PPE, AGMPs, and PCRAs: COVID-19

PPE Basics

The current Best Practice PPE requirements for COVID-19 are droplet/contact precautions (gloves, gown, eye goggles or face shield, and a surgical mask) EXCEPT when an Aerosol Generating Medical Procedure (AGMP) is going to be performed, which requires an N95 instead of a surgical mask (3,4). Please see “What is an AGMP?” in the next section for more details.

Example: Droplet/Contact Precautions

**Please refer to the local policies and procedures at your facility to ensure you are adhering to them**

Infection Prevention and Control: COVID-19

This guidance updates and consolidates infection prevention and control guidance for managing COVID-19 in acute healthcare settings.

Link: Infection Prevention and Control for COVID-19: Second Interim Guidance for Acute Healthcare Settings

Donning and Doffing PPE

Many HCWs have been shown to infect themselves (self-contamination) due to improper donning and doffing of PPE (5,6). It is highly advised each person reviews these processes and follows a visual guide whenever possible to protect themselves and their patients. Here are some helpful links:

Donning:

Poster: Donning (put on) Personal Protective Equipment

Video: Donning Personal Protective Equipment

Doffing:

Poster: Doffing (taking off) Personal Protective Equipment

Video: Doffing Personal Protective Equipment

What is an AGMP?

COVID-19 is a droplet respiratory virus. This means it spreads with droplets that are produced by coughing, sneezing, etc. Surgical masks protect against droplets as they are large enough to be filtered by a surgical mask. These COVID-19 droplets can become small enough to pass through the mask with any procedures which cause aerosolization (see below). An N95 mask filters these particles and is therefore required for all AGMPs (3,4,11). AGMPs are:

• Autopsies involving respiratory tissues
• CPR
• Bag valve mask ventilation
• Bronchoscopy and bronchoalveolar lavage
• Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP)
• Intubation and extubation procedures
• Nasopharyngeal aspirates (*NOT NPS swabs*), washes, and scoping
• Nebulized therapy
• Open airway suctioning
• Sputum Induction
• High flow oxygen (Optiflow, flow rates >30L/min)

What is a Point-of-Care Risk Assessment (PCRA)?

A PCRA must be performed before every patient care interaction. It is a quick method to determine risk and PPE requirements. The assessment focuses on 3 factors: environment, patient, and the type of care being done (12). In almost all areas the bare minimum of gloves, mask, and eye protection for any suspected COVID-19 patient is required, and many facilities also require the use of gowns (3,11,13).

*PLEASE REFER TO THE LOCAL POLICIES AND PROCEDURES IN YOUR CARE AREA*

An example of the process of the Point-of-Care Risk Assessment can be found here: Point of Care Risk Assessment

Please see the links below if you would like some examples of which PPE you might want wear in your care area *remember to follow local policies and procedures*

PPE Recommendations for Community – VCH

PPE Recommendations – Acute – VCH

References

1. World Health Organization. Q&A on coronaviruses (COVID-19) [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses
2. Johns Hopkins University and Medicine. COVID-19 Map – Johns Hopkins Coronavirus Resource Center [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://coronavirus.jhu.edu/map.html
3. British Columbia Centre for Disease Control. Respiratory protection for health care workers caring for potential or confirmed COVID-19 patients [Internet]. 2020 Mar [cited 2020 Aug 11]. Available from: http://www.bccdc.ca/Health-Info-Site/Documents/Respiratory-protection-COVID19.pdf
4. Public Health Ontario. IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 [Internet]. 2020 Jul [cited 2020 Aug 11]. Available from: https://www.ontario.ca/laws/regulation/930067
5. Alberta Health Services. COVID-19 Scientific Advisory Group Rapid Response Report [Internet]. 2020 Apr [cited 2020 Aug 11]. Available from: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-hcw-clothing-personal-items-report.pdf
6. P Suen LK, Ping Guo Y, K Tong DW, M Leung PH, Lung D, P Ng MS, et al. Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission. Antimicrob Resist Infect Control [Internet]. 2018 [cited 2020 Aug 11];7(157):1–9. Available from: https://doi.org/10.1186/s13756-018-0433-y
7. Vancouver Coastal Health Infection Prevention and Control. Donning (put on) Personal Protective Equipment [Internet]. 2020 [cited 2020 Aug 11]. Available from: http://ipac.vch.ca/Documents/Acute Resource manual/Donning PPE.pdf
8. Vancouver Coastal Health Clinical Education. Donning Personal Protective Equipment – YouTube [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://www.youtube.com/watch?v=eJsKmcblkiA&feature=youtu.be
9. Vancouver Coastal Health Infection Prevention and Control. Doffing (take off) Personal Protective Equipment [Internet]. 2020 [cited 2020 Aug 11]. Available from: http://ipac.vch.ca/Documents/Acute Resource manual/Doffing PPE.pdf
10. Vancouver Coastal Health Clinical Education. Doffing Personal Protective Equipment – YouTube [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://www.youtube.com/watch?v=ooZqZdehBCg&feature=youtu.be
11. Vancouver Coastal Health. PPE Recommendations-Acute [Internet]. 2020 Apr [cited 2020 Aug 11]. Available from: http://ipac.vch.ca/Documents/COVID-19/Dress Codes and PPE/PPE_Recommendations_%28Acute%29_V2.pdf
12. Hamilton Health Sciences. Point of Care Risk Assessment [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://www.hamiltonhealthsciences.ca/wp-content/uploads/2020/06/PointOfCareRiskAssessment_June3.pdf
13. Vancouver Coastal Health. PPE Recommendations- Community [Internet]. 2020 Apr [cited 2020 Aug 11]. Available from: http://ipac.vch.ca/Documents/COVID-19/Dress Codes and PPE/PPE_Recommendations_%28Community%29.pdf
14. World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions [Internet]. 2020 [cited 2020 Aug 11]. Available from: https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions