“COVID 19: Information for Sterile Processing Staff --What YOU Need to Know”

S PONSORED BY: ST ERI LE P ROCESSI NG U NI VERSI TY, L LCN A NCY C HOBI N, R N, A AS, A CSP, C SPM, C FERROBERTA H ARBI SON, BBA , L SS G R EENBELT, CH L , CRCST

CO PYRI GH T – ST ERI LE P ROCESSI NG U NI VERSI TY, L LC, 2 020 , A L L R I GH TS R ESERVED

WELCOME !

Your speakers today:Nancy Chobin, RN, AAS, ACSP, CSPM, CFER – President Sterile Processing University, LLCRoberta Harbison, BBA, LSS Greenbelt, CHL, CRCST – Senior Consultant, Sterile Processing University, LLC

This webinar will address the many issues SPD personnel are facing processing devices that may be contaminated with COVID-19.

We have received numerous emails and phone calls from concerned SPD personnel who are confused and afraid (in some cases) of processing practices.

As sterile processing professionals, we wanted to share the most up-to-date information from scientific sources, to help you through this difficult time.

Guidelines

We will have all attendees on mute during the sessions.

PLEASE PUT ALL DEVICES ON MUTE AS WE ARE

RECORDING THIS SESSION.

There will be time allocated at the end of the presentation

for questions and answers.Please enter in the Chat box

at the bottom of your screen.

Please do not videotape or record this session – it is

copyrighted

If you want a copy of the handouts, please email us

and we will send you a copy. We will tape this session and

post it on our webpage within 5 days.

You will be emailed your CEU Certificate as well as an Evaluation Form within 5 days. • We would greatly appreciate your

feedback.

Objectives:

Discuss Standard precautions for SPD Discuss

Review the proper sequence for donning and doffing PPEReview

Discuss the various types of PPE used in SPD; their indications for use and applications to the COVID-19 virus

Discuss

Objectives

Discuss

Discuss individual accountability (situational awareness)

Discuss

Discuss the importance and necessity of good hand hygiene

Discuss

Discuss what the industry is doing to address the current PPE shortages

Review

Review the risks of reprocessing single use devices on healthcare workers and facility

Review

Review choices of what we can do when we do not have enough PPE

Discuss

Discuss the vision for SPD - Who We Are

Review

Review the mission of sterile processing

Discuss

Discuss our values and how we exhibit them

WHY WE ARE HERE –Coronavirus

Coronavirus vs COVID-19

Experts refer to this coronavirus as the “novel coronavirus,” meaning it’s a new type of coronavirus that was

not previously known or understood by health experts. COVID-19 is the

illness caused by the novel coronavirus.

COVID-19 can lead to major health problems like pneumonia and organ failure, and it can

also cause issues like shortness of breath and fever People who are at the highest risk for severe complications from COVID-19 are those who are over 65, anyone who may be

immunocompromised, and those with chronic medical conditions like heart disease, diabetes and lung disease.

The severity of coronaviruses can range from being mild ― like the common cold ― to more serious symptoms that can lead to hospitalization, like lung problems. Some

examples of previous coronaviruses include Severe Acute Respiratory Syndrome (SARS)

and Middle East Respiratory Syndrome (MERS).

WHAT IS THIS?

Symptoms of COVID-19 are a cough, a high temperature

and shortness of breath.

Simple measures like washing your hands often with soap and water can

help stop viruses like coronavirus COVID-19

spreading.

There’s no specific treatment for COVID-19. Treatment aims to relieve the symptoms until you

recover.

It's not known exactly how COVID-19 spreads from person to person, but

similar viruses are spread in cough droplets.

PrecautionsPerson-to-person spread:◦ Between people who are in close contact with one another

(within about 6 feet).◦ Through respiratory droplets produced when an infected

person coughs, sneezes or talks.◦ These droplets can land in the mouths or noses of people

who are nearby or possibly be inhaled into the lungs.◦ Some recent studies have suggested that COVID-19 may be

spread by people who are not even showing symptoms.

Precautions

Standard Precautions - represents a philosophy that assumes that all patients are potentially infectious.

Transmission-based precautions might be necessary to prevent the transmission of specific diseases or microorganisms that are spread by contact, droplet, and airborne transmission.

Standard precautions contain key elements of infection prevention and control practices, such as hand hygiene and wearing PPE.

When required, transmission-based precautions supplement standard precautions, infection prevention and control practices such as hand hygiene and wearing PPE to avoid contact with contaminated items, blood, or other bodily fluids.

Standard Precautions - Definition

Group of infection prevention practices that apply to all patients, regardless of suspected or confirmed diagnosis or presumed infection status.

Is a combination and expansion of Universal Precautions and Body Substance Isolation.

Based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes, may contain transmissible infectious agents.

Includes hand hygiene, and depending on the anticipated exposure, use of gloves, gown, mask, eye protection, or face shield.

Equipment or items in the patient environment likely to have been contaminated with infectious fluids must be handled in a manner to prevent transmission of infectious agents (e.g., wear gloves for handling, contain heavily soiled equipment, properly clean and disinfect or sterilize reusable equipment before use on another patient).” (CDC, 2007)

Importance of PPEPersonal Protective Equipment (PPE) should ALWAYS be used in the Decontamination Area and when handling contaminated items.CDC is strongly recommending the use of PPE but just as important is the need to know how to don (apply) or doff (remove) the PPE to ensure you are protected and do not contaminate yourself or your clothing.Kang, et al. (2017) discovered that healthcare personnel contaminated themselves in almost 80 percent of the PPE simulations!

DONNING PPESequence:

Don headcover (not considered PPE)

Don shoe covers should be donned first. Then wash your hands.

The gown should be donned next.◦ To don a gown, first select the appropriate type for the task and the

right size. (At least a level 3). Isolation gowns can have limited protection from fluids.

◦ The gown should open in the back. Secure the gown at the neck and waist.

The mask should be put on next; it should be properly adjusted to fit.

◦ Some masks are fastened with ties, others with elastic. If the mask has ties, place the mask over your mouth, nose, and chin. Fit the flexible nosepiece to the form of your nose bridge. Tie the upper set of ties at the back of your head and the lower set at the base of your neck.

Diagrams from CDC PPE Use in Healthcare Settings

DONNING PPEThe goggles or face shield should be donned next.

◦ Position either the goggles or the face shield over your face and/or eyes and secure it to your head using the attached earpieces or head band. Adjust it to fit comfortably. Goggles should feel snug but not tight.

NOTE: Safety eyeglasses are NOT a substitute for goggles or a face shield.

Gloves are donned last.◦ Insert each hand into the appropriate glove and

adjust as needed for comfort and dexterity. If you are wearing a gown, tuck the gown cuffs securely under each glove to provide continuous barrier protection for your skin.

Diagrams from CDC PPE Use in Healthcare Settings

Doffing PPE

To remove PPE safely, need to identify which areas are considered “clean” and which are considered “contaminated.”

Generally, the shoe covers, the outside front and sleeves of the gown, and the outside front of the mask and goggles or face shield are considered contaminated, regardless of whether there is visible soil.

The outside of the glove is also contaminated.

The areas that are considered clean are the parts that will be touched when removing PPE: the inside of the gloves; the inside and back of the gown, including the ties; and the ties, elastic, or earpieces of the mask and goggles or face shield.

DOFFING PPE

When the gown has a tie at the back of the neck, PPE should be removed as follows:

The shoe covers are considered to be the most contaminated

pieces of PPE -remove first.

DOFFING GLOVESThe gloves are removed next. With a gloved hand, grasp the opposite glove and peel the glove off.

Hold the removed glove in the gloved hand.

Carefully slide the fingers of the ungloved hand under the top of the remaining glove (at the wrist) and peel that glove off over the first glove removed. Discard the gloves.

DOFFING PPE

The goggles or face shield should be removed next.◦ The outside of the goggles or face shield is

considered contaminated; remove the goggles or face shield by grasping the earpieces or head band.

◦ Using ungloved hands, grasp the “clean” earpieces or head band and lift them away from your face.

◦ If the goggles or face shield are reusable, place them in a designated receptacle for subsequent reprocessing.

◦ Otherwise, discard them in the waste receptacle.

DOFFING GOWN

The gown should be removed next.◦ Unfasten the gown ties with the ungloved hands. ◦ Slip your hands underneath the gown at the neck and

shoulder and peel away the gown from your shoulders.◦ Slip the fingers of one hand under the cuff of the

opposite arm. ◦ Pull your hand into the sleeve, grasping the gown from

the inside. ◦ Reach across and push the sleeve off the opposite arm. ◦ Fold the gown towards the inside and fold or roll it into a

bundle. (Only the “clean” part of the gown should be visible.)

◦ Place the gown into a waste or linen container, as appropriate.

DOFFING PPE

• Do not touch the front of the mask to remove it. • Untie the bottom tie and then, using the upper tie, lift off

the mask. • Discard it into a waste container.

The mask should be the next thing removed.

• Lift the head covering off of the head by grasping it in the center and lifting upward.

• Discard it into a waste container.

Head covering (not considered part of PPE) should be removed last,

before leaving the decontamination area.

PPE

Before leaving the decontamination area, remove

all protective attire, being careful not to contaminate the clothing beneath or their skin.

Thoroughly wash hands.

Designated areas for donning and removing protective attire should be provided, and there

should be a trash container readily available for the

disposal of single-use PPE.

The poster depicting the process of donning and doffing PPE can be obtained at the CDC website: http://www.cdc.gov.

(same one used for Ebola -(CDC, 2015b).

FDA Definitions of MasksFace Mask – A mask, with or without a face shield, that covers the user’s nose and mouth and may or may not meet fluid barrier or filtration efficiency levels.

Face Shield - A face shield is a device used to protect the user's eyes and face from bodily fluids, liquid splashes, or potentially infectious materials. Generally, a face shield is situated at the crown of the head and is constructed with plastic to cover the user’s eyes and face.

Surgical Mask – A mask that covers the user’s nose and mouth and provides a physical barrier to fluids and particulate materials. The mask meets certain fluid barrier protection standards and Class I or Class II flammability tests.

FDA Definitions of Masks

N95 Respirator – A disposable half-mask filtering facepiece respirator (FFR) that covers the user’s airway (nose and mouth) and offers protection from particulate materials.

NIOSH Approved N95 Respirator – An N95 respirator, approved by NIOSH that meets filtration efficiency level per regulations.

Surgical N95 Respirator – A disposable mask used in a healthcare setting that is worn by HCP during procedures to protect both the patient and HCP from the transfer of microorganisms, body fluids, and particulate material at an N95 filtration efficiency level.

Surgical N95 respirators are both approved by NIOSH as an N95 respirator and also cleared by the FDA as a surgical mask.

These products are frequently referred to as medical respirators, healthcare respirators, or surgical N95s.

Masks for SPD Decontamination

N-95 masks should be prioritized for health care practitioners in close

contact (i.e. 6 feet) of patients known or suspect of COVID-19

during aerosol generating procedures and infectious diseases when airborne precautions should

be followed.

If your facility has approved your wearing a N-95 mask (and are

available), you must be medically cleared and have fit training with

competencies verified.

Even regular face or surgical masks, if not worn correctly may not

provide an adequate seal.

Decontamination Safety

The COVID-19 virus can be eliminated by methods routinely

used in Sterile Processing departments; high-level

disinfection and sterilization.

Evidence the COVID-19 can survive on surfaces for hours or days if they are not cleaned and

disinfected.

Need to think about the potential for environmental contamination and personal exposure when we transport, handle and manually

clean instruments and endoscopes that may have been

exposed to COVID-19.

Risk no higher than it has always been with other serious

pathogens, and everyone will be safe if they follow the practices needed to prevent exposure to

HIV, hepatitis, bacteria and fungi.

Must practice good hand hygiene and correct donning and doffing

of PPE.

https://www.epa.gov/pesticide-registration/list-n-disinfectants-

use-against-sars-cov-2CDC Disinfectant List for COVID19

Decontamination SafetyThe COVID-19 virus can live on hard surfaces for up to 72 hours.(CDC)Up to 24 hours on porous surfaces (e.g. cardboard).(CDC)The predominant mode of transmission was from person to person (particularly those who were not exhibiting symptoms) not through contact with potentially infected surfaces. (Joseph Vinetz, professor of medicine, Yale University and infectious disease researcher). *There is also poor survivability of these coronaviruses on surfaces. Viruses need living tissue to grow.

USA Today 3 -20-20

Decontam SafetyTransport containers, decontam areas on the dirty side, and the PPE worn when handling instruments may be contaminated, and the virus is more likely to survive in wet conditions.

When manual cleaning, splashing can occur. Avoid spray faucets which can aerosolize.

Must wear correct PPE.

No one has immunity to this particular virus.

Complacency could cause serious illness among reprocessing personnel.

Cori Ofstead - Conversation with Julie Williamson 3-24-20

Decontamination Safety

Do not reuse PPE.

Do not use less PPE.

If asked, speak with management.

Determine how they’re going to decontaminate the PPE before reuse. (Roberta will speak more on this)

Anything used in manual cleaning is highly contaminated and should not be reused, unless it can be cleaned and disinfected or sterilized in ways that do not compromise the materials.

Vendor consultations may be necessary for this.

Cori Ofstead - Conversation with Julie Williamson 3-24-20

Don’t Be A T-REX

THANK YOUWe appreciate your attending this webinar and hope you found it helpful to you.

We will answer any questions you have.

Please enter in the chat box (if you have not already done so.

References

3M Company. (2020). Decontamination methods for 3M N95 respirators. Technical bulletin, 1-2.

3M Company. (2020, March). Surgical N95 vs. standard N95 – which to consider? Retrieved from www.3m.com: https://multimedia.3m.com/mws/media/1794572O/surgical-n95-vs-standard-n95-which-to-consider.pdf

Advanced Sterilization Products . (2020). Instructions for use for reprocessing N95 Masks in STERRAD sterilization systems during the Covid-19 public health emergency. Advanced Sterilization Products.

Centers for Disease Control and Prevention. (2020, March 27). Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Retrieved from www.cdc.gov: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

Crotti, N. (2020). Medline to reprocess N95 respirators to fight Covid-19 spread.

Mezher, M. (2020). FDA lifts requirements for masks, respirators, looks to reprocessing to ease shortages.

Reprocessing N95 masks with ultraviolet germicidal irradiation. (2020, March 27). Retrieved from www.netec.org: https://netec.org/tag/covid-19.

Sterile Processing University, LLC. (2019). The Basics of Sterile Processing textbook: 7th edition. Lebanon, NJ. Sterile Processing University, LLC.,

Steris Corporation. (2020, March). Technical response to Covid-19 reprocessing. Retrieved from www.steris.com/-/media/documents: https://www.steris.com/-/media/documents/pdfs/covid-19/coronaviruscommunicationfinal.ashx

The Association for the Advancement of Medical Instrumentation. (n.d.). AAMI advanced safety in health technology. Retrieved from Sterile processing benchmarking : https://www.aami.org/search/results/index.cfm?keywords=sterile+processing+benchmark

The United States Food & Drug Administration. (2020). Battelle emergency use authorization form. The United States Food & Drug Administration.

Williamson, J. (2020, March 27). Covid-19 with Cori Ofstead. Retrieved from https://www.iahcsmm.org/iahcsmm-news/insights-covid-19-qanda-march-2020

CDC website: Use of PPE in Healthcare Settings. www.cdc.gov.

CDC Guidelines for COVID-19, 2020.