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N95 Transition for Care of Patients With COVID-19

To the UW Medicine Community:

Since January, UW Medicine has responded to the COVID-19 pandemic on many fronts, always focusing on providing outstanding care for our patients and ensuring the safety of healthcare workers. We have been able to respond to changes and the latest information quickly and have implemented our policies based on evidence. One of the key focus areas has been securing reliable supplies for personal protective equipment (PPE). This has been a constant focus since the start of the pandemic. Our supply chain partners have spent countless hours tracking down opportunities for supply purchases and proactively forecasting our needs.

Early on, we recognized that N95 respirators were going to be a critical supply item, so we reviewed the evidence and, based on that evidence, made the decision to limit respirator use to the highest-risk patient care scenarios – aerosol generating procedures (AGPs) – consistent with national guidance when supply is limited. The available data supported the safety of using surgical masks for other COVID-19-related patient care and ensured that we had enough respirators for high-risk situations. Since that time, we have tested almost 12,000 employees and investigated nearly 1,000 exposures, which has provided us with additional local evidence that has also supported this approach. Our plan has always been to transition to broader use of N95 respirators when we were able to obtain a supply of N95s that aligned with our forecast of future need.

Over the last two weeks, the Supply Chain team has been able to identify an opportunity to purchase 500,000 reliable N95 respirators at a significant mark up in cost ($2.6 million dollars). This provides us with the necessary stock to more broadly distribute for routine care of patients with COVID-19. This PPE change represents the culmination of months of work on the parts of the infection prevention, employee health and supply chain teams. Given this new supply, we are beginning a transition to N95 respirator use in the care of patients with known or suspected COVID-19. It is important to recognize that the current approach using surgical masks and eye protection is safe.

First Stage

  • As of the end of this week, UW Medicine is transitioning to OPTIONAL RESPIRATOR USE (N95/PAPR/CAPR) for the direct patient care of patients with known COVID-19.
  • HCWs who use N95s will be required to extend the use of the respirator by keeping it in place from donning until taking a break. Once removed, the respirator should be placed in a repository for re-processing and a new respirator should be donned. More information on extended use is below.
  • Increased fit-testing access for HCWs who opt to wear an N95.

Important Note: This PPE change is being rolled out across all UW Medicine sites. We anticipate that this policy will eventually be extended to include the care of patients with suspected COVID-19 (PUIs). If supplies and fit testing allow, N95 use for suspected and confirmed COVID-19 patients may become mandatory. If at any time our N95 supply chain is further disrupted, we will need to reevaluate the sustainability of this strategy.

Extended use

Extended use means that a mask is worn for a prolonged period, for multiple patient encounters, before being removed. Any time an N95 is taken off, it must be discarded for re-processing. As always, safe doffing is critical to avoid self-contamination. N95 reuse (that is, putting a mask back on that has recently been worn) is not currently permitted due to the risk of contamination.

In the ICU and on acute care floors, if you are caring for more than one patient with known COVID-19, you may wear your N95 respirator with face shield or procedure mask over N95 between these patients without having to change your N95. Once care is complete, procedure masks must be removed and discarded. A fresh procedure mask will be donned with the next patient encounter. N95s will need to be changed when transitioning from encounters with COVID-19 patients to non-COVID-19 care.

In the Emergency Department (ED), where open areas make it challenging to isolate patients with COVID-19 into a specific area and where a patient’s diagnosis may not yet be confirmed, an N95 can be worn as the universal mask. A procedure mask would be worn on top of the N95 and removed when transitioning between COVID-19 and non-COVID-19 patients. In the ED, N95 masks that are removed for breaks and meals will need to be discarded in the proper area for re-processing collection.

Please note that new N95 models such as the 3M 9205+ are not fluid resistant and require the use of a face shield or surgical mask when there is a risk for blood or body fluid exposure.

Fit testing

Please note that to wear an N95 respirator, you must be fit tested. We have already begun the process of fit testing staff who were not previously fitted as well as re-fit testing staff to N95 models that are new to our system.

Stay safe

Community exposure and staff-to-staff transmission remain the largest risks to our workforce and are responsible for most HCW infections. With rising rates of COVID-19 across Washington state, we need to interact with one another with the assumption that some of our colleagues could be contagious. This extends to community contacts. The good news about a vaccine in the near future is promising, so let’s take every precaution to stay safe.

We are so grateful for the UW Medicine community and for your hard work to keep patients and each other safe. Thank you for everything you do. We will get through this together!

Sincerely,

Seth Cohen, MD, MSc
Medical Director of Infection Prevention
UW Medical Center

Nandita Mani, MD
Associate Medical Director of Infection Prevention
UW Medical Center

John Lynch, MD, MPH
Associate Medical Director
Harborview Medical Center

Adrienne Schippers, RN, BSN
Manager, Infection Prevention & Control
UW Medical Center

Santiago Neme, MD, MPH
Medical Director
UW Medical Center – Northwest

Kathy Strand, RN
Manager, Employee Health
UW Medical Center

Vanessa Makarewicz, RN, MN, CIC
Manager, Infection Prevention & Control
Harborview Medical Center

Allison Zelikoff, RN-BC, MSN
Manager, Employee Health
Harborview Medical Center

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