Practical Solutions for Healthcare Worker Protection During the COVID-19 Pandemic Response in the Ambulatory, Emergency, and Inpatient Settings

Abstract

Objective: Protecting healthcare workers is an essential component of a successful response to the COVID-19 pandemic. The resource intensive nature of infectious disease protection, budgetary constraints, and global shortages of personal protective equipment (PPE) make this a daunting task. Practical, easily implemented strategies for healthcare workers (HCW) protection are needed. Methods: We cross-reference the “Systems, Space, Staff, and Stuff” paradigm from disaster management and the “Hierarchy of Controls” approach to infection prevention from the Center for Disease Control and Prevention (CDC) to generate a narrative overview of worker protection strategies relevant to COVID-19. Results: Alternative types of PPE, management of hazards, and reorganizing how people work can optimize HCWs protection. Conclusions: A comprehensive PPE strategy can utilize the “systems, space, staff, stuff” paradigm of disaster management to identify new or underutilized solutions to HCWs protection.

Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings

“…This framework was developed by the National Institute of Occupational Safety and Health (NIOSH) to describe interventions to improve workplace safety by reducing workplace hazard risk. 14 , 15 This framework has been applied to a variety of workplace settings, including healthcare, during the pandemic to prevent risk of exposure to SARS-CoV-2 (i.e, the “hazard”), to health care providers (HCP), patients, and visitors. The framework includes elimination, substitution, engineering controls, administrative controls, and use of personal protective equipment (PPE), in descending order ( Figure 2 ).…”

“…While correct and consistent use of PPE is a cornerstone of HCP and patient safety, it appears at the bottom of the pyramid as it is susceptible to human error and requires compliance. 15 In the setting of the COVID-19 pandemic, universal source control (i.e., use of a facemask for HCP, patients, and visitors) has been implemented and associated with reduced risk of transmission. 47 , 48 , 49 , 50 , 51 Additionally, use of eye protection (i.e., face shields or goggles) is recommended for use by HCP in all clinical encounters during periods of substantial to high community transmission as a barrier to prevent direct mucous membrane inoculation and contamination of the eyes by hands.…”

Continuum of care for patients with obstructive sleep apnea after one year from the COVID-19 pandemic onset: no time for further delays

“…The correct selection of PPE is based on the nature of patient interaction and the likely mode of transmission. Thus, the use of PPE in a sleep center should be adequate to the different level of risk associated with closeness to the patient [ 35 , 58 ]. The CDC strongly recommends, even when the risk of contamination is low to protect both airways and eyes [ 59 ].…”

“…Extended use of respirators, referring to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients without removing the respirator between patient encounters, is considered the best option [ 59 ]. Higher level of protection (N99 or N100) is suggested if performing aerosol-generating procedures [ 35 , 58 ]. Eye protection should be always worn during patient care encounters to ensure that also the eyes are protected from exposure to respiratory secretions, though this is often omitted in the ambulatory setting[ 59].…”

Unused Non-sterile Latex Disposable Gloves Contamination with Healthcare-associated Bacteria and Contamination Reduction by Reminder Signs

“…Safety of healthcare workers and patients, including the response to the currently ongoing COVID-19 pandemic (Kraus et al, 2020), requires hand hygiene and disinfection, which remains the main recommended practice aimed at reducing healthcare-associated infections (Haque et al, 2020;Kingston et al, 2016;Nishiwaki and Ichikawa 2014). Nonsterile latex disposable gloves (NSLDGs) are commonly used to protect healthcare workers' hands against the spread of pathogens (Picheansanthian and Chotibang 2015).…”