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On Shift PPE
(Click the link to comment and to vote – voting not working through email, sorry!)
Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
Couldn’t put every possibility, so pick the one closest to what you are doing. Also, your choice may depend on your hospital’s recommendations and your PPE availability
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Jas March 14, 2020 - 12:03 pm
Our current ED plan:
– Surgical mask for all patient encounters
– N95 if being admitted and high concern for COVID19 (travel, known contact, “risk factors”/clinical judgement) or presenting in extremis
– CAPR during airway manipulation
Kelly March 14, 2020 - 4:10 pm
It is unclear whether COVID-19 is transmitted significantly via the airborne route (like measles, chickenpox, TB) or only via droplets (like all the other respiratory viruses), but it is looking more and more like respiratory droplet precautions are sufficient for most encounters. Guidelines still recommend airborne precautions for aerosol generating procedures. The latest CDC recommendations can be found here: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html Guidance for when running out of PPE can be found here https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html
and for N95 re-use here https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
A Feb 16-24 WHO-China Joint Mission Report https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
stated that: household transmission is the most common method of transmission, between 1-5% of traced contacts of a positive case were also positive, most healthcare worker infections occurred early in the outbreak and many of the HCW were potentially infected in their household, children < 18 years old had a relatively low attack rate (2.4% of all reported cases). South Korea has been testing more aggressively than other countries, and has found a 0.6% case fatality rate.
EMCrit has a nice up to date summary of what we know about COVID-19 so far. https://emcrit.org/ibcc/covid19/