Respiratory and Eye PPE Selection Guidance for Patient Care Activities & Settings

Summary of revisions:

05/01/2021 Document created

07/13/2021

07/27/2021

08/17/2021

01/10/2022

Document revised to include all respiratory infectious disease and reflect CDC guidance on PPE requirements for care of COVID patients

Added Appendix III & IV, relevant to conditions of Moderate, Substantial, and High COVID 19 community transmission

Added specific roles to tables on pages 9 12

Replaced “level 1, 2, or 3 mask” with “medical grade facemask. All facemasks sourced by HCA are medical grade. Supply chain will provide specific types of masks in needed areas (i.e. surgery)

02/28/2022

04/07/2022

Updated language to include new CDC Community Levels alongside Community Transmission. Removed OSHA ETS language due to expiration. Note that some states have adopted OSHA ETS language and those requirements should continue to be followed locally

Removed non patient care areas and changed guidance title to indicate patient care areas specifically. Non patient care areas (i.e. administrative offices, kitchens, cafeterias etc.) should follow guidance provided for those areas.

05/05/2022

09/27/2022

Removed CDC Community Levels language as CDC recommends use of Community Transmission specifically for healthcare settings. Regrouped levels so High Community Transmission has its own requirements and Low/Moderate/Substantial are together.

Updated minimum respiratory protection requirements for select patient care activities & settings in non high transmission scenarios to include an option for no mask in alignment with CDC updates from 09/23/2022. Added notes to Scope section regarding respiratory protection in relation to Flu and standard transmission based precautions.

10/05/2022

Clarified that visitors in rooms with patient with confirmed or suspected COVID 19 or other infectious respiratory disease should wear a medical grade facemask while in that room. This is in alignment with transmission based precautions.

PURPOSE

• Outlines respiratory and eye protection an individual performing patient care and/or within a patient care area should wear with regards to COVID 19 community transmission level

• For use by Division, Facility and Department clinical and operational leaders, direct caregivers, and other staff who are responsible for ensuring the use of appropriate PPE in patient care areas

SCOPE

• Respiratory and eye protection for COVID 19 considerations. Always adhere to transmission based precautions as outlined by CDC in relation to other patient symptoms/illnesses/care activities/etc.

• Surgical Services has provided specific guidance for PPE in Operating Room and other Procedural Areas, available here

• Non patient care areas (i.e. administrative offices, kitchens, cafeterias, etc.) should follow PPE guidelines designated forthose settings

• NOTE: This document does not address masking requirements as related to HCA Healthcare colleagues and flu vaccination. Refer to HR Communicable Disease policy HR.ER.006 (link available here) for details.

IMPORTANT CONSIDERATIONS

• PPE requirements in this document meet minimum requirements for individual safety and alignment with CDC recommendations. Higher levels of respiratory and eye PPE should be made available to all colleagues upon request.

• Aerosol Generating Procedures (AGP) guidance is located here

• In instances of respiratory infectious disease surge and/or PPE shortages, additional supplementary guidance may be appropriate regarding selection and stewardship/conservation measures for PPE

• If unable to fit test to a NIOSH approved N 95, PAPR or CAPR can be substituted

• Cloth masks should not be worn in patient care areas with the exception of visitors if they decline a medical grade mask

PROCESS

1. Review each appendix and conduct assessment of current practices (repeat as necessary based on updates)

2. Adjust practice as needed to meet standards set forth in this document

3. Educate and clearly communicate the importance of appropriate PPE selection and compliance

Appendix I

Low/Moderate/Substantial Community Transmission

DIRECT CARE PROVIDERS

Individual/Role Patient Care Activity or Setting

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

• Caring for patient with NO confirmed or suspected respiratory or infectious disease

• Caring for patient WITH nonCOVID respiratory infectious disease (i.e. flu, rsv)

Minimum Respiratory Protection

• No facemask

OR

• Medical grade facemask

• No facemask

OR

• Medical grade facemask

Minimum Eye Protection

• None

• None

• Adhere to standard transmission based precautions guidance

Direct Care Providers

(including, but not limited to: RN, MD, RT, PCT, Dialysis)

• Caring for patient WITH confirmed or suspected COVID 19

• AGP

Patient with NO confirmed or suspected respiratory disease

• AGP (or within 30 min of AGP)

Patient WITH confirmed or suspected respiratory disease (including COVID-19)

1

• Fit-tested NIOSH approved N95 respirator

• Medical grade facemask OR

• Non fit tested NIOSH approved N95 respirator

• Fit tested NIOSH approved N95 respirator

important considerations

• Face shield OR

• Goggles

• None

• Face shield OR

• Goggles

Appendix I

Low/Moderate/Substantial Community Transmission

EVS AND FANS

Individual/Role Patient Care Activity or Setting

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

• Patient room with NO confirmed or suspected respiratory or infectious disease

• Patient room WITH non COVID respiratory infectious disease (i.e. flu, rsv)

Minimum Respiratory Protection Minimum Eye Protection

• No facemask

OR

• Medical grade facemask

• No facemask OR

• Medical grade facemask

• None

• None

• Follow transmission based precautions

Environmental Services

• Patient room WITH confirmed or suspected COVID 19

• Fit tested NIOSH approved N95 respirator

• Face shield OR

• Goggles

Food and Nutrition Services

• AGP Room

Patient with NO confirmed or suspected respiratory disease

• Medical grade facemask OR

• Non fit tested NIOSH approved N95 respirator

• None

• AGP Room (or within 30 min of AGP)

Patient WITH confirmed or suspected respiratory disease (including COVID-19)

NOTE: When possible, do not enter room while AGP in progress

• Fit tested NIOSH approved N95 respirator

• Face shield OR

• Goggles

Appendix I

Low/Moderate/Substantial Community Transmission

NON DIRECT CARE STAFF

Individual/Role Patient Care Activity or Setting

Non Direct Care Staff (including, but not limited to: administration, volunteers, clergy, screeners, facilities management, plant ops, vendor)

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

Minimum Respiratory Protection Minimum Eye Protection

• No facemask

OR

• Medical grade facemask

• None

• Occupied patient room or assisting with clinical care

See Page 1

• Refer to table for Direct Care providers

this document

important considerations

Appendix I

Low/Moderate/Substantial Community Transmission

PATIENTS

Individual/Role Activity or Setting Minimum Respiratory Protection

• None (except if required during specific care task)

Minimum Eye Protection

• In patient room

Patient

• Outside of patient room

NOTE: IF patient with confirmed orsuspected COVID 19 or other infectious respiratory disease, wearmedical grade facemask when healthcare worker is present

• None

NOTE: IF patient with confirmed or suspected COVID 19 or other infectious respiratory disease, wear medical grade facemask outside of room per standard transmission based precautions

See Page 1 of this document for important considerations

• None

• None

Appendix I

Low/Moderate/Substantial Community Transmission

VISITORS

Individual/Role Activity

Setting

• Patient room WITH confirmed or suspected COVID 19 or non COVID respiratory infectious disease (i.e.flu, rsv)

NOTE: IF patient with confirmed or suspected COVID19 or other infectious respiratory disease is receiving an AGP, vacate room while AGP is in process and return after 30 minutes if possible

Minimum

• Medical grade facemask (recommended)

OR

• Cloth Mask (visitor’s own)

• No facemask

OR

Visitor

• Patient room with NO confirmed or suspected respiratory or infectious disease

• Cloth Mask (visitor’s own)

OR

• Medical grade facemask

• No facemask OR

• None

• None

• Outside of patient room

• Cloth mask (visitor’s own) OR

• Medical grade facemask

• None

Appendix II

Low/Moderate/Substantial Community Transmission

Appendix III

High Community Transmission

DIRECT CARE PROVIDERS

Individual/Role Patient Care Activity or Setting Minimum Respiratory Protection Minimum Eye Protection

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

• Caring for patient with NO confirmed or suspected respiratory or infectious disease

Direct Care Providers

• For highlighted scenarios, strongly recommend non fit tested NIOSH approved N95 respirators unless specific request for fit-tested NIOSH approved N95.

• Ensure appropriate training.

• Caring for patient WITH nonCOVID respiratory infectious disease (i.e. flu, rsv)

• Caring for patient WITH confirmed or suspected COVID 19

• AGP

Patient with NO confirmed or suspected respiratory disease

• AGP (or within 30 minutes of AGP)

Patient WITH confirmed or suspected respiratory disease (including COVID 19)

• Medical grade facemask

• Non-fit tested NIOSH approved N95 respirator (recommended)* OR

• Medical grade facemask

• Non-fit tested NIOSH approved N95 respirator (recommended)* OR

• Medical grade facemask

• Fit-tested NIOSH approved N95 respirator

• Face shield or goggles recommended but not required

• Face shield OR

• Goggles

• Face shield OR

• Goggles

• Face shield OR

• Goggles

• Fit-tested NIOSH approved N95 respirator

• Fit-tested NIOSH approved N95 respirator

considerations

• Face shield OR

• Goggles

• Face shield OR

• Goggles

Appendix III

High Community Transmission

EVS and FANS

Individual/Role Patient Care Activity or Setting

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

Minimum Respiratory Protection Minimum Eye Protection

• Medical grade facemask

Environmental Services Food and Nutrition Services

• Patient room with NO confirmed or suspected respiratory or infectious disease

• Non fit tested NIOSH approved N95 respirator (recommended) OR

• Medical grade facemask

• Face shield or goggles recommended but not required

• Face shield OR

• Goggles

• Patient room WITH non-COVID respiratory infectious disease (i.e. flu, rsv)

• Non-fit tested NIOSH approved N95 respirator (recommended) OR

• Medical grade facemask

• Face shield OR

• Goggles

• For highlighted scenarios, strongly recommend non fit tested NIOSH approved N95 respirators unless specific request for fit-tested NIOSH approved N95.

• Ensure appropriate training.

• Patient room WITH confirmed or suspected COVID-19

• AGP Room

Patient with NO confirmed or suspected respiratory disease

• AGP Room (or within 30 minutes of AGP)

Patient WITH confirmed or suspected respiratory disease (including COVID-19)

NOTE: When possible, do not enter room while AGP in progress

• Fit-tested NIOSH approved N95 respirator

• Fit tested NIOSH approved N95 respirator

• Face shield OR

• Goggles

• Face shield OR

• Goggles

• Fit-tested NIOSH approved N95 respirator

See Page 1 of this document for important considerations

• Face shield OR

• Goggles

Appendix III

High Community Transmission

NON DIRECT CARE STAFF

Individual/Role Patient Care Activity or Setting

Non Direct Care Staff (including, but not limited to: administration, volunteers, clergy, screeners, facilities management, plant ops, vendor)

• Unoccupied patient room or other shared space on the unit (i.e. hallways, supply rooms, nursing stations, etc.)

Minimum Respiratory Protection Minimum Eye Protection

• Medical grade facemask

• None

• Occuped patient room or assisting with clinical care

• Refer to table for Direct Care providers

See Page 1 of this document for important considerations

Appendix III

High Community Transmission

PATIENTS

Individual/Role Activity or Setting

• In patient room

Patient

• Other shared space on the unit (i.e. hallways, bathrooms, etc.)

Minimum Respiratory Protection Minimum Eye Protection

• None (except if required during specific care task)

NOTE: IF patient with confirmed or suspected COVID 19 or other infectious respiratory disease, wear medical grade facemask when healthcare worker is present

• Medical grade facemask

• None

• None

VISITORS

Individual/Role Activity or Setting

• In patient room

Visitor

NOTE: IF patient with confirmed or suspected COVID 19 or other infectious respiratory disease is receiving an AGP, vacate room while AGP is in process and return after 30 minutes if possible

• Other shared space on the unit (i.e. hallways, bathrooms, etc.)

Minimum Respiratory Protection Minimum Eye Protection

• Medical grade facemask (preferred)

OR

• Cloth mask (visitor’s own)

• None

• Medical grade facemask

• None

Appendix IV

High Community Transmission