uncuffed ETTs (peds/neo)

Personal Protective Equipment (PPE) by patient type:

  • Asymptomatic patients or patients without respiratory symptoms —> medical mask + face shield + gloves per standard precautions
  • Patients with suspected or confirmed COVID-19 (not receiving an AGP) —> medical mask + gown and gloves + face shield
  • Patients with suspected or confirmed COVID-19 (during AGP procedure and for 1 hour after procedure completion) —> N95 or CAPR + gown and gloves + face shield

*May be referred to as deep suctioning beyond oral suctioning. 

 For additional details on PPE selection and isolation precautions, see link

 References:

  • Alhazzani, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).
  • Cheng V, Wong S-C, Chen J, Yip C, Chuang V, Tsang O, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020 Mar 5 [Epub ahead of print].
  • Loeb, M. et al. SARS among critical care nurses, Toronto. Emerg. Infect. Dis. 10, 251–255 (2004)
  • Raboud, J. et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS One 5, e10717 (2010)
  • Prevention, C. f. (2020, May 4). Healthcare Infection Prevention and Control FAQs for COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html
  • Pichi, Barbara, et al. “CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management.” Oral Oncology 105 (2020): 104682.
  • Raboud, J. et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS One 5, e10717 (2010)
  • Tran, K.; Cimon, K.; Severn, M.; Pessoa-Silva, C.L.; Conly, J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS ONE 2012, 7.
  • World Health Organization (https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations)
  • World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. (2019)

Face shields

Face shields for all UI Health Care employees
Updated on 09/24/2020 at 8:46 am

Face shields are provided for all UI Health Care employees.

A face shield covers the eyes, nose, and mouth, as well as helps you from touching your face. We know that COVID-19 is spread by droplets, such as from a cough or sneeze, so using face shields helps protect us from these infectious droplets.

Eye protection guidelines
Updated on 10/01/2020 at 7:41 am

When taking care of patients and working in onstage clinical areas, all UI Health Care faculty and staff must wear a medical-grade mask and eye protection. 

Face shields

Face shields are the preferred personal protective equipment (PPE) for eye protection during most clinical situations while we provide care for patients within UI Health Care during the COVID-19 pandemic.

Face shields provide the best coverage of both the eyes and face.

An acceptable face shield must:

  1. Extend to at least the chin level
  2. Limit the space between the forehead and face shield as much as possible
  3. Wrap around the face far enough to protect the corners of the eyes

Alternative eye protection

If wearing a face shield makes it difficult to perform job duties, alternative eye protection may be worn instead.

Acceptable alternative eye protection must:

  • Limit the space between the eye protection and the brow as much as possible
  • Fit snugly to the sides of the face or have side shields such that the eyes are protected from the side
  • If a health care worker wears prescription eyeglasses, the eye protection must be able to accommodate their glasses. Individually purchased prescription safety glasses are acceptable if they meet the above criteria.
  • Surgical mask with splash shield is recommended to be used in OR/procedural areas only.

Examples of acceptable alternative eye protection in stores include:

Light weight face shields:

Speyes eye shield (Two-piece system: shield and frame)

Items not in Hospital Stores but acceptable for use:

Art to Frames

Iowa MADE shield

Download a flyer with this guidance here.

How to properly clean face shields and CAPR Disposable Lens Cuffs (DLC)

Face shields should be cleaned after each use. 

PPE Reprocessing Instructions
CAPR disposable lens cuff 
  1. Obtain a clean horizontal surface for disinfecting reusables (Process begins with removal of PPE from face in anteroom or hallway)
  2. Hand hygiene
  3. While wearing gloves, carefully wipe the insidefollowed by the outside of the lens using an approved cleaner/disinfectant
  4. Check chin cuff integrity and inspect for damage; if damaged dispose
  5. Fully air dry
  6. Clean/disinfect the horizontal surface with approved cleaner/disinfectant
  7. Remove gloves and perform hand hygiene
  8. Place in envelope* labeled with healthcare worker’s name
  9. Hand Hygiene

Note: Re-used lens cuffs are to be re-used by a single wearer

Face shields and goggles
  1. Obtain a clean horizontal surface for disinfecting reusables (Process begins with removal of PPE from face in anteroom or hallway)
  2. Hand hygiene
  3. Don gloves
  4. Carefully wipe the inside, followed by the outside of the face shield or goggles using an approved cleaner/disinfectant
  5. Inspect for damage; if damaged dispose
  6. Fully air dry
  7. Clean/disinfect the horizontal surface with approved cleaner/disinfectant
  8. Remove gloves and perform hand hygiene
  9. Place in clean location labeled with health care worker’s name. Smaller face shields/goggles may be stored in an envelope*
  10. Hand Hygiene

 

*Envelope: PS#156140

Definitions:

DLC: Disposable lens cuff

CAPR: Controlled Air Purifying Respirator

How to correctly remove a face shield

We have already had multiple reports of face shields breaking. This has occurred when trying to remove it by pushing upward on the bottom of the clear shield.

To remove the face shield without damaging it, loosen the knob that sits over the back of your head, and lift the face shield off with a straight upward motion of the headpiece (not the clear shield).

Guidance for avoiding neck pain with face shield use

View frequently asked questions about face shields here.

Guidance on face masks

For staff: What type of mask you should wear with your face shield and when
Updated on 11/24/2020 at 9:50 am

NOTE: Personal protective equipment (PPE) guidance for the care of COVID-19 patients and persons under investigation (PUIs) is unchanged, and can be found here.

The following guidance is subject to change based upon the availability of medical-grade masks. We will closely monitor the supply of these masks and may need to convert to cloth masks for all employees and patients if we reach a critical shortage or are rapidly depleting the supply of these masks during the COVID-19 surge. We strongly encourage you to conserve these masks.

In onstage clinical spaces (such as clinics, inpatient units, procedural units, or clinical hallways)

  • Medical-grade mask + face shield is required
  • The mask should be worn underneath your face shield. Your face shield protects your eyes, protects the mask from contamination, and helps prevent touching of the face and repeated adjustments of the mask. A single mask should be worn all day, and in certain circumstances can be worn more than one day. Discard the mask only when soiled, damaged, or hard to breathe through.
  • Medical-grade masks will be available within clinics or on your unit. If you interact with patients but are within a service that is not assigned to one specific unit, such as Respiratory Therapy, Food and Nutrition Services, etc., please work with your manager.
  • KN95s are equivalent to a medical-grade mask. Utilize them just as you would a medical-grade face mask with ear loops.

In public spaces (such as non-clinical hallways, cafeterias, or while entering and exiting the facility)

  • Cloth or medical-grade mask is required
  • You may wear a face shield while in addition to your mask. (Shield must be removed when passing through screening to allow the thermal scanner to operate.)

Read more about what to wear in shared work spaces.


View frequently asked questions about face masks and face coverings here
.

PPE guidance for shared spaces
Updated on 11/24/2020 at 9:50 am
Face masks to be worn at all times
Updated on 11/24/2020 at 8:56 am

All UI Health Care employees, students, learners, volunteers, and contractors in our facilities must wear face mask at all times while in our facilities unless they are alone in a private office.

For patients and visitors
Updated on 11/24/2020 at 8:46 am

In clinic areas, patients and visitors who present without a mask are to be given a mask to wear, either a cloth or medical-grade. Patients unable to wear a face mask for medical reasons will be provided a face shield. Face masks should not be worn by children under age 2.

In inpatient areas, all patients, regardless of COVID-19 infection status, are to wear a mask* when they leave their room (e.g., during transport, for procedures, walks, therapies). When the mask is not in use, it should be stored at their bedside in a clean, dry place and can be re-used as needed.

Patients who are COVID-19-positive are to wear a mask when staff enter their room. Exceptions may be made in a patient’s room only if the patient is physically unable to wear a mask.

*There may be some patients who cannot wear due to intolerance, clinical reason (e.g., intubated), or children under age 2.

View frequently asked questions about face masks here.

N95 respirators

N95 masks and aerosol-generating procedures
Updated on 12/03/2020 at 8:24 am

Due to the diligent and tireless work of our supply chain team, our supply of N95 masks is now stable enough for all frontline, direct care staff to use N95 masks during all aerosol generating procedures (AGPs).

View a list of AGPs here.

This guidance is applicable in all areas, except for perioperative and procedural settings (including the delivery rooms) where the patient has had a negative COVID-19 test in the last 48 hours. Personnel caring for patients who do not have COVID-19 in the NICU are not required to wear N95s during AGPs. In these settings existing PPE guidance should continue to be followed.

Note: It is safe to perform an AGP without wearing an N95 on a patient who does not have COVID-19. This has been the consistent guidance from the CDC and our Program of Hospital Epidemiology. We are moving to universal N95s during AGPs to standardize our process and to eliminate any confusion. Now staff can use N95 masks for all AGPs, rather than having to distinguish between patients with and without COVID-19.

If you have not yet been fit tested to an N95

If you have not yet been fit tested, you will receive an assignment titled “N95 Respirator Fitting Review” in Compliance & Qualifications (CQ) on Friday, Dec. 4. You should then follow the steps below to complete this compliance as soon as possible.

  1. First, complete the required OSHA survey in ReadySet
  2. Schedule a fit testing with the University Employee Health Clinic (UEHC). You can do this by calling UEHC at 319-356-3631 to schedule your 15-to-20-minute appointment. UEHC is located at 1097-1 Boyd Tower, at UI Hospitals & Clinics (Elevator A, Level 1). Hours are from 7:30 a.m. to 4:30 p.m., Monday through Friday.

Click to enlarge.

If you have already been fit tested to an N95

If you have already been fit tested to an N95 respirator, please confirm the make and model of your respirator by following these instructions. If you are fit tested to a 3M 1804 respirator, please follow the guidelines outlined here.

If you are already fit tested to any other type of N95, no further action is needed.

Changes take effect Monday, Dec. 7

On Monday, Dec. 7, N95s can begin to be used for all AGPs (not just during AGPs with COVID-19 patients). If you have not yet been fit tested for an N95, continue using your surgical or medical-grade mask and shield as you have been. Once you have been fit tested you may begin using an N95.

View details about when you should wear an N95 here.

Type 1804 N95 masks will continue to be reprocessed until further notice, however, starting on Monday, Dec. 7, we will stop reprocessing all other N95 masks. This means most N95 masks should be discarded after each use.

If you wear an 1804 N95 mask, additional information is provided here.

Information for employees fitted to an 1804 N95 respirator
Updated on 12/03/2020 at 8:22 am
How to find the size of your N95 Respirator
Updated on 05/18/2020 at 1:25 pm
N95 respirators decontamination guidance for models 1804 only
Updated on 12/03/2020 at 9:02 am

More details about models 1804 respirators can be found here.


University of Iowa Hospitals & Clinics

Ionized Hydrogen Peroxide (iHP) Decontamination Procedure – N95 Respirators

*Important Note: users of N95 respirators must not wear lipstick or other makeup when wearing an N95 respirator as it will contaminate the inside of the respirator, rendering it unable to be decontaminated by this process.

Health Care Provider (HCP) Instructions:

  • HCP obtains new fit-tested N95 respirator from secure storage location in their unit/department.
  • Using a black permanent marker, (Sharpie), HCP writes their first initial, last name, unit name/location, and date of first use on the outside/bottom edge of the N95 avoiding the top nose/bridge area and central filtration area.
  • HCP dons the respirator per the usual procedure ensuring the integrity of the respirator and proper fit.
  • HCP uses the respirator following the institution’s extended use guidelines.

HCP Doffing:

  • Remove the N95 respirator following appropriate doffing guidelines (be sure to use clean hands and not touch the front of the respirator; handle it only by the elastic straps).
  • Place the used N95 respirator in a brown paper bag ensuring that the bag is correctly labeled with the HCPs full name, unit name/location in which to return it. (Infection Control Note: brown paper bag must be used due to moisture build up during use that must be allowed to evaporate).
  • Place the brown paper bag in the designated “dirty N95” drop off location within the unit/department.
  • Note: if the HCP is a “float” staff member and will not return to the same unit/department for their next shift, mark the N95 and paper bag with the added word “FLOAT” in bold letters and include the request locations for pick up.
  • Place brown bag in “dirty” biohazard bin.

HCP Reuse of Decontaminated N95s

  • At the start of your next shift, the HCP will present to the clean storage area in the unit/department to pick up their decontaminated N95, assuring that their name is on the N95 contained within the new white paper bag before taking it.

(Note: if the HCP is “float” staff, they should present to the clean pickup area that was provided on the brown paper bag).

  • The HCP will notice a tally mark in a different color that has been added to the front/bottom edge of their N95 respirator by the Decontamination Technician after it was processed. This is to track the number of times a particular N95 has gone through the decontamination process.  N95 respirators will be available for five uses, initial use and four decontamination cycles and use.
  • The HCP should inspect the N95 prior to donning to assess for any obvious damage, failure of the elastic straps, etc. If damage is found, notify the unit/department supervisory staff before obtaining a new N95.
  • The HCP dons the respirator per usual procedure ensuring the integrity of the respirator and proper fit.
  • HCP uses the respirator following the institution extended use guidelines.
  • If the HCP finds that there is no decontaminated N95 available with their name on it, they will notify their unit/department supervisor. Situations that may result in no decontamination of N95s are:
    • The Decontamination Technician will inspect N95 respirators for residual lipstick/makeup contamination on the inside surfaces prior to processing them. If contamination is found, the N95 will be discarded, the unit/department leadership will be notified and a log entry will be made.
    • If obvious damage/defects are noted on any N95 submitted for decontamination, it will be discarded by the Decontamination Technician, the unit/department leadership will be notified and a log entry will be made.

Final: 03.30.20

N95 guide
Updated on 12/08/2020 at 1:21 pm

View frequently asked questions about N95 respirators to be used during aerosol-generating procedures here.

Videos: Donning and doffing

COVID-19 PPE

COVID-19 with N95

COVID-19 with CAPR

Social distancing: We stand together, safely