Below are common questions, answers, and resources for our NorthStar Anesthesia clinicians and corporate employees. We will keep this information updated on a regular basis. If you have questions that are not addressed below, please reach out to [email protected].
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Here is a CDC link with good information: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
First, notify the infection control provider for your facility and ask for additional guidance. Here is a CDC link with good information including a chart to provide guidance depending on the specifics of the exposure. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
The CDC provides an overview at this link: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html
Here is a link from the CDC with general information on personal protective equipment. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
Contact your local leader and the infection prevention provider for your facility.
The video link below is another excellent source of information for the need and the process for safe PPE donning and doffing. Please keep in mind when doffing the equipment that it may be contaminated and extra precaution should be taken if you have been exposed to SARS-CoV-19 virus.
Stanford University and 4C Air, Inc. published March 25, 2020: Can N95 facial masks be used after disinfection? And for how many times?
https://m.box.com/shared_item/https%3A%2F%2Fstanfordmedicine.box.com%2Fv%2Fcovid19-PPE-1-1
Summary:
“Bleach and microwaves were failures at point of care because the bleach gases (skin and respiratory irritants) remained after multiple strategies were used to remove them, the microwave melted the masks and soaking them first led to reduced filtration. EtO, UVGI, and hydrogen peroxide decontamination were safe and effective in the models tested but it is not known if they would retain filtration, material strength, and airflow integrity with repeated use. EtO, UVGI, and hydrogen peroxide limitations include time from decontamination to reuse and available space and materials to decontaminate in an OR setting. 70C /158F heating in an oven (not your home oven) for 30min, or hot water vapor from boiling water for 10 min, are additional effective decontamination methods” (“N95 Mask UPDATE”; pp 5, 6)
N95 Filtering Facepiece Respirators Decontamination and Reuse (FFR-DR)
N95 reuse is certainly not optimal, however if faced with a choice of reusing an N95 vs. improvising (using a mask which hasn’t been certified or fit-tested), the clear choice is to decontaminate and reuse (DR).
The following are some suggestions based upon the primary sources below when reusing an N95 mask:
Manufacturers say to use the masks up to 8 hours and discard, however if decontaminated and stored properly the mask may be reused multiple times (dependent upon time of usage and decontamination technique).
Covering with a surgical mask and full-face shield (e.g., use of barriers) may help prevent droplet spray contamination. Face shields will be more protective than goggles from droplet contamination.
It is highly advisable that you review the primary literature (see links below) to evaluate your local decontamination resources.
Evidence based ultraviolet germicidal irradiation information from the University of Nebraska should be reviewed and evaluated for local practicality (see below).
Centers for Disease Control
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers.
The decision to implement policies that permit extended use or limited reuse of N95 respirators should be made by the professionals who manage the institution’s respiratory protection program in consultation with their occupational health and infection control departments.
Extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission.
Discard N95 respirators following use during aerosol generating procedures.
Decontaminate and hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses. Discard the paper bag between uses since the inside of the bag may be contaminated.
APIC - Association of Professionals in Infection Control and Epidemiology
Refers to CDC guidelines for conserving respirators and discusses alternatives to N95 respirators, including powered air purifying respirators (PAPRs)
Extending the use or reusing respiratory protection is preferred over prioritizing the allocation of N95 respirators and surgical/procedure masks based on exposure risk.
Consider labeling the respirator with the user’s name to prevent staff from reusing another’s respirator; labeling should be written on the straps whenever feasible to prevent damage to the respirator
AJIC - American Journal of Infection Control
https://www.ajicjournal.org/artic…/S0196-6553(18)30140-8/pdf
https://www.ncbi.nlm.nih.gov/…/PMC46994…/pdf/nihms747549.pdf
University of Nebraska**
https://repository.netecweb.org/items/show/838
**UVGI based decontamination methods, including UV tower and bulb description with workflow process.
UVGI requires appropriate UV equipment. UV dosing (joules/cm2), temperature and humidity measurements may be necessary to ensure appropriate decontamination.
The UVGI method requires dose-dependent decontamination period, however this method “may be most suitable for large-scale applications due to simplicity of use and ability to rapidly scale”.
The results of the NIH study indicate FFR-DR (Decontaminate and Reuse) can be effective. Building on a 2011 study (Heimbuch et al), this study evaluated the decontamination efficiency of an optimized UVGI dose (1J/cm2) delivered to an intact FFR contaminated with both H1N1 influenza and a soiling agent.
For FFR-DR, FFR face pieces pose the greatest challenge for UVGI disinfection, whereas FFR straps can likely be disinfected through alternative means (e.g. disinfecting wipes).
Annals of Work Exposure and Health (2012)
https://academic.oup.com/annweh/article/56/1/92/166111
This study showed that three decontamination methods (UVGI, MGS, and MH) satisfactorily decontaminated the 3M 1860s and 1870 FFRs as measured by a virus culture method.
Within the constraints of the experiment, the three methods were all completely effective for the decontamination of FFRs as assessed by a culture method. These conclusions are further supported by data reported by Heimbuch et al. (2011) in which H1N1 droplets and droplet nuclei applied to six models of FFRs were decontaminated using the same three energetic methods described here.
These findings suggest that, when properly implemented, these decontamination methods could suppress cross-contamination through contact with FFRs during situations in which reusing FFRs is necessary. However, these conclusions apply only to the models tested in this study.
Although this study did not investigate the effect of these treatments on fit, Viscusi et al. (2011) reported no significant decrease in the protective capability of FFRs following decontamination.
Caveat: The consideration for reuse of FFRs following decontamination must address two major issues: first, whether the FFR retains full function and provides a similar level of protection after treatment and second whether the decontamination treatment is effective at reducing the infectious capability of the targeted organism. This study focused primarily on the second point and the development of methods for accurate assessment of the amount of virus contaminating the FFR and the amount removed by the decontamination method.
Annals of Occupational Hygiene (2009)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781738/
Although there are currently no guidelines for the level of decontamination required for contaminated FFRs, multiple FFR-DR methods have shown significant reductions in virus viability. The decontamination method must remove the viral threat, be harmless to the user, and not compromise the integrity of the various elements of the respirator.
Vaporized Hydrogen Peroxide (VHP) decontamination is an option for N95s, if your facility that has this. Hydrogen peroxide vapor is often used to disinfect entire rooms, but a chamber can be made for purposes of mask disinfection.
UVGI is another option but is limited by available equipment, as discussed above (Univ of Nebraska and AJIC).
Ethylene Oxide (EtO) is used in a wide range of work settings as a sterilant or fumigant, including healthcare diagnosis and treatment facilities, and medical products manufacturing.
Microwave oven irradiation and bleach baths were found to be the “least desirable”.
3M Surgical N95 Infographic
https://multimedia.3m.com/…/surgical-n95-vs-standard-n95-wh…
Medical/surgical N95s are appropriate. Hardware store masks have not been studied for efficacy.
Here is CDC's most updated PPE information: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/infection-prevention-control-faq.htm
The CDC has a strategy specifically addressing this concern: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html
Per the CDC (https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html#practices-restrictions), there are two options for determining when a person may end home isolation, using either (1) a test-based option or (2) a non-test based option (a time-since-illness and time-since-recovery).
Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when at least seven days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness.
There are few published reports at this time referring to SARS-CoV-19.
Pregnant women experience immunologic and physiologic changes which make them more susceptible to viral respiratory infections, including COVID-19 when compared to the general public.
In a limited case study (published in peer-reviewed literature) a series of infants born to mothers with COVID-19 none of the infants have tested positive for SARS-CoV-2. Additionally, no significant viral load has been detected in samples of amniotic fluid.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pregnant-women-faq.html
Yes, Society of Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine have issued a joint statement on Labor and Delivery COVID 19 Considerations. Click here to view the document.
Here is a very comprehensive guide for COVID-19 Airway Management protocol: https://icmanaesthesiacovid-19.org/airway-management
Here is an infographic for you to download and post in your anesthesia office, ICUs, and EDs: APSF Airway Infographic
American Patient Safety Foundation has also developed a resource center for COVID-19 information: https://www.apsf.org/novel-coronavirus-covid-19-resource-center/
A professionally manufactured N95 mask is always preferred, however if no alternatives are available you might consider the following video technique.
A surgical mask placed over the filter intake may also provide additional protection.
Some NorthStar teammates are finding success with the “intubating box”. It is simple to use, inexpensive and can be cleaned with bleach or alcohol between uses.
Click here or visit https://intubationbox.com/
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Yes - click here* to access the document.
*This document is restricted to NorthStar Anesthesia employees only. You will be prompted to login using your NorthStar credentials to access the document. For assistance in logging in, please contact [email protected].
Click here for a video on respirator safety.
Below are 12 videos across multiple topics:
How can COVID-19 spread when you don't feel sick?
We understand these are dynamic times and are here to support the local community of patients and providers. However, we are contractually permitted to provide anesthesia care to patients at each of our facilities. Our providers are trained in providing this care and are covered to provide these services to patients. Our providers should be expected to provide the high-level of care contracted with NorthStar. Unnecessary exposure to non-anesthesia patients puts providers at risk and may limit our ability to provide upcoming anesthesia needs. We are here to support the patients that are impacted by COVID-19, however, we cannot ask our providers to provide clinical care that they are not comfortable providing. We will support both the facility and patients when and where our expertise allows.
Yes. Our provider’s work falls in the category of “Essential Services” and because of that, you are able to continue to go to work. Furthermore, NorthStar believes that you should not experience any issues commuting to work as long as you have your facility badge; however, as an extra precaution, we are supplying our clinicians with a letter to carry with them to show to law enforcement, if needed, to further verify their employment. Click on your state below to download the letter*:
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Click here for a summary of HR answers on these topics.
Just send an email to [email protected] and your request will be routed to our IT Service
Please help us ensure that we have the most up to date information on file for our employees should we need to reach all teammates, including those not at the office at the time, by reviewing your Personal and Emergency Contact information in Workday to ensure it is correct.
Click here for step by step instructions for reviewing and updating your information in Workday. Please be aware that contact information is updated with the least number of steps in Workday when doing so from a computer. Click Here to Login to Workday
Thank you for continuing to track your time in Workday for ICU Work and Airway Management. Click here for instructions, if needed. As a reminder, please make sure you or a member of your team is updating the COVID-19 Case Tracker daily for your location.
For step by step instructions on how to request Paid Time Off using the Relief Fund in Workday click here*.
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We've moved our Spotlight stories and pictures to a website. Click here* to access it!
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NorthStar's Spotlight program is a way to highlight a team or individual effort, show appreciation, or share an impactful experience. Our hope is that these stories will help sustain us during the crisis and serve as a reminder of our shared humanity in these trying times.
For more information, please click here*.
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The CDC is continuously changing their recommendations as the Covid-19 situation changes. If you have traveled to China, Iran, most European Countries, United Kingdom and Ireland, you will be required to quarantine for 14 days. This also applies to South Korea. If you want to see the latest specifics from the CDC, use this link- https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
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