What is the current state of N95 inventory/supplies in your facility? Do you have any supply? How long will it last days, 1 week, 2 weeks, more?

We started securing our PPE in early Feb. Units have to check out from our CARECOMM center and all PPE is stored in Employee Health (N95, masks, faceshields, goggles)
Our biggest issue is face shields. We had a supply of reusable goggles that we gave to ED and designated ICUS and unit that will admit COVID pts.
We have few weeks supply of faceshields, but enough resuable goggles to sustain higher risk areas and N95s ok since we allow the Fluid GARD level 3 tie mask for swabbing
We are also low on nasopharyngeal RVP swabs for COVID. This is biggest concern for us. We use one swab to collect OP and NP specimen on pt.and employees.

Are you rationing the equipment you have? For what procedures are you using N95s? Patient evaluation, testing, COVID patient care, intubation/aerosol generating procedures?

To conserve N95 for diagnosed pts, we are allowing FluidGARD level 3 masks with goggles or faceshields for NP swabs. We are just starting to reuse disposable faceshields by running though our UV machines and wiping down. Our materials manager also found heavy duty construction faceshields at Home Depot that we are going to reuse after disinfection.
NP swabs: Use goggles/faceshield, FluidGard level 3 masks, glvoes, gowns.
N95 masks are used for suspected and diagnosed COVID19 patients and it one time use only. For our R/O TB , we ask the HCW to reused mask during shift for same pt.
We also got a supply of the disposable goggles in and will consider reusing these as things progress. We are also looking at another level 3 mask with a faceshield attached to use as backup if FluidGard masks and goggles are depleted.
We are also going to start secruing our procedure masks as utilizaton has gone up five fold and we think employees are taking home. Visitors were also removing boxes from our etiquette stations so we stopped that.

To what extent is your facility equipped with and using elastomerics and PAPRs? Shortages?

We have 5 PAPRS and ordered 20 more units with 250 hoods. We haven't used them yet, but will if necessary.
Our DECON area has full hood/suits but that will be last resort as they have to changed out every 30 minutes due to heat.

Is the system clear for getting additional PPE from suppliers? State or federal government stockpiles? Have you been able to secure supplies? From what source?

We were told the state will supply more N95 nexst week ()35,000 for all state hospitals) so they won't last long.
Our material management is reaching out to all their sources. Once actually reached out to us with a supply of disposable goggles.

Do you expect anticipate that you will be able to secure supplies in the next week, few weeks?

Not sure, we are hoping that the state delivers what they promise.
State is also providing swabs for testing next week.

Aside from the obvious PPE issues, how would you rate compliance with engineering and administrative controls recommended by CDC?

Compliance has been great. The doctors are actually requesting fit testing and asking to learn how to donn and doff PPE so they don't contaminate themselves.
Employees and medical staff are very compliant.

Is your facility allowing exposed, but asymptomatic HCWs to treat patients?

We had two COVID + employees last week and both worked day before symptoms started. We decided to allow employees exposed to COVID+ employees to continue to work as they were asymptomatic during work and we could not quarantine all of our night shift oncology unit or material management unit. Some of the potentially exposed employees not happy that we are not quarantining, but we are going to do daily temps and symptom screen
However, employees with a COVID + household member are being quarantined for 14 days due to increase level of exposure.
We are also quarantining travel from level 3 areas..but travel has decreased significantly over last week so not a current issue.
We haven't had exposure from patients yet as we have good system in place for PPE for rule outs.
Would love to hear how others are handling exposures, both in community and in healthcare setting as we will probably revise if we get a big surge.
Currently we are requiring two negative COVID test 24 hours apart for RTW but CDC also posted option to allow RTW if afebrile 72 hours off fever reducing meds with at least 7 days OOW. This is an ongoing discussion. Curious what others are doing.

Is there still a serious shortage of tests that can be used to determine whether HCWs are exposed and should be quarantined, or whether they can be allowed to work?.

Our hospital set up in house testing about 10 days ago. WE can only run limited COIVID tests on our current equipment, including from Emergency Room and Employee Health. Will get new equipment tomorrow and increase capacity
We closed down our sick childcare center, which is adjacent to main hospital with an outside entrance and Employee HEalth set up screening center one week ago.. All symptomatic team members are screened and tested using same swab for oropharyngeal followed by nasophayngeal specimen. We run RVP first and if negative, run COVID. If RVP + for other virus we do not run COVID at this time as our ID physicians do not feel there is much coinfectioin with COVID and other viruses. Although, yesterday, our lab director read an article of coinfection with COVID and rhinoviruses. We actually are retesting a nurse who had rhinovirus but still has temps so just ordered COVID on her.
We are screening about 40-50 per day (medical staff, employees, residents) with same day turnaround. We felt this was necessary as urgent cares were sending to Quest or LabCorp with 5-6 day turnaround . We do not allow to work until screening resutls are in (same day).
We may start running COVIDs on all screens if we have the capacity.

Would like to hear how other healthcare facilities are handling at risk employees (pregnant, over age 60 with underlying comorbidities and immunocompromised).; We have allowed them to be reassigned from r/o COVID or diagnosed COVID but some of them do not want to work at all. If possible, we try to reassign to lower risk areas, but it is not always possible.

Since our elective surgeries are cancelled, we are using pool of nurses from furloughed areas to work in our screening center, help with fit testing medical staff, and screen employees coming intio the building. Tomorrow we are starting symptom screening of all employees entering main facility. Those who have a + symptom screen will be sent to the EHS screening clinic for an evaluation and possible testing.

WARNING: This email came from an external source outside of Tampa General Hospital.

Dear MCOH Colleagues,

I hope this weekend has brought you some brief respite from the escalating crisis that endangers our clinician colleagues and their patients. PPE deficiencies, particularly for respiratory protection, likely drive agonizing decisions at most of our hospitals daily.

This email is sent on behalf of ACOEM leadership, seeking your input as MCOH clinicians and experts as it relates to an OSHA Emergency Temporary Standard (ETS) for HCP. If you have evidence (or even anecdotes) from the past several weeks that an ETS is indicated, ACOEM would like to hear all that you are comfortable sharing. Please send your responses directly to ACOEM's Director of Government Affairs, Pat O'Connor, at patoconnor@kentoconnor.com. Pat has served ACOEM for many years, and guarantees that responses to him will be ensured anonymity and de-identified for hospital worksites as well as individuals. If you reply to the MCOH listserv only, your responses will simply be to the listserv.

Wishing you all strength, health and resilience in this terrible time, Amy

Specific questions from ACOEM are

What is the current state of N95 inventory/supplies in your facility? Do you have any supply? How long will it last days, 1 week, 2 weeks, more?
Are you rationing the equipment you have? For what procedures are you using N95s? Patient evaluation, testing, COVID patient care, intubation/aerosol generating procedures?
To what extent is your facility equipped with and using elastomerics and PAPRs? Shortages?
Is the system clear for getting additional PPE from suppliers? State or federal government stockpiles? Have you been able to secure supplies? From what source?
Do you expect anticipate that you will be able to secure supplies in the next week, few weeks?
Aside from the obvious PPE issues, how would you rate compliance with engineering and administrative controls recommended by CDC?
Is your facility allowing exposed, but asymptomatic HCWs to treat patients? Is there still a serious shortage of tests that can be used to determine whether HCWs are exposed and should be quarantined, or whether they can be allowed to work?.

Amy J Behrman, MD, FACOEM, FACP

Professor, Department of Emergency Medicine

Medical Director, Occupational Medicine

Perelman School of Medicine

University of Pennsylvania

3400 Spruce Street

Philadelphia, PA 19104

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