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 Subject : Prevention of Staff exposure (Answer in Text).. 04/22/2020 10:50:06 AM 
Leopoldo Rodriguez, MD, MBA, FAAAP, FASA, SAMBA-F
Posts: 53
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ANSWER:

To prevent staff exposure to the virus through carriers, CDC guidelines should be followed:
1. Handwashing as recommended by the CDC.
2. Patients will also do hand hygiene upon entering the facility. ALL patients should be considered asymptomatic carriers and should wear at least a Level 1 ASTM face mask in the clinical areas.
3. All staff will wear Level 3 masks during patient care.
4. Visitors will not be allowed in clinical areas, except for pediatric patients, limiting to one visitor, wearing a level 1 mask.
5. Staff should wear appropriate PPE depending on the exposure to COVID-19:
6. Staff participating in Aerosolizing procedures and nurses taking care of the patient in post-anesthesia recovery: EGD, bronchoscopy, airway surgery, intubations, and others, should wear N95 mask, gown, gloves, face shield or goggles.
7. Non-Aerosolizing procedures and staff taking care of them in post-anesthesia recovery: wear level 3 mask.
8. Patients in the recovery room should be physically separated as well to prevent cross-infection from patient to patient or patient to provider.
 Subject : Re:Prevention of Staff exposure (Answer in Text).. 04/22/2020 11:58:02 AM 
Dr. Gregory Dodson
Posts: 2
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Dr. Rodriguez,
At present our institution (hospital owned ASC in NJ performing only urgent procedures) we are not having our PACU staff wear level 3 masks regardless of type of anesthetic if the patient is asymptomatic and/or COVID negative. We are currently supplying the PACU staff with looped procedural masks. All PPE mandates have come from our parent hospital administration and our COVID taskforce. What references do you have to support this practice? As the medical director of our ASC, I have been concerned about recovery room patients and their tendency to cough and aerosolize secretions in PACU. To this end, we have provided all staff with goggles and face shields, but due to PPE shortages our current masks do not meet the standards you are proposing.
Thank you
 Subject : Re:Prevention of Staff exposure (Answer in Text).. 04/22/2020 12:46:10 PM 
Leopoldo Rodriguez, MD, MBA, FAAAP, FASA, SAMBA-F
Posts: 53
Location: 
Hi Gregory

In a different post, I talked about what are the Mask ASTM levels and what protection do they offer.

The concern is that:
A procedural mask as we wear them all day (to prevent exposure we wear them at all times in clinical areas,) they get wet and decrease their quality, don't protect vs droplets.
Level 3 masks (surgical masks) offer more resistance to humidity and protect against droplets.
We are staying the rooms for about 10 minutes after we wake up the patients to prevent cough, manage airway symptoms in the OR / Procedure room, instead of exposing everyone in the PACU to a potentially asymptomatic patient.

Here is a good reference from the CDC:
https://www.cdc.gov/niosh/docs/2015-117/pdfs/2015-117.pdf go to page 9:

"When Droplet Precautions are recommended, surgical masks function to reduce the transmission of large infectious droplets between the source (patient) and the mucosal surfaces of a susceptible host (healthcare personnel)."

"When Airborne Precautions are recommended, respirators and other control measures, such as patient isolation in an airborne infection isolation room (AIIR) with specialized ventilation, are used to protect healthcare personnel from inhaling infectious particles that are of small diameter, likely to remain infectious over long time or distance, or both."
 
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