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.