Personal Protective Equipment
PPE is regarded as the primary mechanism by which to reduce transmission of the SARS-CoV-2 virus to healthcare workers. Barrier protection with gowns, gloves, face shields and surgical masks may be augmented with respiratory filtration systems, including N95 masks and powered air-purifying respirator (PAPR) systems. At the UCSF Medical Center, we created a paradigm to delineate PPE for AGPs, which carry a higher risk for healthcare providers. Because of the potential for asymptomatic SARS-CoV-2 infection, we recommend the same level of precautions and PPE in COVID-19 positive and asymptomatic patients undergoing aerosol generating procedures.
The perioperative PPE guidelines developed at UCSF are outlined in Table 2. All team members involved in tracheostomy (anesthesia, surgery, nursing) don contact and airborne precaution-level PPE, including gown, double gloves, and either N95 respirator and face shield or PAPR hood. To conserve PPE, N95 masks may be reused in the setting of asymptomatic or COVID-negative patients. For known COVID-19 positive patients or person under investigation (PUI), N95 masks should be single-use.
Donning and doffing of PPE must be appropriately carried out. Fit testing protocols for respirators and education for providers on proper PPE use are necessary. Proper doffing of PPE is particularly critical, as this is the most likely time for inadvertent self-contamination. A PPE “champion” observer may be utilized to monitor providers during doffing of PPE to ensure adherence to proper protocol.