Latest / The SHEA Podcast / COVID-19: Answers to Town Hall Questions, 5/07

Transcript

COVID-19: Answers to Town Hall Questions, 5/07 · The SHEA Podcast

• 0:08
  SPEAKER_02: 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 field of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_02: I am Dr.
• 0:23
  SPEAKER_02: David Bannock, Associate Professor of Medicine and Hospital Epidemiologist at the University of Connecticut School of Medicine, and I will serve as your moderator.
• 0:30
  SPEAKER_02: Discussion on the podcast does not necessarily reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:40
  SPEAKER_02: Shea is excited to launch the 12th episode of this podcast, COVID-19 Updates, What We Know Now.
• 0:46
  SPEAKER_02: Today's episode will focus on the unanswered questions from Shay's COVID-19 town halls.
• 0:51
  SPEAKER_02: In place of the webinar this weekend, we will discuss the most frequently submitted questions on the podcast.
• 0:57
  SPEAKER_02: Our speakers today are Dr.
• 0:59
  SPEAKER_02: Jennifer Hanrahan, infectious specialist at the University of Toledo Medical Center, Dr.
• 1:03
  SPEAKER_02: Walid Javed, hospital epidemiologist at the Mount Sinai Hospital downtown, Dr.
• 1:08
  SPEAKER_02: Cindy Prince, Clinical Associated Professor at the University of Florida.
• 1:11
  SPEAKER_02: Thank you for joining us today.
• 1:13
  SPEAKER_02: Let's get started with our first question.
• 1:15
  SPEAKER_02: So the first question that has come up pertains to some of the challenges with testing.
• 1:20
  SPEAKER_02: And one common theme is persistently positive testing.
• 1:24
  SPEAKER_02: So I'm sure all of you have come across this situation or at least discussed it.
• 1:28
  SPEAKER_02: You know, how do we handle patients that have persistently positive PCR testing after an initial diagnosis of COVID-19?
• 1:35
  SPEAKER_02: Particularly with regard to isolation practices and the use of transmission-based precautions.
• 1:39
  SPEAKER_02: You know, when can we safely remove patients from transmission-based precautions?
• 1:43
  SPEAKER_02: So, first I'll turn it over to Jennifer.
• 1:45
  SPEAKER_02: You want to talk a little bit about this situation where we have patients that are persistently positive and how to approach isolation?
• 1:52
  SPEAKER_00: Yeah, so you know, this is a really interesting question, and this is one of the things that we've been dealing with for a while, and you know, I think that is somewhat difficult to answer.
• 2:02
  SPEAKER_00: Patients who have been severely ill, who have been sick enough to be intubated in the care unit, often test positive for a prolonged period of time.
• 2:10
  SPEAKER_00: I've seen a number of patients now who are testing positive beyond 30, 35 days.
• 2:15
  SPEAKER_00: And, you know, the question is: are they safe to undergo procedures?
• 2:19
  SPEAKER_00: Is it safe for them to have tracheostomies?
• 2:21
  SPEAKER_00: And, you know, when can they safely leave the hospital?
• 2:23
  SPEAKER_00: And if they do leave the hospital, do they need to continue isolation?
• 2:27
  SPEAKER_00: So the CDC did recently publish some guidance on this saying that people were unlikely to be infectious after 10 days.
• 2:35
  SPEAKER_00: And we know from a little bit of published data that people are not likely to have virus that replicates after 10 days.
• 2:43
  SPEAKER_00: So what we've been doing up until now is that we have been getting repeat tests 24 hours apart.
• 2:50
  SPEAKER_00: And you know, when they have two negative tests, we consider them to be non-infectious.
• 2:55
  SPEAKER_00: But you know, one of the things that I would say about this is that I think we need a lot more data.
• 3:00
  SPEAKER_00: The one study that came out of Germany that looked at this looked at people who had either mild or no symptoms.
• 3:07
  SPEAKER_00: And I haven't seen data for this in patients who are severely ill, who are in the intensive care unit.
• 3:13
  SPEAKER_00: And, you know, I think those are the situations where it becomes a little bit more difficult.
• 3:18
  SPEAKER_00: Generally speaking, I would say that it's not like that people are shedding infectious virus for an extended period of time, but I would like a little more data on this.
• 3:27
  SPEAKER_02: So, Dr.
• 3:28
  SPEAKER_02: Prince, I'm interested in your opinion and your practice with regard to uh approaching these kinds of situations where patients have prolonged positive tests.
• 3:36
  SPEAKER_02: Any concerns or any challenges that you found with trying to navigate this issue?
• 3:40
  SPEAKER_01: Yeah, I think that, you know, as Dr.
• 3:42
  SPEAKER_01: Hanra had said, we need to be a little bit cautious about this.
• 3:45
  SPEAKER_01: And I think that you need to consider it in the context of where is the patient, what's going on.
• 3:51
  SPEAKER_01: If you have someone at home, you might feel a little bit more comfortable about assuming that they are no longer continuing to shed infectious virus, but you know, within a healthcare setting where we have concern for transmission, the idea of assuming that that is not infectious virus, that may be more of a problem.
• 4:09
  SPEAKER_01: So, you know, agree with wanting more data on that, and I would just say approaching that with caution within the healthcare setting.
• 4:16
  SPEAKER_02: Yeah, I completely agree.
• 4:17
  SPEAKER_02: I think we have a lot to learn in this area, and the CDC has published some guidance and sort of summarized some of the evidence on their website with uh regard to the rationale behind that guidance, but definitely a lot more to learn.
• 4:27
  SPEAKER_02: So this kind of transitions into sort of the next phase of the COVID-19 experience in the United States, and that's looking towards reopening our hospitals and trying to think about what the future is going to look like for healthcare in a lot of different ways.
• 4:41
  SPEAKER_02: You know, I want to talk to some of those issues, particularly with regard to testing asymptomatic individuals.
• 4:47
  SPEAKER_02: And the two groups that I think have been a big focus are testing asymptomatic individuals before undergoing procedures or surgeries, and then also looking at the potential role for testing asymptomatic healthcare workers.
• 4:59
  SPEAKER_02: So, Willie, what are your thoughts on how to approach testing patients who are going to undergo a surgery or maybe in aerosol-generated procedure in a non-emergent kind of way, even in terms of testing or even thinking about larger picture issues with regard to uh resuming care for these patients?
• 5:14
  SPEAKER_03: Yeah, so I think currently this is our major focus as far as possibly reopening the ambulatory practices and ambulatory surgeries.
• 5:23
  SPEAKER_03: And the question really comes down to how do we assess the risk and how do we minimize that to our staff, our surgeons, and colleagues.
• 5:32
  SPEAKER_03: So, one of the main things uh we do is we evaluate what kind of procedures uh patients are undergoing, we see if they have any symptoms already, and both those things don't create any red flags.
• 5:45
  SPEAKER_03: Each and every person who's gonna undergo any procedure, as a rule, we are testing them or pre-testing them.
• 5:51
  SPEAKER_03: If they are negative, then the reason for them and surgery needs to be minimal.
• 5:58
  SPEAKER_03: We try to test them within 48 hours of their surgery.
• 6:02
  SPEAKER_03: Our goal is mostly to do it within 24 hours of their surgery, so we have more confidence in their negative results.
• 6:11
  SPEAKER_03: People who are in fighting, and even if they get negative results like rest, and precautions are still taken to protect the staff during this time.
• 6:23
  SPEAKER_03: For people who have results which are positive, we continue to isolate them directly because surgeries can be cons.
• 6:32
  SPEAKER_03: If their surgeries can be done a week or two weeks later when there's a result negative, if there is a reasonable cause for urgent surgery, then we are using N95 M and council of same protection as for inpatients, making sure the surgeries are done extraditiously, as well as when we are excavating them, then the patients are separated from general population if they are COVID positive, and making sure that they are otherwise optimized and isolated from others.
• 7:08
  SPEAKER_02: Okay, thanks for sharing that approach.
• 7:10
  SPEAKER_02: I mean, I think when we start testing these patients preoperatively, there's some questions that come up.
• 7:15
  SPEAKER_02: Things like, you know, what's the right setting for us to do these tests?
• 7:18
  SPEAKER_02: Can we do these through our drive-through testing venues that we use for our uh patients who are symptomatic?
• 7:24
  SPEAKER_02: And then what about testing them if they're admitted to the hospital?
• 7:26
  SPEAKER_02: Do we have to consider them as potential PUIs?
• 7:30
  SPEAKER_02: These are the kinds of questions that have been percolating.
• 7:32
  SPEAKER_02: So I'm interested, maybe Jennifer, if you can uh share some of your experiences.
• 7:36
  SPEAKER_00: Sure.
• 7:36
  SPEAKER_00: So, you know, we just started testing asymptomatic patients for both OB and for procedures pretty recently.
• 7:45
  SPEAKER_00: And we have a drive-through testing area set up.
• 7:49
  SPEAKER_00: We're in the process of setting up another separate area in a clinic setting for testing.
• 7:54
  SPEAKER_00: But, you know, we do consider this an aerosolizing procedure.
• 7:58
  SPEAKER_00: And because of that, people are wearing N95 masks, they're wearing eye protection, and they're wearing gowns and gloves.
• 8:04
  SPEAKER_00: We do know that some small percentage of asymptomatic patients are testing positive.
• 8:11
  SPEAKER_00: So, because of that, we are having people wear all of the usual PPE.
• 8:16
  SPEAKER_00: Really, I think some of the issues that have come up are that, you know, there may be some OB patients, for example, who may not want to get tested because they find out that if they're positive, then it means that they're gonna be put in isolation, they may be separated from their infant, they may not be able to have their partner come into the hospital.
• 8:36
  SPEAKER_00: So there's some downstream effects that you have to think about before you start doing this testing because you need to know what you are gonna do when that test comes back positive, even if the person is completely asymptomatic.
• 8:48
  SPEAKER_00: For elective surgery, the implications are are you gonna trust that result to say that the patient doesn't need to have additional PPE used during the procedure?
• 8:59
  SPEAKER_00: If you're gonna be using the same type of PPE regardless of test result, it's probably not worthwhile to do testing of asymptomatic patients.
• 9:08
  SPEAKER_00: So those are some of the issues that we have addressed.
• 9:11
  SPEAKER_00: And I'm just gonna say we made the decision that if people are tested and they are negative, then we are using whatever usual PPE we would have used in the pre-COVID-19 era for surgeries.
• 9:25
  SPEAKER_02: Thanks for sharing that.
• 9:26
  SPEAKER_02: I think that's a big question that comes up.
• 9:28
  SPEAKER_02: You know, really, what is the goal of testing asymptomatic individuals?
• 9:31
  SPEAKER_02: You alluded to the fact that patients who test negative would impact the type of environmental care and PPE that's used when the surgeries are uh performed.
• 9:40
  SPEAKER_02: That has generated a lot of discussion at our institution, trying to mention other places as well.
• 9:44
  SPEAKER_02: You know, what is that information from testing preoperatively?
• 9:47
  SPEAKER_02: How is that really best used in making those kinds of decisions?
• 9:51
  SPEAKER_02: So the other group that has gotten a lot of attention in terms of testing while asymptomatic as healthcare workers, and uh, is there a role for testing asymptomatic healthcare workers at different intervals?
• 10:04
  SPEAKER_02: And really, what's the benefit?
• 10:05
  SPEAKER_02: Which types of healthcare workers should we be thinking about testing?
• 10:09
  SPEAKER_02: In my institution, at least, there's been a lot of different approaches that have been voiced, and we're still trying to reconcile the best way to go.
• 10:16
  SPEAKER_02: So I'm interested in hearing how others have discussed this issue, if they've moved forward with testing any healthcare workers.
• 10:22
  SPEAKER_02: So, uh, Dr.
• 10:23
  SPEAKER_02: Gerade, do you want to um share any experiences or any discussions that you're having at your institution with regard to healthcare worker testing?
• 10:30
  SPEAKER_03: So I think I'll answer this question by addressing a couple of other issues that tie up with this is the testing capacity.
• 10:38
  SPEAKER_03: What we could do if our testing capacity is not limited by the supplies versus what we are doing.
• 10:47
  SPEAKER_03: So right now, I think we are really limited by how many tests we can do at a certain given time.
• 10:54
  SPEAKER_03: And obviously, the priority is people who are sick, who are already in a hospital, and we need to make sure that they are isolated properly.
• 11:04
  SPEAKER_03: So that's for people who are already advanced.
• 11:07
  SPEAKER_03: But for healthcare workers, they are symptomatic.
• 11:10
  SPEAKER_03: We do prioritize symptomatic healthcare workers.
• 11:14
  SPEAKER_03: We need to have limitations based on our testing kids' availability, but we are now making sure we are able to test anybody who wants to get tested.
• 11:24
  SPEAKER_03: Now, there are two types of tests, as you know.
• 11:27
  SPEAKER_03: The PCR-based and antibody testing.
• 11:29
  SPEAKER_03: One of the goals that we have as a system is to test everybody for the antibody.
• 11:34
  SPEAKER_03: But for the PCR testing, we do encourage people who are symptomatic who get tested, but very recently we have opened up to anybody who wants to get tested, can get tested.
• 11:45
  SPEAKER_03: The problem with this approach sometimes would be that a negative test obviously doesn't mean that a person may not develop infection in the next few days.
• 11:53
  SPEAKER_03: And those are the KVRs we have to keep in consideration.
• 11:57
  SPEAKER_02: I think there's a lot of interest in both the uh serology testing as well as doing PCR testing for active infection.
• 12:04
  SPEAKER_02: And you know, a lot of questions that are coming up.
• 12:05
  SPEAKER_02: You know, the IDSA issued some guidance on how to approach serology testing, and uh I think we're still trying to navigate that particular challenge.
• 12:15
  SPEAKER_02: Cindy, do you have any additional thoughts on testing healthcare workers either with serology or PCR test?
• 12:22
  SPEAKER_01: So to comment on the serology testing, I think that you know a lot of people are putting a lot of hope in that right now, and obviously we're still at a very early stage of not only figuring out which tests are really going to be most effective, but really what does it mean to test positive with the serology test?
• 12:41
  SPEAKER_01: You know, down the line, does that really indicate that you have immunity to COVID-19?
• 12:46
  SPEAKER_01: And you know, we just don't have enough of that data yet.
• 12:49
  SPEAKER_01: Certainly, when you're talking about those tests, you're looking for you know a test with good specificity.
• 12:56
  SPEAKER_01: Um, if you're going to use a test like that to assume immunity, then you want to make sure that you have a low number of false positives so that you don't have people believing that they have immunity when they actually don't.
• 13:08
  SPEAKER_01: But we're just far too early in the game, I think, to really use those to make clinical decisions right now on whether or not someone is immune to COVID-19.
• 13:18
  SPEAKER_00: David, can I add in a couple of things also that I think are worth mentioning in regards to serology?
• 13:24
  SPEAKER_00: You know, we are just starting to do serologic testing, and a lot of people, I think, are hoping that they're going to test positive.
• 13:32
  SPEAKER_00: A lot of people have been saying to me that they think that they've already had this infection.
• 13:36
  SPEAKER_00: And even with the caveats that we don't know what the antibody means, we don't know if it confers protective immunity, we don't know whether you can get reinfected, we don't know if the strain is mutating, all those kinds of things, you know, are unanswered questions.
• 13:51
  SPEAKER_00: Still, I think that people will have the idea that they have some protection if they've already been infected.
• 13:57
  SPEAKER_00: But a lot more people seem to think that they've been infected with COVID-19 than are likely to have been infected.
• 14:03
  SPEAKER_00: I think that if you look at the projections or the estimates of current prevalence, they're actually much lower than what I've been hearing from healthcare workers as far as people who think that they've been exposed.
• 14:13
  SPEAKER_00: So I think that there definitely needs to be a lot of education that goes into procedure.
• 14:19
  SPEAKER_00: I just wanted to add that.
• 14:21
  SPEAKER_02: Yeah, I think that's a critical point.
• 14:22
  SPEAKER_02: You know, we actually did a small um serological survey of our healthcare workers and found a very low percentage of individuals actually had antibodies that were detectable.
• 14:33
  SPEAKER_02: And these were all healthcare workers who were taking care of patients with COVID-19.
• 14:37
  SPEAKER_02: So I agree.
• 14:38
  SPEAKER_02: I think that the questions that come up, both pertaining to how to interpret a positive antibody result, um, you know, are these really virus neutralizing antibodies?
• 14:46
  SPEAKER_02: How long do they last for?
• 14:47
  SPEAKER_02: You know, what is the actual specificity?
• 14:49
  SPEAKER_02: Um, there's been so many different serology tests that are becoming available and they've undergone different degrees of validation.
• 14:56
  SPEAKER_02: And I think those are the really important questions that are arising.
• 15:00
  SPEAKER_02: We were a little surprised with how low our positivity rate was using serology testing.
• 15:05
  SPEAKER_02: So, Cindy or Jennifer, do you want to comment on doing any sort of PCR testing for active infection amongst asymptomatic healthcare workers?
• 15:14
  SPEAKER_00: This is Jennifer.
• 15:15
  SPEAKER_00: I can say that we have decided not to do screening for asymptomatic healthcare workers with PCR mostly because of the limited supply of swabs.
• 15:24
  SPEAKER_00: I mean, we're still having problems with supply of nasopharyngeal swabs, viral transport media, and so on.
• 15:30
  SPEAKER_00: I think that as testing becomes more available, which it clearly will over the ensuing months, it may be worth revisiting this question.
• 15:38
  SPEAKER_00: But then you still have to ask, how often are you going to do the testing?
• 15:42
  SPEAKER_00: Because whenever you do testing, it's basically a snapshot.
• 15:45
  SPEAKER_00: I mean, it may be negative now, but that doesn't mean it's going to be negative tomorrow or next week.
• 15:49
  SPEAKER_00: So you have to kind of define, you know, when you think a significant exposure has taken place.
• 15:55
  SPEAKER_00: I think what you said before about the prevalence of antibodies being really low among your healthcare workers is instructive because what that means is that our PPE procedures have actually worked and maybe better than some of us might have thought early on, especially with all of the difficulties with supply.
• 16:12
  SPEAKER_00: So if that is the case, then there may not really be that much utility in testing asymptomatic healthcare workers.
• 16:19
  SPEAKER_00: So I think this is going to be an area that is, you know, there's certainly going to be more discussion about it.
• 16:24
  SPEAKER_00: Cindy, I'm curious what your thoughts are on that.
• 16:27
  SPEAKER_01: Yeah, I think you make some really great points.
• 16:29
  SPEAKER_01: And I think what I would add is just acceptability of testing.
• 16:33
  SPEAKER_01: I mean, if we are starting to talk about frequent testing of healthcare workers who are asymptomatic, you know, not just shortages, but even if you do have the supplies necessary for testing, how frequently do you test them?
• 16:46
  SPEAKER_01: And what point do you feel like people are going to be less accepting of being consistently tested for COVID-19, especially if they keep coming up negative?
• 16:56
  SPEAKER_02: I think those are all the really uh salient points that we have to think about with regard to healthcare workers as testing becomes less of a rate-limiting step.
• 17:04
  SPEAKER_02: So I want to transition into some additional topics.
• 17:07
  SPEAKER_02: Jennifer brought up PPE, and there are two different areas that we want to go into with regard to PPE.
• 17:13
  SPEAKER_02: The first being reprocessing masks.
• 17:16
  SPEAKER_02: I don't know if any of you have experience with reprocessing.
• 17:19
  SPEAKER_02: We are sort of in the infancy of that at our institution.
• 17:22
  SPEAKER_02: I'm trying to figure out uh the best approach with regard to how to distribute these reprocess masks, how to ensure that they're still adequate, how many times they should be reprocessed.
• 17:33
  SPEAKER_00: Sure.
• 17:34
  SPEAKER_00: So we have been reprocessing masks, and really kind of the rate limiting step is you know, the rubber bands, you know, can start to fall apart or the integrity of the mask can start to wear down after processing several times.
• 17:47
  SPEAKER_00: So I think depending on, you know, whether you're using vaporized hydrogen peroxide or if you're using heat, the number of times that it can be reprocessed is going to be slightly different.
• 17:57
  SPEAKER_00: Um, the question of how many times can they be safely reprocessed, I think it's gonna depend on the method.
• 18:03
  SPEAKER_00: The bigger area that I think we don't have really clear guidance on is you know, how long can a mask actually be worn?
• 18:10
  SPEAKER_00: We do have people that are wearing masks for extended periods of times.
• 18:14
  SPEAKER_00: Like if they're in a COVID unit, they may be wearing that mask for the entire day.
• 18:19
  SPEAKER_00: And these are you know not masks that are necessarily designed for that.
• 18:23
  SPEAKER_00: So I think we probably do need some more specific guidance on that, and you know, most of the guidance is not very clear about actual time.
• 18:34
  SPEAKER_03: We as a system looked into reprocessing, and I know there's some CDC guidance and some recommendations about uh reprocessing the instruments up to five times, and then you can establish processes to track that as well.
• 18:48
  SPEAKER_03: But one step we did already was to try a small limited number of N95 masks for reprocessing.
• 18:56
  SPEAKER_03: We look into how that mask was reprocessed, and then we sent those reprocessed masks for testing for their performance as well to other certifying lab just to confirm that when we reprocess these masks that they still function properly.
• 19:12
  SPEAKER_03: Our idea would be to mark them and reuse them if that is needed, but this choice of mask or reprocess mask would be the last choice that we will make in terms of supplying an 95 mask to our staff.
• 19:27
  SPEAKER_02: So the last PPE-related question that's been coming up is sort of thinking about the future.
• 19:32
  SPEAKER_02: We've been moving towards an increasing use of not just surgical masks for all patient encounters in the hospital, but really incorporating face shields as an important part of personal protective equipment when we're taking care of patients in the hospital, not just COVID patients, but kind of all patients in general.
• 19:49
  SPEAKER_02: And you know, there's a lot of discussion that moving forward, we're gonna see increasing use of both surgical masks and face shields in routine patient care, particularly in the hospital, thinking about potential for resurgence of COVID-19 moving into the fall and the winter, as well as other respiratory viruses.
• 20:06
  SPEAKER_02: So I'm interested in how others are approaching using face shields as a standard part of PPE.
• 20:13
  SPEAKER_00: Yeah, so we actually have been using N95 masks and face shields all the time in our COVID units.
• 20:21
  SPEAKER_00: So we have a designated COVID hospital that we have actually been sending all of our COVID patients to.
• 20:28
  SPEAKER_00: And then we have other hospitals that have smaller numbers and that have specific units designated.
• 20:34
  SPEAKER_00: And in those units, people are wearing N95 masks and either face shields or goggles basically all the time.
• 20:40
  SPEAKER_00: In other areas of the hospital, we're having people wear N95 masks in patient care areas.
• 20:46
  SPEAKER_00: And the question that has come up is when can you start to step down from this?
• 20:51
  SPEAKER_00: So we are currently looking at stepping down to surgical masks and eye protection, but the eye protection is clearly an important part of it.
• 20:59
  SPEAKER_00: And I think it's actually a little bit more difficult because it's not that easy to work in current healthcare settings, it's not that easy to type on a computer wearing some of the goggles and face shields, definitely gets in the way.
• 21:12
  SPEAKER_00: And so people tend to take them on and off.
• 21:14
  SPEAKER_00: I think it is going to be interesting to see whether or not surgical masks are gonna be sufficient.
• 21:19
  SPEAKER_00: I think that we're gonna be getting more information about this.
• 21:23
  SPEAKER_00: I look forward to being able to step down to surgical masks.
• 21:26
  SPEAKER_02: Sydney, do you have any thoughts on PPE in the future?
• 21:30
  SPEAKER_01: Yeah, I think the idea of where are we going with PPE use is really interesting.
• 21:35
  SPEAKER_01: Um, I think if you look back historically, it seems like you know, we don't have a lot of data on PPE compliance, but we know that compliance has not always been great when it's been studied.
• 21:46
  SPEAKER_01: Um I think that compliance obviously changes as you get in a situation like with COVID-19 where people really feel strongly that they need that PPE to protect themselves and prevent infection.
• 21:58
  SPEAKER_01: And so, you know, down the line, I think it's going to depend very much on, you know, are we seeing resurgence of COVID-19?
• 22:06
  SPEAKER_01: You know, are we finding that people have concern over other respiratory viruses as well?
• 22:12
  SPEAKER_01: You know, are they feeling as strongly about protecting themselves against flu and some of these other viruses as they are with COVID-19?
• 22:20
  SPEAKER_01: And so it'll be interesting to see what happens, but I do feel like we're probably going to see increased use of at minimum surgical masks and eye protection.
• 22:30
  SPEAKER_01: Um Jennifer makes a good point though that you know eye protection is a challenge because a lot of people don't seem to have easy access to it.
• 22:38
  SPEAKER_01: Um, at least in regular times they didn't.
• 22:40
  SPEAKER_01: And also, you know, the level of eye protection can differ if you have goggles that are scratched up and fogged and just getting difficult to see through because of repeated cleaning.
• 22:52
  SPEAKER_01: That's a real issue, and that's gonna decrease compliance with that.
• 22:56
  SPEAKER_03: I agree with all what has been said about the face shields.
• 22:59
  SPEAKER_03: They are going to be an integral part of the PPE.
• 23:02
  SPEAKER_03: Moving forward, I think we also need to think about not only face shields, but other protections like goggles and how we can integrate them in a risk-based strategy.
• 23:13
  SPEAKER_03: For example, for up close procedures, we are using face shields that provide uh entire face cover, versus for a person who has very little interaction with patients.
• 23:24
  SPEAKER_03: We sometimes use healthcare goggles for these uh interactions as well.
• 23:29
  SPEAKER_03: So integrating different kinds of PPEs is going to be a step that we will take moving forward.
• 23:35
  SPEAKER_03: And planning for upcoming possible surge, we want to make sure that we have all options open.
• 23:42
  SPEAKER_03: So cross-training staff with different kinds of PPE is also one thing to be considered moving forward.
• 23:49
  SPEAKER_02: And I think those are great points.
• 23:51
  SPEAKER_02: I can agree that uh the way we think about PPE in the future is gonna look different.
• 23:55
  SPEAKER_02: I anticipate we're gonna see pretty significant changes.
• 23:58
  SPEAKER_02: So I want to thank everyone who was able to participate in this call, Dr.
• 24:01
  SPEAKER_02: Hamrahan, Dr.
• 24:02
  SPEAKER_02: Prince, Dr.
• 24:03
  SPEAKER_02: Javain.
• 24:03
  SPEAKER_02: Thank you guys for joining.
• 24:05
  SPEAKER_02: I think given some great insight into a lot of the questions that we're all thinking about as we move forward.
• 24:09
  SPEAKER_02: And there's certainly going to be many other questions that we'll be able to discuss in the future.
• 24:13
  SPEAKER_02: Thank you very much to our speakers for sharing your perspectives and experiences, and a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 24:23
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 24:29
  SPEAKER_02: You will find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAY COVID-19 town halls.
• 24:37
  SPEAKER_02: 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.
• 24:50
  SPEAKER_02: That concludes this episode of the Rapid Response Podcast.
• 24:54
  SPEAKER_02: Thank you for tuning in.