Improving the Protection of Health Care Workers in Health Systems

^{By Julie Gould}

Kristy Warren MSN-Ed, RN, BA, CLLM, director, Clinical Resources for Encompass Group, reviews current PPE issues facing health care workers, rates of reusing PPE among health care professionals, and highlights a new solution to help address PPE shortages.  

Please introduce yourself and tell us about your background in health care. 

I began my nursing career in the emergency department with a focus on trauma and advanced cardiac life support.  While working in the ED in 2008, I joined the American Heart Association where I held the role of advanced cardiac life support Instructor teaching health care providers advanced and basic life support.  Over the course of seven years in the emergency setting I held several roles of increasing responsibility including leadership.  In 2011, I transitioned into the In-patient acute care setting in the role of critical care nurse educator. While earning my Masters in Nursing Education, I was promoted to lead educator responsible for leading all clinical educators in an acute care facility. When a need arose at this facility, I was asked to lead a critical care in-patient unit and team.  In July of 2016, I joined Encompass Group, LLC in the role of Director of Clinical Resources. 

Can you talk a little about the PPE issue facing health care workers? How have we seen it change as the pandemic rages on?

I don’t think any health care worker or health care organization could have ever imagined the magnitude of this pandemic. Typically, hospitals have enough PPE in storage to endure any delay of supply, but no one was ready for the global shortage of PPE production and lack of availability. As a result, this created a shortage of PPE which left health care workers vulnerable. This led to standards of protection we never considered before such as reusing valuable PPE that would normally be disposed of significantly raising the potential infection risk to the provider. Until there was more knowledge of the virus health care workers did not properly understand how COVID -19 was transmitted, and upon learning that it was transmitted through respiratory droplets health care workers became aware of how vulnerable they are especially in circumstances that introduce aerosols or respiratory droplets into the space around them. 

Can you talk about the rates of reusing PPE among health care professionals? How is this putting both the clinician and patient at risk? 

Due to the shortage of valuable PPE such as the N95 masks, health care workers are faced with having to reuse these items.  Prior to the pandemic providers would use a N95 and discard it after use.  With the pandemic health care facilities are looking into best practices on how to reuse N95s, how many times they may be used and how often.  The CDC currently offers some strategies for optimizing the supply of N95s.  Suggestions are made depending on burn rate or the amount being used and discarded. This includes having the provider wear the mask for an extended period of time (not removing or doffing it) while having multiple patient encounters.  There are also recommendations for storage of the N95s in paper bags in hopes that the virus would die off during a waiting period. 

Limitations to reusing the PPE would include fit, filtration rates, contamination and / or damage.  In scenarios where the health care providers are in direct contact with known or suspected COVID-19 positive patients it is critical to have full protection.  Providers are at an increased risk if their PPE is lose fitting, does not seal properly, or is damaged or heavily soiled (which may not always be visible).  Those providers that are performing aerosol generating procedures are at the greatest risk due to the microscopic size of the respiratory droplets and close proximity to the patient.  

Discuss some details about COVAIRE. How can this solution help address PPE shortages? 

Encompass Group, LLC recently announced COVAIRE™, an innovative new product that helps contain viral aerosols using a clear plastic disposable barrier. COVAIRE provides visual access with ease of maneuverability while further protecting the health care worker from aerosolized particles during high-risk aerosol-generating procedures. It’s an additional layer of protection to compliment providers’ current PPE. 

COVAIRE is generously sized–adequate length and girth for a bariatric patient–and made of a clear, medical grade film that’s safe, comfortable, and lightweight. With its contoured silhouette, COVAIRE tucks under the patient’s head, covering the temporal and ear regions. A curved opening on each side allows the provider to insert his/her arms for a full range of movement without restriction when operating an apparatus, intubating or extubating. COVAIRE does not move while in use. Once a procedure is complete, COVAIRE folds up, aerosolized viral particles are contained on the product and can be safely disposed of. 

COVAIRE’s cost-effective, small individual package size allows it to be stored for easy access in code, respiratory, and anesthesia carts. It can be utilized in all patient care areas: OR, ICU, ED, In-patient, Out-patient, and Cardiology.

Containing the viral particles on the COVAIRE reduces or mitigates the risk of contaminated viral particles attaching to valuable PPE that may need to be reused and further minimizes the risk of the health care provider exposure.   

On a broader scale, how can solutions like COVAIRE help health care clinicians? 

Research shows us that the risk of spreading COVID -19 is highest during aerosol generating procedures (AGP). We have also discovered that the virus may linger in the air from minutes to hours putting everyone entering or exiting the room where an AGP may have occurred at risk.  COVAIRE acts as an additional form of necessary PPE that aids in trapping and containing the viral respiratory droplets to further prevent the airborne release or exposure in the environment.  Once the procedure is completed, the COVAIRE is then discarded in a manner that contains the viral particles. 

Is there anything else you would like to add?

Adhering to strict COVID-19 protocols and adding additional levels of protection when appropriate will help to mitigate the risks associated with caring for this population. Health care workers should be frequently updated on changes in protocols to ensure increased safety, awareness, and further prevent the spread of the virus. Health care professionals should stay up to date on all new developments and research done on COVID -19 and consistently evaluate and update their current protocols. Protocols can be significantly strengthened by adding COVAIRE as an additional layer of protection for aerosol generating procedures to further mitigate risks and protect health care providers.