This blog outlines a Personal Protective Equipment (PPE) Checklist For Airborne Transmission (For physicians, nurses, and other frontline healthcare staff) -Battling SARS-CoV-2 (Coronavirus) which causes the disease COVID-19
What is BYOPPE? It's like BYOB but instead of the B, it's PPE. Why is it time to BYOPPE?
There have been dozens of U.S. front line physicians, nurses, and care providers infected by COVID-19 as of March 20, 2020. The biggest thing we can do to prevent this from happening further is to equip them with Personal Protective Equipment, PPE. In this post, we provide a visual aid and the supporting data for this below checklist to assist doctors, nurses, and administrators to reinforce a common knowledge of appropriate Personal Protective Equipment, or PPE for infection by droplet transmission via the environment in the air.
Figure 1. Essentials for Frontline Healthcare Professionals
Design: Anthony Lee, Heroic Voice Academy
New research shows that persons can become infected through the air as well as by touching contaminated objects. The disease is airborne according to World Health Organization, WHO. MIT reports that it’s potentially more than 26.2 ft, , or can travel 8 meters from cough (not accounting for air movement) [1]
It’s also suspended in the air for up to three hours
A study by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), Princeton University and UCLA published in The New England Journal of Medicine suggests that the coronavirus lives in aerosols. The virus becomes suspended in the environment and air as droplets when someone coughs or sneezes. This is for up to three hours. On surfaces such as plastic and stainless steel, the virus survived for up to two to three days. See Figure 2.
Figure 2. Distribution of aerosol infective particles
This urgently changes the game to protect our healthcare workforce.
Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, emphasized on Monday March 16, the importance of health care workers taking additional steps to protect themselves. She also told reporters that the virus is transmitted through droplets from sneezing or coughing.
More on the WHO statement can be found at this post:
Since it’s a “novel” Coronavirus, there isn’t a robust pathogen- specific evidence base for PPE guidance. However, we refer to the World Health Organization’s guidance for viral infection control here based on Ebola. It is unclear at this time how SARS-CoV-2 compares exactly to Ebola. Though we do know that it’s constantly evolving as a virus; Scientists can follow the real-time tracking of the evolution of COVID-19 which is posted on this open source website
Keep in mind, the hardest-hit region of Hubei province deployed 100,000 medical protective suits a day according to the Shanghai Daily online publication Shine.
“Personal Protective Equipment for Use in a Filovirus Disease Outbreak: Rapid Advice Guideline.”
The Chinese experience has been enormous and it’s a mistake not to learn from it.
In the report, physicians note that it’s essential that those on the front line of patient care have the opportunity to share their hard-won experience. Faced with an unknown virus, sharing and collaboration are the best remedy.”
See the edited report in the Handbook of COVID-19 Prevention and Treatment, based on the experience of China where the disease originated.
Figure 3. COVID-19 Risk Level Based Personal Protection
Source: Handbook of COVID-19 Prevention and Treatment
DONNING PROCEDURES FOR DRESSING; NOTE MD washes hands AFTER putting shoes and clothes on.
Source: Handbook of COVID-19 Prevention and Treatment
DOFFING PROCEDURES FOR REMOVAL OF PPE; Note hand washing 5 times in the doffing cycle is REQUIRED for Suit use
Source: Handbook of COVID-19 Prevention and Treatment
What Healthcare Professionals and Anyone Who Cares About Them Need to Know:
1. CDC guidelines are based on supply availability to assist healthcare organizations in operationalizing levels of equipment on hand. They are not always updated to reflect specific safety standards.
2. We don’t know how long it will take to release the National stockpile or how long it will last. For masks, it is estimated to provide roughly enough masks for 13 health systems for 13 weeks according to New York’s healthcare committee chair Mark D. Levine.
3. Since we don’t know when or where they would be directed, we believe you need to help source your own protective equipment NOW. Reportedly, one of the largest physician groups in the U.S., Envision Healthcare has instructed their doctors to secure their own Protective Personal Equipment, PPE.
If we were to have in America what’s happening in Italy, the impact on the stock market would be even worse, and the toll on our social fabric unspeakable. Healthcare professional, here’s your call to action to protect yourself and your colleagues.
1. Keep the checklist of PPE (Figure 1) as a photo on your phone in your photos so you can always refer to it.
2. Be able to explain that no branch of government has an immediate solution to supply levels required as of today March 20, 2020.
3. Be able to communicate the gravity and magnitude of the virus and the factor by which it’s contagious -10X the amount and mortality several times that of the regular flu according to NIAID/NIH Director Dr. Anthony Fauci.
What Physicians Must Do Today:
Research into supply chain challenges indicates the potential for extreme, near immediate crisis. Therefore, we do recommend that for those physicians that can afford to buy your own supply of PPE that you do so now. This is according to the level of protection you would assign to yours and other's that come into contact with you -their risk level, which will be ever evolving as the virus itself does.
Personal Protective Equipment (PPE) for personal purchase can be found on the following sites as of the writing of this article:
Tychem bodysuits
https://www.mscdirect.com
Plastic caps, Faceshields & small quantities of full-face respirators
https://www.discountsafetygear.com
Gloves, goggles, N95 respirator masks, earliest arrival April 16
For hospitals or health systems without logistics, infrastructure, and campaign resources to support donations, you may try this resource as a potential source for the following items.
N95 masks
Surgical masks
Isolation gowns
Ventilators
By:
Sherri Douville CEO & Board Member at Medigram, Inc. Prior to her current work in the mobile privacy, security, health IT and AI industry, Sherri worked in the medical device industry consulting on the areas of physician acceptance and economic feasibility of medical devices. Prior to that, Sherri worked in Field Marketing, Sales and as a National Sales Trainer for over a decade in over a dozen disease states; including with a variety of respiratory infections and treatment. During that time, she leveraged her multi-disciplinary STEM background to help physicians understand the microbiology behind the sensitivity and effectiveness of specific and different pathogens to a range of anti-infective agents
Dr. Art Douville, CMO at Medigram and Attending Neurologist. In addition to practicing Neurology, Dr. Art Douville has held several leadership and administrative positions in healthcare including helping physicians understand and leverage the data by which they're measured. He also has experience as a hospital Chief Medical Officer for two separate health systems. He oversaw both infection control and biohazard governance in hospital environments. Dr. Douville has expertise in clinical integration and was recently Regional Vice President/ Chief Medical Officer at Verity Health System. In this position, Dr. Douville oversaw physician relations, patient safety & quality, regulatory compliance, and the development of innovative clinical programs. He was part of the leadership team to spearhead bundled payment and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiatives. Dr. Douville has over a decade of experience leading physician culture and developing leadership, performance improvement, regulatory compliance, clinical process design and implementation, as well as physician alignment.