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COVID-19: Environment of Care and PPE, 3/05 · The SHEA Podcast

• 0:21
  SPEAKER_01: I am healthy after COVID 19 updates.
• 0:40
  SPEAKER_01: Informative care as it pertains to providing care for patients with hospitals or prevent COVID-19 infection.
• 0:47
  SPEAKER_01: Our speaker today is Dr.
• 0:48
  SPEAKER_01: David Weber.
• 0:49
  SPEAKER_01: Dr.
• 0:50
  SPEAKER_01: Weber is a professor of medicine and pediatrics at the University of North Carolina and Associate Chief Medical Officer for UNC hospitals.
• 0:57
  SPEAKER_01: Dr.
• 0:57
  SPEAKER_01: Weber, thanks for joining us today.
• 0:59
  SPEAKER_00: Thank you very much.
• 1:00
  SPEAKER_01: So, Dr.
• 1:01
  SPEAKER_01: Weber, I was hoping that you could potentially give us a little background on where things stand with COVID-19 in the big picture, and then we can hone in on some of the more detailed aspects of clinical care for patients with possible COVID-19 infection.
• 1:15
  SPEAKER_00: Thank you.
• 1:15
  SPEAKER_00: And of course, this is an update as of March 4th.
• 1:18
  SPEAKER_00: Globally, there are more than 94,000 cases and more than 3,200 deaths, and approximately 70 countries have cases.
• 1:28
  SPEAKER_00: China, of course, has now had approximately 80,000 cases and more than 3,000 deaths.
• 1:33
  SPEAKER_00: But over the last week to 10 days, the number of new cases per day has been decreasing.
• 1:39
  SPEAKER_00: The real growth is outside of China with approximately 9,000 cases now and more than 100 deaths, in particular, rapidly increasing prevalence in geographic spread, with a focus certainly on Iran with approximately 3,000 cases, South Korea, approximately 5,500 cases, and Italy with approximately 2,500 cases.
• 2:04
  SPEAKER_00: Importantly, the spread from this epicenter in Italy is now involving other nearby countries.
• 2:10
  SPEAKER_00: So roughly in about 200 cases in each of France, Germany, and Spain.
• 2:16
  SPEAKER_00: Importantly, although those numbers seem relatively small, a week ago those numbers were in single digits.
• 2:22
  SPEAKER_00: So these are rapidly increasing.
• 2:24
  SPEAKER_00: And we've now had reports of COVID in small numbers in South America and in Africa.
• 2:31
  SPEAKER_00: In the United States, 128 cases, nine deaths, and I'm not going to go through details where they all are, but importantly, there is person-to-person spread.
• 2:40
  SPEAKER_00: There are now four examples of community acquisition where the source was unknown.
• 2:45
  SPEAKER_00: You're familiar with the outbreak in a nursing home in Washington, where all nine deaths have occurred.
• 2:51
  SPEAKER_00: And looking at the molecular biology of the viruses circulating, it is believed that there's been circulation in Washington for somewhere between three and six weeks.
• 3:02
  SPEAKER_00: Multiple dates now with cases, including one case described last night in my home state of North Carolina.
• 3:09
  SPEAKER_00: CDC's warning for their level three, China, Iran, South Korea, and Italy, and level two for Japan.
• 3:15
  SPEAKER_00: Importantly, I also want to point out to many of us, but not all of us, certainly, are involved in large academic centers.
• 3:22
  SPEAKER_00: CDC yesterday made a recommendation to cease all student exchange programs and bring all U.S.
• 3:27
  SPEAKER_00: students who are in an exchange program home.
• 3:30
  SPEAKER_00: And increasingly, universities and companies are beginning to impose travel restrictions.
• 3:35
  SPEAKER_00: These are usually for international travel to meetings, but in some cases domestic travel to meetings as well.
• 3:42
  SPEAKER_01: Thank you for that summary.
• 3:44
  SPEAKER_01: I think you covered a lot of different aspects of the epidemic, everything from travel concerns, but also concerns about community transmission here in the United States.
• 3:54
  SPEAKER_01: And I think that's something that's always at the forefront of our minds here in the United States.
• 3:58
  SPEAKER_01: We know that COVID-19 is here, it's at our doorstep.
• 4:01
  SPEAKER_01: We have to be thinking about it when we're evaluating patients every day.
• 4:05
  SPEAKER_01: So I want to focus a little discussion on the environment of care when we're taking care of patients with possible COVID-19 infection, who may eventually go on to have diagnosed improving COVID-19 infection.
• 4:17
  SPEAKER_01: And we know that these patients are going to present to our hospital in several different areas, potentially directly through the emergency department or through one of our ambulatory care sites.
• 4:27
  SPEAKER_01: And they're all structured a little bit differently.
• 4:29
  SPEAKER_01: But I want to focus on the ambulatory care setting.
• 4:32
  SPEAKER_01: It seems like from what we've seen in other countries, the preponderance of COVID-19 cases are in primarily ambulatory areas.
• 4:40
  SPEAKER_01: So I want to set a stage of a patient who is entering an ambulatory care facility and upon the initial valuation is presenting with symptoms and potentially a travel-related epidemiologic exposure that would raise concern for a COVID-19 infection.
• 4:56
  SPEAKER_01: Can you walk us through how we would think about that patient entering our facility in terms of the overall environment?
• 5:02
  SPEAKER_01: And then we can focus in a little bit more on some of the detailed aspects.
• 5:06
  SPEAKER_00: Absolutely.
• 5:07
  SPEAKER_00: Based on CDC and health department guides, our motto is very simple: identify, isolate, and form.
• 5:14
  SPEAKER_00: So right at the doors, we have signs both for universal respiratory hygiene, as well as signs saying if you have travel outside the United States in the last 14 days and respiratory symptoms, immediately identify yourself.
• 5:27
  SPEAKER_00: Built into our electronic medical tool, EPIC, is our own design screening, which again, at every episode, coming into any clinic for any reason, going to an X-ray facility just to get an X-ray of your ankle because you might have sprained it, going and getting a phlebotomy test, coming to pharmacy to pick up drugs, you will be screened.
• 5:47
  SPEAKER_00: And you will be first asked about symptoms, you will be asked about travel.
• 5:51
  SPEAKER_00: If those two are both positive and it's based on the travel advisories of the CDC and their recommendations, then a message pops up and it tells you what to do, which essentially is give the patient a mask, immediately escort them back to a private room, since most clinics will not have an airborne isolation room, mask the patient.
• 6:12
  SPEAKER_00: Any healthcare providers going in that room to get additional information should wear gowns, gloves, a surgical mask, and a face shield or eye goggles.
• 6:22
  SPEAKER_00: So again, identify isolate and next is inform, and they would hit a little button and it's going to then populate every single chart right at the top that says possible COVID in big red letters.
• 6:33
  SPEAKER_00: And then from there, another information sheet pops up and tells who to call, depending upon which of our affiliates they are and which clinic.
• 6:49
  SPEAKER_00: Between those two, they would then make a decision whether the patient really doesn't meet testing criteria, or if they do, that they should be tested, and that enters us into the next stage.
• 7:00
  SPEAKER_00: If they do need testing, and even doing a nasopharyngeal swab would be considered something requiring airborne isolation, we would then move the patient to a facility that had an airborne isolation room, greater than 12 air exchanges an hour, direct out exhausted air, negative pressure.
• 7:17
  SPEAKER_00: And at that stage, all of our healthcare providers would minimally be in an N95 mask with the other personal protective equipment or a PAPPRE.
• 7:26
  SPEAKER_01: Thanks for walking us through that.
• 7:28
  SPEAKER_01: I think you brought up a lot of important points, both when we think about the environment of care, but you also referred to personal protective equipment or PPE, which has really been an area of focus when it comes to thinking about our measures that we need to take when approaching these patients.
• 7:44
  SPEAKER_01: PPE is always critical, both in protecting the healthcare worker, but also thinking about healthcare workers as potential vectors of threat.
• 7:52
  SPEAKER_01: So I do want to get into a little bit more detail in the PPE discussion.
• 7:55
  SPEAKER_01: In the last episode, Dr.
• 7:57
  SPEAKER_01: Bell uh referenced the current CDC guidance, which describes a very high level of PVE, which includes an N95 respirator.
• 8:06
  SPEAKER_01: And I think you acknowledged in your discussion that that may not be practical for outpatient settings, but I want you to give us a little bit more detail on comparing the utility and the actual utilization of N95 respirators versus surgical masks as it pertains to the care of patients with COVID-19.
• 8:25
  SPEAKER_00: We believe that for a very short exposure, having a mask on the patient and a mask both on the healthcare provider is sufficient protection.
• 8:34
  SPEAKER_00: We don't believe it's feasible, certainly in my institution and probably yours, to train hundreds of people in our, we have roughly 200 clinics.
• 8:43
  SPEAKER_00: We think it's unlikely somebody would present at this stage to a dermatology clinic, for instance.
• 8:48
  SPEAKER_00: And we don't have enough N95s then to train thousands of additional people, and then to put boxes of N95s in every one of these 200 clinics.
• 8:58
  SPEAKER_00: We believe we're not putting people at risk for a very short exposure with both masks.
• 9:03
  SPEAKER_00: Then we would move them to an airborne isolation room where we would clearly use N95 respirators, and they clearly are more efficient and better protection for health care providers.
• 9:14
  SPEAKER_00: And once you're in an airborne isolation room, you can take the mask off the patient.
• 9:18
  SPEAKER_00: Certainly, if you have availability and people are trained, I think an air-purified respirator is even better.
• 9:25
  SPEAKER_00: It's probably marginally better than an N95 in testing.
• 9:29
  SPEAKER_00: And then, of course, if we move the patient, then they'd get moved to an intensive care unit.
• 9:34
  SPEAKER_00: At a minimum, you want to mask the patient as they're moving through a facility.
• 9:38
  SPEAKER_00: They obviously make these new isolation stretchers that are HEPA filtered.
• 9:42
  SPEAKER_00: If you have access to that type of a device, you would want to use such a device while the patient is being moved.
• 9:49
  SPEAKER_00: I should say the other great vulnerability besides having a patient come in and sit in the waiting room for four hours and not know they might have COVID is putting on or taking off your PPE incorrectly.
• 10:01
  SPEAKER_00: We've certainly emphasized training everyone.
• 10:04
  SPEAKER_00: Just today, we now have a tape that people can watch that actually describes that.
• 10:09
  SPEAKER_00: But once they come to our airborne isolation room for tests of any type that might generate an aerosol, we actually plan to have a PPE monitor there.
• 10:18
  SPEAKER_00: That person has three functions.
• 10:20
  SPEAKER_00: One, to make sure people who shouldn't be in the room don't wander in.
• 10:23
  SPEAKER_00: Second, we will have a log of all people entering the room and leaving so that we can track that.
• 10:29
  SPEAKER_00: And third, their goal is they're all specially trained to observe our healthcare providers putting on their PPE.
• 10:36
  SPEAKER_00: And more importantly, with a dedicated sheet in front of them, go step by step about how they take off the PPE to make sure they don't contaminate their underlying skin, mucus, membranes, or clothes.
• 10:49
  SPEAKER_01: So it sounds like you're taking an approach where the level of PPE is highly influenced by the type of activities that the healthcare worker is performing.
• 10:58
  SPEAKER_01: So for high-risk activities, things like close contact with mucous membranes, aerosol generating procedures, much higher level of consideration would need to be given for a 95 or respirator protection of PPE versus those lower risk activities, which would involve much less intimate and potentially a casual contact with patients.
• 11:19
  SPEAKER_01: You referenced some concerns about the actual PPE utilization itself, and concerns about inadequate practices, including doffing PPE as being a point of potential risk to the healthcare worker.
• 11:33
  SPEAKER_01: Could you elaborate on some of the things you've seen in your experience, some potential pitfalls that healthcare workers may encounter when they're doffing PPE that may put themselves at risk?
• 11:44
  SPEAKER_00: Yeah.
• 11:44
  SPEAKER_00: So obviously we teach them to peel their gloves from the inside out so that they don't contaminate their skin as they're taking the glove off.
• 11:52
  SPEAKER_00: We have several frequent uses of a waterless alcohol foam for hand hygiene in our PPE removal.
• 11:58
  SPEAKER_00: We'll talk more about that later, but it's effective against this virus.
• 12:02
  SPEAKER_00: You don't want somebody reaching behind their neck to untie their gown and then contaminating the back.
• 12:09
  SPEAKER_00: You want them to grasp the front of the gown and pull so that they're only directly touching the gown.
• 12:15
  SPEAKER_00: You don't want someone inadvertently reaching up and scratching their eyes.
• 12:19
  SPEAKER_00: You don't want them reaching behind their head to grab the elastic straps.
• 12:23
  SPEAKER_00: So CDC has excellent guidelines and you know, people need to practice.
• 12:28
  SPEAKER_00: And just like if you're hearing on the plane, you'll hear the co-pilot saying, now you do this, now you do this, now you do this.
• 12:34
  SPEAKER_00: That's actually what we do.
• 12:36
  SPEAKER_00: We read the guideline right down there, tell our healthcare provider with somebody watching to make sure that there are no breaches, and that's just as important as the type of PPE you're using, and maybe even more important.
• 12:49
  SPEAKER_01: Great.
• 12:49
  SPEAKER_01: Now I think that's really critical.
• 12:51
  SPEAKER_01: The education and often re-education, uh, particularly when we're thinking about areas in ambulatory care sites that may not encounter a lot of patients that would require healthcare workers to use PBE and may not be as comfortable with donning and DOFIN, you know, really thinking about how we can provide that education becomes a big part of the overall uh implementation process.
• 13:12
  SPEAKER_01: We've been trying to focus on ambulatory outpatient care sites, but can you maybe summarize your thoughts on that patient that is much more acutely ill, potentially entering the facility through the emergency department and maybe transfer to a medical unit or even an intensive care unit?
• 13:30
  SPEAKER_01: How would you think about that patient moving through in terms of the overall guiding principles?
• 13:36
  SPEAKER_01: And then if you want to comment a little bit more about uh specific aspects like PPE use in that type of environment.
• 13:43
  SPEAKER_00: So I think the key is to minimize exposure.
• 13:46
  SPEAKER_00: So definitely you have to move someone for any cough-inducing procedure to an airborne isolation room.
• 13:52
  SPEAKER_00: So you want a designated place ahead of time where they're going to be.
• 13:56
  SPEAKER_00: For us, it's an airborne isolation room and the edge of our emergency department, which actually has its own outside door right next to it, so we don't have to parade them through the entire ED.
• 14:06
  SPEAKER_00: We've made the decision that we're not going to put these patients into a floor bed.
• 14:11
  SPEAKER_00: We're going to put them in the uh intensive care unit.
• 14:14
  SPEAKER_00: Why is that?
• 14:15
  SPEAKER_00: The last thing we want is somebody getting quite ill, somebody calling a code or a rapid response, and suddenly 12 people are rushing into the room without PPE properly.
• 14:25
  SPEAKER_00: If they're already in the ICU, you might need a stat call to anesthesia.
• 14:29
  SPEAKER_00: But the idea that many people need to go rushing into the room is not going to be likely the case.
• 14:35
  SPEAKER_00: So that's why we're going to use ICU rooms.
• 14:38
  SPEAKER_00: Again, if we have hundreds of patients as opposed to two or three, that may change.
• 14:42
  SPEAKER_00: The other thing that we are doing on the shift for which that patient is being seen by a nurse and a physician and an inpatient, they are dedicated only to that patient.
• 14:52
  SPEAKER_00: Again, the last thing we want is somebody in the room and one of our intensivists, and somebody knocking on the door saying, you know, your resident just hit an artery while they were putting in a central line.
• 15:02
  SPEAKER_00: We knew you right away in room four, or the patient in room five is in cardiac arrest.
• 15:07
  SPEAKER_00: And then they rush out without taking their PP off properly.
• 15:11
  SPEAKER_00: We will let them see patients on other shifts, but we've made the decision that on that shift they are dedicated to that patient.
• 15:18
  SPEAKER_00: That's also true in the emergency department.
• 15:20
  SPEAKER_00: The nurse who's in the ED for that patient is dedicated to that patient.
• 15:25
  SPEAKER_00: They're not going to see anyone during the time that patient's in the ED.
• 15:29
  SPEAKER_00: If possible, we'll dedicate a physician.
• 15:31
  SPEAKER_00: We may not be able to, but at least we'll have a trained nurse in the room who doesn't have to be rushing in and out doing other things because, again, we feel that's a recipe for disaster.
• 15:41
  SPEAKER_00: So that's another part of this PPE management and making sure people put it on and take it off properly.
• 15:49
  SPEAKER_01: So it sounds like there's a lot of planning that's taking place.
• 15:52
  SPEAKER_01: Everything from planning a dedicated pathway for the patient as he or she proceeds through different areas of the facility, planning for dedicated staff, and ensuring that they have the adequate training.
• 16:04
  SPEAKER_01: So definitely honing in on the aspect that preparation can really be critical in reducing the amount of exposure that would result from a patient with COVID-19 in a healthcare facility.
• 16:15
  SPEAKER_01: So we've talked a little bit about PPE, and there's a lot of questions coming up regarding PPE management.
• 16:22
  SPEAKER_01: And there's been shortages of surgical mass, shortages of N95 respirators.
• 16:28
  SPEAKER_01: Can you share a little bit as far as your institutional approach to attempting to conserve PPE and at least monitoring the PPE supply?
• 16:38
  SPEAKER_00: So, first let me uh talk about the supply.
• 16:40
  SPEAKER_00: We ever since SARS and we did, I personally took care of the eighth and last lab-confirmed case of SARS in the US about 20 years ago.
• 16:48
  SPEAKER_00: We have always tried to maintain a three-month supply of PPE.
• 16:52
  SPEAKER_00: So that may be a little bit ahead of many of you.
• 16:55
  SPEAKER_00: But in terms of supply, first of all, I would say this is a highly desired item.
• 16:59
  SPEAKER_00: Whatever you have in your warehouses, you need to have that under locking key and 24-hour surveillance because we think it may walk away.
• 17:07
  SPEAKER_00: To the extent you can put in other orders to increase supply, I encourage you to do so.
• 17:12
  SPEAKER_00: I'll also mention that just this week the FDA put out an emergency authorization that allows us to use respiratory equipment like N95 masks that are not officially approved by ASHA, but have been approved by another country as equivalent devices.
• 17:29
  SPEAKER_00: The CDC does have on their webpage a list of countries and a list of, say, N95 respirators that you can legally use that meet those countries, say Brazil or Australia's guidelines, that you could now use under this emergency authorization and not run afoul of problems with TASH.
• 17:49
  SPEAKER_00: I encourage you to do that.
• 17:51
  SPEAKER_00: On the other side, you need to make sure people are not using PPE inappropriate.
• 17:56
  SPEAKER_00: So now we've moved from antibiotic stewardship to PPE stewardship.
• 18:00
  SPEAKER_00: We sent out a notice to all of our clinicians on Friday.
• 18:03
  SPEAKER_00: Some of the things we did was we had isolation carts and they had all our types of isolation.
• 18:10
  SPEAKER_00: We don't need for a flu patient or a pertussis patient, we don't need N95 respirators.
• 18:16
  SPEAKER_00: We've removed those off of that.
• 18:18
  SPEAKER_00: We've taken our boxes, which were just sitting by the front door of the hospital with signs to use, where they're in direct visualization of a healthcare provider or behind the desk, because we've literally seen people picking up three boxes and walking out the door.
• 18:31
  SPEAKER_00: So we have to be much more conservative.
• 18:33
  SPEAKER_00: So we've tried to move them from where they're in immediate public access without a healthcare provider.
• 18:39
  SPEAKER_00: We've also seen occasionally bar workers just walking around the halls with masks on because they're worried.
• 18:45
  SPEAKER_00: We've discouraged that strongly.
• 18:47
  SPEAKER_00: And we think masks should be used really for healthcare providers with patients with known droplet spread.
• 18:52
  SPEAKER_00: Patients, as we've said, in the early phases, so they move to an appropriate room who might have a droplet or airborne disease.
• 18:59
  SPEAKER_00: Obviously, for procedures such as operations, all of those are appropriate.
• 19:05
  SPEAKER_00: We're limiting, at least at my academic center, we're no longer parading in groups of medical students, nursing students into rooms with droplet precautions.
• 19:13
  SPEAKER_00: We're trying to limit the number of people going into those rooms to more essential personnel in order to conserve our supply of PPE there.
• 19:23
  SPEAKER_00: So those are just many of the things that we've been doing as just part of PPE stewardship.
• 19:30
  SPEAKER_01: So it sounds like the major focus has been on conserving the existing PPE and also simultaneously thinking outside the box as far as ways to acquire PPE and what might be usable in different types of situations.
• 19:45
  SPEAKER_01: So when evaluating an individual who potentially is a returning traveler from an area with significant community associated COVID-19 spread or potentially in an area where rates are particularly high.
• 19:58
  SPEAKER_01: Who may be coming back to the facility, maybe encountering health care who does not have fever or respiratory symptoms.
• 20:05
  SPEAKER_01: Do you have any guidance on how you would think about that individual, potentially a returning traveler who is asymptomatic in terms of symptoms that we typically associated with COVID-19?
• 20:15
  SPEAKER_00: So there have been a few anecdotal reports of potential transmission from asymptomatic individuals.
• 20:22
  SPEAKER_00: It's hard to judge those whether asymptomatic spread occurs, and if so, to what degree.
• 22:00
  SPEAKER_00: Never bring them into a healthcare facility.
• 22:04
  SPEAKER_01: I think those are really important points.
• 22:06
  SPEAKER_01: The whole notion of exploring alternatives to direct face-to-face care when it's not necessarily indicated.
• 22:13
  SPEAKER_01: Things like engaging the health department and really partnering with health departments in being able to evaluate and potentially provide care to patients outside of the hospital.
• 22:24
  SPEAKER_01: I think those are really critical.
• 22:25
  SPEAKER_01: And you know, we've also found excellent relationships with our health department in approaching these kinds of situations.
• 22:32
  SPEAKER_01: So a lot of the discussions focused on PPE, but I do want to shift away and talk about a couple other topics that have been in the forefront of people's minds when it comes to taking care of patients with possible COVID-19 infection.
• 22:45
  SPEAKER_01: One of them surrounds the question about hand hygiene.
• 22:48
  SPEAKER_01: So can you share some insight into appropriate hand hygiene in these types of situations, both in terms of frequency as well as product selection, so soap and water versus an alcohol-based hand sanitizer?
• 23:04
  SPEAKER_00: So the fortunate thing about COVID, one of the few fortunate things, it's an envelope virus and it's relatively easily inactivated.
• 23:12
  SPEAKER_00: We don't have any data really that I'm aware of on COVID-19 yet, but we have data on SARS and MERS and many other coronaviruses.
• 23:20
  SPEAKER_00: And we do know that it is susceptible to 60 to 90 percent alcohol, and it would be removed as other coronaviruses by good hand hygiene.
• 23:29
  SPEAKER_00: So that is the good news.
• 23:30
  SPEAKER_00: We should all practice the five moments of hand hygiene that are recommended by the WHO, certainly before and after any glove removal when there's ever a chance of contamination.
• 23:43
  SPEAKER_00: And so we actually have multiple steps, as I said, when we do DOFIN, where we do do hand hygiene.
• 23:49
  SPEAKER_00: Either are perfectly acceptable methods.
• 23:51
  SPEAKER_00: Obviously, both have to be done correctly, which means for a waterless alcohol product, a sufficient amount of product, you have to uh put it over both the both surfaces of the hands in between the web spaces of the fingers.
• 24:04
  SPEAKER_00: You'd want a minimum of uh 10 seconds for your hand hygiene, I think, either washing or uh with the waterless uh alcohol uh products.
• 24:14
  SPEAKER_01: Great.
• 24:15
  SPEAKER_01: Thanks for uh sharing that insight on hand hygiene.
• 24:18
  SPEAKER_01: There's been some different information out there as far as cleaning and disinfection.
• 24:22
  SPEAKER_01: What are the best products?
• 24:24
  SPEAKER_01: Are all products effective?
• 24:25
  SPEAKER_01: Is there a preferential product?
• 24:27
  SPEAKER_01: So I was hoping you could share some insight into your approach to cleaning and disinfection surrounding patients with possible or proven COVID-19 infection.
• 24:37
  SPEAKER_00: So we do know that the coronaviruses, as does influenza, will survive on surfaces for hours to days.
• 24:44
  SPEAKER_00: It depends.
• 24:45
  SPEAKER_00: They do better at lower temperature and uh uh humidity in terms of survival.
• 24:50
  SPEAKER_00: So surface disinfection is important.
• 24:52
  SPEAKER_00: Again, it's an envelope virus.
• 24:54
  SPEAKER_00: Certainly uh any disinfectant we use in the hospital with an emerging viral claim and specifically a coronavirus claim would be uh uh active.
• 25:03
  SPEAKER_00: If the product didn't have a coronavirus and an emerging virus claim, then if it had a claim against a non-envelope virus or mycobacteria, that product would be effective as well.
• 25:15
  SPEAKER_00: So almost all the products we would be using standardly in the hospital, fortunately, have activity against the COVID-19.
• 25:23
  SPEAKER_01: Thank you, Dr.
• 25:24
  SPEAKER_01: Weber.
• 25:24
  SPEAKER_01: I think that is very helpful as we think about our cleaning and disinfection processes and in a lot of ways reassuring when we think about the products that we have available to us at our disposal.
• 25:34
  SPEAKER_01: Thank you again to Dr.
• 25:36
  SPEAKER_01: Weber for sharing your perspective and experiences on the outbreak.
• 25:39
  SPEAKER_01: I think you've given us a lot of great information and a lot of great guidance as we think about how to prepare.
• 25:46
  SPEAKER_01: Please be sure to tune in to next week's episode.
• 25:49
  SPEAKER_01: We'll be addressing diagnostic testing for COVID-19.
• 25:52
  SPEAKER_01: This podcast can be accessed on phase online education center learning CE under the Rapid Response Program.
• 25:59
  SPEAKER_01: You will find additional resources such as the recorded webinar Healthcare Facility Outbreak Preparedness.
• 26:05
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 26:08
  SPEAKER_01: Thank you for tuning in.