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COVID-19: PPE: Getting Resourceful with No Resources, 4/16 · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare-associated infections and antibiotic resistance and seeking to advance the fields of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_01: I am Dr.
• 0:23
  SPEAKER_01: David Bannock from the University of Connecticut School of Medicine, and I'll serve as today's moderator.
• 0:28
  SPEAKER_01: Discussion on the podcast doesn't reflect Shay's perspective, but rather facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:37
  SPEAKER_01: Shay is excited to launch the ninth episode of this podcast, COVID-19 updates, What We Know Now.
• 0:43
  SPEAKER_01: Today's episode will focus on PPE and how we can be resourceful and creative to combat PPE shortages.
• 0:49
  SPEAKER_01: Our speakers today are Dr.
• 0:51
  SPEAKER_01: Jennifer Hanrahan, infectious disease specialist at the University of Toledo Medical Center, and Dr.
• 0:56
  SPEAKER_01: Bernard Caymans, Professor of Medicine and Infectious Diseases at Mount Sinai Hospital in New York City.
• 1:02
  SPEAKER_01: Thank you for joining us today.
• 1:04
  SPEAKER_01: I will now turn it over to Dr.
• 1:05
  SPEAKER_01: Hanrahan to get us started with news and guidance update for the week.
• 1:09
  SPEAKER_00: Thank you, David.
• 1:10
  SPEAKER_00: There were a number of items in the news this week, including a lot of discussion about when to relax social distancing and use of testing, including serological surveys.
• 1:19
  SPEAKER_00: The Infectious Disease Society of America published a COVID-19 rapid treatment guideline for clinicians, which basically recommended doing all treatments with corticosteroids, hydroxychloroquine, and other agents in the context of a clinical trial due to insufficient information about these drugs with regard to COVID-19 at this time.
• 1:39
  SPEAKER_00: The CDC has updated policies for critical infrastructure workers to ensure continuity of operations of essential functions.
• 1:46
  SPEAKER_00: The CDC advises that critical infrastructure workers may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the community.
• 2:00
  SPEAKER_00: Critical infrastructure workers who have had an exposure but remain asymptomatic should be screened by employers prior to starting work, should have regular monitoring, either by self-monitoring or through an occupational health program, wear a mask for 14 days after last exposure, maintain social distancing, and clean and disinfect workspaces and shared equipment.
• 2:19
  SPEAKER_00: Employees should not share headsets or other objects that are near the mouth or nose.
• 2:23
  SPEAKER_00: More details are available on the CDC website.
• 2:27
  SPEAKER_00: The CDC also updated groups at higher risk for severe illness.
• 2:31
  SPEAKER_00: And this includes people who are age 65 and older, and people who live in a nursing home or long-term care facility.
• 2:38
  SPEAKER_00: In addition, people of all ages with underlying medical conditions, particularly if not well controlled, including people with chronic lung disease, people with serious heart conditions, immunocompromised people, people with severe obesity defined as a body mass index of 40 or higher, people with diabetes, chronic kidney disease undergoing dialysis, and people with liver disease are all considered at higher risk for severe illness.
• 3:02
  SPEAKER_00: An MMWR report on hospitalization rates and characteristics of patients with lab-confirmed coronavirus disease for the month of March 2020 in 14 COVID net states show the highest rates in Connecticut, Michigan, and New York.
• 3:16
  SPEAKER_00: The risk of hospitalization when adjusted for age was increased for people over age 65, and there were relatively few hospitalizations for people under age 18.
• 3:27
  SPEAKER_00: In addition, there were relatively few hospitalizations for people with rheumologic disease and pregnancy.
• 3:32
  SPEAKER_00: Another MMWR report published April 14th reviewed infection with COVID-19 in nearly 9,300 healthcare workers and found that there were 723 hospitalizations, including 184 ICU admissions and 27 deaths in healthcare workers.
• 3:49
  SPEAKER_00: 55% of the healthcare workers had only healthcare exposure, 27% only household exposure, 13% community exposure, and 5% had multiple exposure settings.
• 4:00
  SPEAKER_00: The report states that this is likely an underestimation of actual cases in healthcare workers due to testing practices and that efforts to ensure health and safety of healthcare workers both at work and in the community are critical and notes that improving surveillance would be beneficial to all.
• 4:17
  SPEAKER_00: A second MMW article on COVID-19 and healthcare workers described three healthcare workers who developed COVID-19 after unprotected exposure to the first case of community-acquired COVID-19 in the United States.
• 4:29
  SPEAKER_00: The workers who developed infection after exposure had longer exposure times on average, 120 minutes versus 25 minutes total, and were more likely to be present for nebulizer treatments compared with workers who didn't become infected.
• 4:44
  SPEAKER_00: A letter was sent to New Internal Medicine regarding universal screening for women admitted between March 22nd and April 4th to a New York City hospital and found 13.5% had asymptomatic infection with SARS-CoV-2, and 1.9% had symptomatic infection.
• 5:00
  SPEAKER_00: Universal screening for pregnant women may help guide PPEs, neonatal care, and bed placement.
• 5:07
  SPEAKER_00: Data from China has suggested pediatric coronavirus cases may be less severe than cases in adults, and details of symptoms were available for 291 children through an MMWR report and found that relatively few children with COVID-19 are hospitalized, and fewer children than adults experience symptoms, and the symptoms seem to be less severe.
• 5:28
  SPEAKER_00: The implication of this is that children may not have the same symptoms as adults and may play an important role in transmission.
• 5:35
  SPEAKER_00: Finally, there will be many downstream effects from coronavirus.
• 5:39
  SPEAKER_00: One of the important potential problems is an eruption in childhood vaccination schedules, which could lead to further measles, rubella, and other vaccine-preventable illness outbreaks in the future.
• 5:49
  SPEAKER_00: And so this needs to be kept in mind with any interruption in vaccines.
• 5:54
  SPEAKER_01: Thank you, Dr.
• 5:55
  SPEAKER_01: Hanrahan.
• 5:56
  SPEAKER_01: That was a great overview of the most recent updates and guidance.
• 6:00
  SPEAKER_01: I want to transition now to Dr.
• 6:02
  SPEAKER_01: Kaman.
• 6:02
  SPEAKER_01: So, Dr.
• 6:03
  SPEAKER_01: Kamans, thank you for coming onto the podcast.
• 6:05
  SPEAKER_01: You know, really uh appreciate having you share your experience, your practice, and your epidemiology role is at a multi-hospital system in New York City, which has been the epicenter of COVID-19 in the United States.
• 6:18
  SPEAKER_01: So we're excited to hear your perspective.
• 6:21
  SPEAKER_01: I want to take you back to the early days of COVID-19 in your hospital system, thinking about when you saw your first cases and the overall approach and the environment of care and PVE.
• 6:32
  SPEAKER_01: Can you share that experience and we'll talk about how things have evolved since then?
• 6:36
  SPEAKER_02: Thank you, David.
• 6:37
  SPEAKER_02: First of all, it is a pleasure and honor to speak to Shea members about our experience in the New York metropolitan area.
• 6:45
  SPEAKER_02: I actually remember the first patient we ever admitted was to an ICU, and that was actually March 7th.
• 6:51
  SPEAKER_02: It was a Saturday.
• 6:53
  SPEAKER_02: And at that time, we had already diagnosed a few patients on the outpatient side.
• 6:58
  SPEAKER_02: But that day was the first time where we had to admit an inpatient.
• 7:03
  SPEAKER_02: And I think no matter how much we educated our healthcare workers and retrained them on donning and doffing of recommended PPE.
• 7:13
  SPEAKER_02: But even after doing that, they were still very nervous, and we actually had to do training again at the beginning of their shift, so during huddles.
• 7:22
  SPEAKER_02: And there was a lot of PPE use even at that time.
• 7:27
  SPEAKER_02: And I think that is that the sooner you cohort patients, the better.
• 7:31
  SPEAKER_02: Because you ideally want to isolate COVID-19 patients.
• 7:36
  SPEAKER_02: In our situation, it became overwhelming in that keeping patients isolated in single rooms ended up burning our PPE.
• 7:45
  SPEAKER_02: In fact, one of the things that we found while following the CDC recommendation of using N95, preferably for any patient encounter, we saw that we actually burned about a third of our N95 respirator supply within a week.
• 8:02
  SPEAKER_02: And we didn't even have that many patients at that time.
• 8:05
  SPEAKER_02: We just had a lot of PEIs.
• 8:07
  SPEAKER_02: So that was really uh a lesson that we learned very early and had to adopt.
• 8:12
  SPEAKER_01: Thanks for sharing that.
• 8:13
  SPEAKER_01: I think that's uh what's been reflected at a lot of institutions.
• 8:16
  SPEAKER_01: Uh you know, even thinking about my own hospital when we first saw cases of COVID-19 in the hospital, we had initially been very liberal with our PPE use, particularly the N95 respirators, and saw a relatively rapid depletion of our existing supply in those early days, which made us really rethink about how we're using PPE and moving to an era of PPE conservation and stewardship.
• 8:40
  SPEAKER_01: So I want to talk about that with regard to uh the N95 respirators.
• 8:44
  SPEAKER_01: That's been a real focus um at essentially almost all facilities.
• 8:48
  SPEAKER_01: So can you kind of walk us through uh what the experience has been like with regard to the N95 respirators or respirators in generally?
• 8:55
  SPEAKER_01: And I think the two areas that people are most interested in are extended use and reuse of N95 respirators.
• 9:00
  SPEAKER_01: So kind of walk us through how that's all evolved.
• 9:04
  SPEAKER_02: So that evolved very quickly, right?
• 9:05
  SPEAKER_02: So our first case happened on the Saturday.
• 9:08
  SPEAKER_02: Within the next week, we worked out a plan to then recommend extended use and limited reuse based on the OSHA and CDC guidelines that really helped prolong our supply from three weeks to maybe six weeks, right?
• 9:25
  SPEAKER_02: Until we can replenish our supplies.
• 9:27
  SPEAKER_02: And so we then ordered about 25,000.
• 9:30
  SPEAKER_02: Mind you, we have seven acute care hospitals in our system.
• 9:33
  SPEAKER_02: So we also ordered 25,000 paper bags to go along with that.
• 9:38
  SPEAKER_02: And then we distributed the paper bags.
• 9:41
  SPEAKER_02: Nursing were the biggest users, as you might imagine, because they do spend a lot of time with our patients.
• 9:48
  SPEAKER_02: They were the ones who actually ended up doing extended use, while other healthcare workers then would do the limited reuse.
• 9:56
  SPEAKER_02: But everyone then would save their N95 in a paper bag.
• 10:01
  SPEAKER_02: At least we were lucky enough that we were able to provide one per day per person.
• 10:06
  SPEAKER_02: In the beginning, we tried to do the risk-based strategy in terms of needing N95 respirators, meaning only use it when you're performing aerosol generating procedures.
• 10:18
  SPEAKER_02: But because of the fear and anxiety among our healthcare workers, there was really a request that they would like to have it available.
• 10:25
  SPEAKER_02: And again, once we looked into our situation, COVID-19 patients, even those who aren't in ICUs, were very unstable.
• 10:34
  SPEAKER_02: And so there were actually a lot of respiratory arrests.
• 10:38
  SPEAKER_02: Our healthcare workers would then have to run into the room.
• 10:42
  SPEAKER_02: And so it really helped that we just went ahead and provided them with N95s.
• 10:47
  SPEAKER_02: Just about everybody who was working on a COVID unit or COVID ICU.
• 10:52
  SPEAKER_02: When I first saw the guidelines and saying you can do a whole shift wearing an N95, I didn't think that our healthcare workers can do it.
• 11:00
  SPEAKER_02: But it turns out a lot of them can.
• 11:02
  SPEAKER_02: So they would keep it on and then go to lunch and then come back and put it on again.
• 11:07
  SPEAKER_02: And so it can be done.
• 11:08
  SPEAKER_02: And it really does help in terms of prolonging your supplies for N95.
• 11:14
  SPEAKER_01: I agree.
• 11:15
  SPEAKER_01: I think in some areas of our institution, once we started implementing extended use, uh, we saw a dramatic improvement in the rate that we were depleting uh N95 respirators.
• 11:25
  SPEAKER_01: So it can really make a huge difference.
• 11:27
  SPEAKER_01: Now, from your experience, I would ask, do you have any specific tips for institutions that are going to be implementing either extended use or reuse?
• 11:35
  SPEAKER_01: So we found it to be helpful to give explicit instructions and kind of uniform the practice.
• 11:40
  SPEAKER_01: We also found that some settings were more amenable to extended use, but can you share your experience for an institution that's going to be moving towards extended use or reuse of N95 respirator software?
• 11:51
  SPEAKER_02: Yeah, so we actually did a document that did a step-by-step guide on how to do that, including when to put it in a paper bag, not to touch the inside of the N95 respirator.
• 12:03
  SPEAKER_02: And along with that, we actually also did face shields.
• 12:07
  SPEAKER_02: We promoted the use of face shields so we can actually prevent the N95 from being contaminated, so being covered by a face shield.
• 12:15
  SPEAKER_02: And we did have a shortage of face shields, but our healthcare workers were troopers in terms of wiping down a face shield and you're reusing them.
• 12:24
  SPEAKER_02: And some of them would reuse them for three days in a row.
• 12:28
  SPEAKER_02: And again, our supply chain has improved now that we can actually say they could throw away their face shields after the end of the shift.
• 12:36
  SPEAKER_02: But the other thing that we also recommended was if their choice of eye protection was goggles, to actually cover the N95 with a surgical mask to then also prevent the N95 from being contaminated.
• 12:49
  SPEAKER_02: But we did provide that step-by-step guide on how to do that properly.
• 12:54
  SPEAKER_01: You have a lot of great experience to share.
• 12:56
  SPEAKER_01: So thanks for uh reflecting on some of that.
• 12:58
  SPEAKER_01: We found a similar strategy of using the face shields over the N95s was something that worked quite well, you know, having that barrier and uh reusing the face shields.
• 13:08
  SPEAKER_01: Interestingly, it sounds like there's been a lot of push to uh produce face shields um through 3D printing.
• 13:13
  SPEAKER_01: And I know we've been uh fortunate to benefit from that, but it seems like that's been a real focus of the manufacturing throughout the country is to make these uh face shields, which I think are great barriers to the N95.
• 13:24
  SPEAKER_01: So thinking about the other PPE, uh gowns and gloves are also getting a lot of attention.
• 13:29
  SPEAKER_01: Uh and some hospitals are coming up with shortages of both of those.
• 13:33
  SPEAKER_01: Um, is that something that you've had experience with?
• 13:36
  SPEAKER_02: Yes, it's like playing whack-a-mole with PPE.
• 13:39
  SPEAKER_02: It started out with surgical masks, right?
• 13:41
  SPEAKER_02: Then and 95 respirators, now we're actually dealing with gowns.
• 13:45
  SPEAKER_02: And I have sleepless nights about having only a few days of gowns, but so far we've been lucky to get more supplies in to give us another few days.
• 13:55
  SPEAKER_02: And just to share about the volume is at our peak, we had about 2,200 patients distributed among seven hospitals, and we were using about 100,000 gallons a week.
• 14:06
  SPEAKER_02: That's probably a quadruple of what we normally use anyway without COVID-19.
• 14:12
  SPEAKER_02: And so it's it's been very difficult to actually source them.
• 14:16
  SPEAKER_02: What we found that was very helpful is because we now cannot get 100,000 from one supplier.
• 14:22
  SPEAKER_02: So we are getting, you know, 25,000 from one supplier, and then the city health department and the state health department have been amazing in sending us supplies as well.
• 14:33
  SPEAKER_02: So the issues then we would have level two gowns that look different.
• 14:37
  SPEAKER_02: So one of the things that we did was actually create our own catalog that would be available on the website that our healthcare workers just click on PPE catalog, and we'll show you all the different gowns that we have, the brands and colors, all that that we are distributing, because unfortunately, their gown may change from day to day.
• 14:58
  SPEAKER_02: And they're all not the same.
• 15:00
  SPEAKER_02: I mean, so some may have a back that's a little exposed.
• 15:03
  SPEAKER_02: And so again, unfortunately, it is really hard to find the right one now at this time.
• 15:09
  SPEAKER_02: But certainly having a catalog of all the surgical masks that's available, all the gowns.
• 15:16
  SPEAKER_02: We're lucky we haven't had to have different N95s, but again, if we ever use other N95 respirators, we probably will create that as well.
• 15:25
  SPEAKER_01: I love that catalog idea.
• 15:27
  SPEAKER_01: We've gone through a process where we've introduced new equipment just because we've had new suppliers or even donations of things like gowns and different face masks.
• 15:37
  SPEAKER_01: And sometimes it can be overwhelming to the frontline providers to see something new in practice and there may be some level of discomfort with either how to use it or the level of protection that it provides.
• 15:47
  SPEAKER_01: Is it really equivalent to what the old mask or the old gown was?
• 15:51
  SPEAKER_01: So I think having that catalog is a great idea.
• 15:53
  SPEAKER_01: And then in terms of other PPE uh surgical and procedure masks, have you found that to be uh challenging in any way or had to adapt your utilization of either of those?
• 16:03
  SPEAKER_02: That was the first PPE though short, right, in our institutions.
• 16:06
  SPEAKER_02: And so some hospitals had to resort to having a PPE SWAT team where they would go around and distribute the surgical masks, but that wasn't as acute anymore.
• 16:18
  SPEAKER_02: Once we were able to give out N95s to all healthcare workers who worked in COVID areas, so they would just walk around with their N95s, again, because these are now full COVID units.
• 16:30
  SPEAKER_02: We were probably using about 14,000 N95 respirators a day.
• 16:36
  SPEAKER_02: So that's our burn rate, which is very hard to imagine.
• 16:40
  SPEAKER_02: But so the surgical masks are not a problem anymore, but you know, the gloves may become an issue.
• 16:48
  SPEAKER_02: Our suppliers have said that it may come to a point where our gloves will be short as well.
• 16:53
  SPEAKER_02: And true enough, right?
• 16:54
  SPEAKER_02: Over the weekend, the FDA sent a letter about advising healthcare workers on what to do in case there's a glove shortage.
• 17:02
  SPEAKER_02: And so the only suggestion I would give is potentially to buy utility gloves that our EVS workers can reuse.
• 17:10
  SPEAKER_02: So then they don't have to use the medical gloves, medical grade gloves.
• 17:14
  SPEAKER_02: And then the other potential would be to use vinyl and latex gloves for those purposes.
• 17:21
  SPEAKER_02: So you can save the nitrile ones for patients.
• 17:25
  SPEAKER_02: And the food services workers as well can use vinyl gloves instead of the medical gloves that we use.
• 17:31
  SPEAKER_02: So it's a scary thought, but it could happen.
• 17:34
  SPEAKER_01: That's good advice.
• 17:35
  SPEAKER_01: I would never have imagined that we'd be uh stewards of vinyl gloves, but uh apparently you know it sounds like it's coming to that point.
• 17:42
  SPEAKER_01: So I think any strategy that we can use to try to use our gloves and all of our PPE more efficiently, I think is definitely the way to go.
• 17:50
  SPEAKER_01: And that kind of brings me into the next topic, which is how do you transform your environment of care in a way that optimizes your utilization of PPE?
• 17:58
  SPEAKER_01: You know, there's a lot of movement to IO containment units, uh, you know, at my facility, we've moved in that direction.
• 18:04
  SPEAKER_01: And part of the impetus was really to preserve PPE.
• 18:08
  SPEAKER_01: And I know in in your hospital and your hospital system, you've shifted into COVID units and uh different types of biocontainment units.
• 18:16
  SPEAKER_01: So can you kind of give us the historical perspective of how that's evolved within your system and some of the benefits and maybe even some of the things to watch out for as hospitals make that transition?
• 18:28
  SPEAKER_02: Yeah, sure.
• 18:29
  SPEAKER_02: I think to share just some of our smaller hospitals with 220 beds, they are 90, 95% COVID hospitals now.
• 18:38
  SPEAKER_02: So the whole hospital, right, is one biocontainment unit.
• 18:42
  SPEAKER_02: So it really helped in the beginning that those two hospitals we already recommended that they start cohorting patients.
• 18:48
  SPEAKER_02: So it started out with just having two patients, right?
• 18:51
  SPEAKER_02: As soon as there were two patients of the same gender were confirmed with COVID-19, they were then cohorted.
• 18:58
  SPEAKER_02: We were mindful though they also had CDF, CRs, or CRE, then we would not cohort them with anybody.
• 19:06
  SPEAKER_02: Although we went to full COVID units now, um, majority of our units are full COVID units where healthcare workers are actually wearing PPE even in the hallways.
• 19:18
  SPEAKER_02: The reason why we're not 100% is because some of the orientation that units can't really happen, but as soon as you can do it, I would.
• 19:26
  SPEAKER_02: So meaning you would only change gloves when you're cohorting patients in the room, you would then don your PPE and you would just change gloves and do hand hygiene when you take care of the next patient.
• 19:39
  SPEAKER_02: And some of our rooms even can cohort four patients, actually, so that also helps.
• 19:44
  SPEAKER_02: That then you would also have to assign the nurse then with all those four patients and even the physicians.
• 19:51
  SPEAKER_02: That actually was the hardest part, right?
• 19:53
  SPEAKER_02: Because our physician teams have patients all over the hospital, but we actually made it from earlier on.
• 20:00
  SPEAKER_02: And we found that when you actually make a complete COVID unit where they don't have to doff as much as you would if you were in single patient rooms, the healthcare workers actually felt a little bit more comfortable.
• 20:15
  SPEAKER_02: I think donning and doffing takes a lot of stress, right?
• 20:18
  SPEAKER_02: It adds a lot of time to your work, and so just our own anecdotal observation that a full COVID unit in a mixed floor, there was a lot more chaos in the mixed floor than the full COVID unit.
• 20:31
  SPEAKER_02: You have to then put lines on the floor, right?
• 20:34
  SPEAKER_02: So we actually did red, yellow, green, just like Evoola, where red means you have to have that as a contaminant, yellow was where you still can wear PPE, but certainly we made sure that those are pretty much the hallways, then you have to wear clean gloves all the time.
• 20:52
  SPEAKER_02: So when you leave the room, you have to change your gloves.
• 20:55
  SPEAKER_02: And then, of course, break rooms and medicine rooms as much as possible, those are going to be clean, right?
• 21:02
  SPEAKER_02: Yeah, so no one is wearing PPE except for their N95 or their surgical mask in those rooms.
• 21:09
  SPEAKER_02: But again, in some areas it's not really possible.
• 21:13
  SPEAKER_02: So we had to approach it possible by hospital, unit by unit.
• 21:17
  SPEAKER_02: Those were the things that we had to do to preserve our PPE.
• 21:21
  SPEAKER_01: So how has that been in terms of the effectiveness of preserving PPE?
• 21:24
  SPEAKER_01: Have you found that's made a big difference in your burn rate with all the different components of the PPE?
• 21:30
  SPEAKER_01: To be perfectly honest, I actually don't know.
• 21:33
  SPEAKER_02: We haven't had a chance to look at it.
• 21:36
  SPEAKER_02: It just seems that theoretically it will work, but at least the one thing I can tell you is that, again, from our anecdotal observation, that a full COVID unit seemed to work better than a mixed one, potentially.
• 21:50
  SPEAKER_01: I agree.
• 21:50
  SPEAKER_01: We had experience here converting a unit to a full COVID biocontainment unit, and I was a little hesitant at first, but you know, it really took off.
• 22:00
  SPEAKER_01: And uh the staff really appreciated it.
• 22:02
  SPEAKER_01: And I think it it has helped our PPE utilization from what we're seeing.
• 22:05
  SPEAKER_01: But I think the staff was overall much more comfortable providing care in that kind of environment versus the mixed unit.
• 22:11
  SPEAKER_01: We still have a couple areas of our hospital that are mixed.
• 22:14
  SPEAKER_01: And I think those areas are the ones that do create the most anxiety going from patient to patient and concern about donning and doffing in between patients.
• 22:23
  SPEAKER_01: The last thing I want to talk about, which is something that's gotten a lot of attention recently, is reprocessing of PPE and specifically the N95 respirators.
• 22:31
  SPEAKER_01: Have you had any experience of that within your system or any thoughts on reprocessing overall?
• 22:37
  SPEAKER_02: So we actually looked at reprocessing at the same time that we implemented our limited reuse and extended use program.
• 22:46
  SPEAKER_02: And I can tell you though, at least even now we're just collecting.
• 22:49
  SPEAKER_02: We were collecting N95 respirators and facials at that time.
• 22:54
  SPEAKER_02: And we looked at ethylene oxide sterilization.
• 22:58
  SPEAKER_02: Unfortunately, those are not recommended by both the CDC and even OSHA.
• 23:03
  SPEAKER_02: Mind you, I think it's because you have to wait a long time to then release those N95 respirators.
• 23:10
  SPEAKER_02: Because you know, we do use ETO for a lot of sterilization for our OR equipment, right?
• 23:15
  SPEAKER_02: Our OR supplies.
• 23:17
  SPEAKER_02: So I think it's safe.
• 23:18
  SPEAKER_02: I think it's just you have to wait a long time.
• 23:21
  SPEAKER_02: And I think our colleagues at UNC Chapel Hill have done some studies.
• 23:25
  SPEAKER_02: Dr.
• 23:26
  SPEAKER_02: Rotala and Dr.
• 23:27
  SPEAKER_02: Weber probably has data to show that it is just as safe.
• 23:31
  SPEAKER_02: But having said that, we did have to go with another method.
• 23:35
  SPEAKER_02: Again, we're just collecting, but we have looked at hydrogen peroxide vaporization through Battel, a third-party vendor, and also vaporized hydrogen peroxide using the Sterus V Pro Max 2 machine.
• 23:48
  SPEAKER_02: And also we have Sterads.
• 23:50
  SPEAKER_02: So all those have already received an emergency use from the FDA, and so those are potentially all viable options, right?
• 24:00
  SPEAKER_02: And then there's also using the BioQuil, which the group at Duke have also done.
• 24:15
  SPEAKER_02: The Sterus Vpro Max2 using hydrogen peroxide as well can go up to 10 cycles, while the Sterad can only do two cycles.
• 24:25
  SPEAKER_02: I actually had personal experience sorting through the N95s that have been collected in these boxes that we have used.
• 24:33
  SPEAKER_02: And I have to say, our healthcare workers have been really good.
• 24:36
  SPEAKER_02: We were really worried that we would see trash in there.
• 24:40
  SPEAKER_02: But for the most part, they were actually all face shields and N95.
• 24:44
  SPEAKER_02: So I was really grateful for that.
• 24:46
  SPEAKER_02: But you know, looking at three or four of them, I found maybe just 50% of the N95 would be good enough for reprocessing.
• 24:55
  SPEAKER_02: And so I think you can probably only do it once.
• 24:58
  SPEAKER_02: And by the time that happens, I doubt that the N95 would keep its uh shape or form, that it probably won't create a tight seal anymore.
• 25:07
  SPEAKER_02: So so while there's an advantage of you know the Battel program being able to reprocess it 20 times, I just don't know how realistic that would be that you can actually reprocess an N95 uh 20 times.
• 25:21
  SPEAKER_02: Mind you, if you are using them a single use potentially, yeah, then you could probably reprocess them several times.
• 25:28
  SPEAKER_02: But the way we've been doing it, and I think which is the better solution is to actually do extended use and limited reuse, only because then at that point you don't have to reprocess them and then you don't have to depend on something that an N95 respirator was ever intended to be used for.
• 25:48
  SPEAKER_02: But again, we're still collecting them and we will continue just because I don't know how the supply will be.
• 25:54
  SPEAKER_02: But we are secure in our N95s now for weeks.
• 25:57
  SPEAKER_01: We're in the same boat.
• 25:58
  SPEAKER_01: We're um at the point where we're collecting and still trying to figure out when we'll reach that point where we have to move into the reprocessing phase and we've been exploring all the different strategies that you alluded to.
• 26:11
  SPEAKER_01: There was a Shea Town Hall that was done uh this past weekend with Dr.
• 26:15
  SPEAKER_01: Weber and some other healthcare epidemiologists who went into much more detail about their own experiences.
• 26:20
  SPEAKER_01: So I'd encourage any of the podcast listeners, if they're interested in that, to listen to those town hall meetings because they really get into some of the nuts and bolts of uh reprocessing and share some of their own personal experiences.
• 26:31
  SPEAKER_01: So thank you, uh Dr.
• 26:32
  SPEAKER_01: Caymans, for coming on to the podcast to discuss your experiences.
• 26:37
  SPEAKER_01: I think it's really helpful to hear what you've been through in New York City and some of these ways that you've been able to maximize your resources.
• 26:45
  SPEAKER_01: Any closing thoughts or uh final advice for hospitals that are moving into this phase?
• 26:50
  SPEAKER_02: Plan early.
• 26:52
  SPEAKER_02: Be prepared that unfortunately, because of the fear and the anxiety and all the hype out there, that no one will listen to you.
• 27:04
  SPEAKER_02: They'll do whatever they think that will be safe for them.
• 27:07
  SPEAKER_02: And for us, it was very hard for our group of hospital epidemiologists, but unless they're doing something really unsafe, you just have to learn to let go.
• 27:17
  SPEAKER_01: I think that's very good advice.
• 27:19
  SPEAKER_01: So thank you again, Dr.
• 27:20
  SPEAKER_01: Cayman's, for uh sharing your perspective and experiences.
• 27:24
  SPEAKER_01: And a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 27:31
  SPEAKER_01: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 27:38
  SPEAKER_01: You'll also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAY COVID-19 town halls.
• 27:46
  SPEAKER_01: Additional resources available on Learning CE pertinent to this pandemic include the SHAY CDC Outbreak Response Training Program, ORTP, and the prevention course in HAA Knowledge and Control Prevention Check.
• 28:00
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 28:03
  SPEAKER_01: Thank you again, Dr.
• 28:04
  SPEAKER_01: Cayman's, and thank you for tuning in.