COVID-19 Document Library

N95 respirators (or PAPRs) continue to be required for direct care of patients on Airborne (e.g., tuberculosis, measles) or Special Airborne Contact (e.g., suspected or confirmed COVID infection) precautions. Additionally, CDC has updated their guidelines and now recommends healthcare workers in areas where there is moderate to substantial community transmission of COVID-19 use N95 respirators when performing procedures that are high-risk for generating aerosols, since healthcare workers in facilities with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic patients who may be COVID-19 positive. This can include patients who tested negative during their pre-procedure test, but then develop symptoms in subsequent days. To accommodate these recommendations, Duke has implemented changes in recommended PPE for staff in perioperative and procedural areas where high-risk aerosol-generating procedures are performed.

Additionally, to ensure availability of N95 respirators when needed, DUHS has deployed new models of N95s to certain care areas. Staff may notice that DUHS now supplies N95 respirators that have a valve. Staff should use the N95 respirator model that is available at their location and per instructions of their local leadership. In this document, we have answered several frequently asked questions and highlighted key features of the different types of N95 respirators in the table below. Uploaded 09.22.20

Duke Health recommends the use of eye protection for all staff having direct interaction with patients and visitors. Direct interaction is defined as face-to-face interaction such as entering a patient’s care environment (e.g. exam room, hospital room, bay, etc.) or coming within 6 feet for any duration of time. Face shields are the preferred eye protection as they provide full coverage of the eyes and protect the underlying face mask from potential contamination.

We recognize that some team members are seeking alternatives to face shields. Supply chain issues have made purchase of large quantities of safety goggles challenging. As such, this resource is meant to provide guidance for selecting alternate adequate eye protection to the widely available Duke-approved face shields. Uploaded 09.25.20

Based on supply shortages of chemotherapy-tested exam gloves, OESO and IP have evaluated and approved a number of alternative gloves that meet our high standards. This handout shows the options that are currently or may soon be distributed to help you identify these approved chemo gloves and for which drugs they are appropriate. Please note that the Cardinal Flexal nitrile exam glove is expected to replace the Cardinal Esteem Comfort in some areas by the end of December 2020. Uploaded 12.6.20

This document provides guidance for masking and addresses questions regarding double masking. Below is the content of the document. Uploaded: 1.29.21 

Renewed discussions regarding the potential benefit of double masking on source control and prevention of COVID-19 transmission have prompted many questions about whether changes will be made to the current DUHS masking policy.  Eleven months of experience has demonstrated that the healthcare setting is a well-controlled environment with robust infection prevention protocols in place that help limit the transmission of COVID-19. The healthcare setting is distinctly different than a community setting without these strict controls in place and much of our workforce is now vaccinated.  Furthermore, masks used in healthcare settings are also assessed for filtration efficacy and meet regulatory standards before distribution.  

Unfortunately, no well-designed studies have been conducted to scientifically answer the question “are two masks better at preventing COVID-transmission than one?” One study demonstrates the impact of wearing a well-fitting mask to improve source control and how wearing an overlying mask may improve overall mask fit.¹ Logically, having additional layers of barrier protection over the nose and mouth would reduce particle dispersion. 

With the now broadly circulating B1.1.7 (UK) variant and concern over the B1.351 (S. African) variant in the U.S., many are looking for ways to augment the infection prevention strategies in place – double masking is one such strategy. As we strive to continuously update our COVID-19 guidance to keep in step with the scientific community, we updated masking guidance language as follows. We will continue to closely monitor COVID-19 infections among team members and, should we see any concerning trends or signals, will reevaluate our recommendations below:

Double masking is optional for patients, visitors, and Duke team members at this time. However, we do encourage team members to make simple mask modifications to improve fit, and thereby improve source control. More tips to make your mask fit better are available on the Infection Prevention webpage.

• For patients and visitors: Patients and visitors will be offered a Duke-issued medical mask when entering the healthcare space. If the patient or visitor is wearing their own mask, they may place the Duke-issued mask over the top of their mask if they choose. Patients and visitors may wear their own masks as long as they adequately cover the mouth and nose and have ties or earloops. Patients and visitors may not wear neck gaiters or bandanas. Patients and visitors may not wear any mask with an exhalation valve. Simple mask modifications can be made to help improve fit, if needed. Review a full list of our patient and visitor masking guidelines.
• For Duke team members: Duke team members are still required to wear a Duke-issued medical mask in the healthcare setting. Should team members choose to wear a second mask, they may place a Duke-issued mask over the top of their own mask. Simple mask modifications can be made to help improve fit, if needed. Wearing the Duke-issued medical mask as the outer layer provides a fluid-resistant barrier. We continue to recommend eye protection during patient care activities. Review a full list of our team member masking guidelines.

Mask modifications:

There are many options to make your mask fit better if it is too loose.

• This video demonstrates one way to make your mask tighter.
• A second option is to simply twist the straps of your Duke-issued mask before you put it on so that the elastic is in a crisscross.
• Another option is to use a plastic clip to pull the straps tighter behind your head.

References:

Mueller et al. Matter 2020 Sep 2;3(3):950-962.

Duke Raleigh Hospital is providing cloth gowns for team members to replace our disposable isolation gowns previously used for care. Team members should follow proper doffing protocols for the cloth gowns as indicated in the file. Uploaded 06.17.20

This tip sheet aims to help healthcare workers better understand protocols for the reuse and extended use of face masks, face shields, N95 respirators and PAPR hoods. Please refer to the full instructions for extended use and reuse of N95s and face shields, PAPR hoods, and face masks and face shields for additional information. Uploaded 04.15.20

This document can be accessed through the Secure Policy Center. It outlines the following: inmate patient transport guidelines, guard PPE for rooms with and without a window, and patient safety requirements. Uploaded 04.22.20

This document is an FAQ about Duke Health’s process for decontaminating N95 masks. Uploaded 04.21.20

This resource can be used to help healthcare workers determine the best process for reuse and extended use of their face shield. Specifics about the disposable face shields as compared to the extended use face shields are included in this resource. Uploaded 04.22.20

Head coverings, including bouffant caps, headbands with buttons and surgical caps, are not CDC recommended or required PPE for the care of suspected or confirmed COVID-19 patients (outside of performing sterile procedures). This document provides more information about DUHS recommendations on head coverings for our team members. Uploaded 04.22.20

All PAPR-related instructions, including the newer 3M Versaflo and 3M Ford PAPRs as well as other brands of PAPRs used at Duke Health, are combined into one document for donning and doffing additional PPE and disinfecting the PAPR in inpatient and outpatient settings. We have addressed doffing and disinfection of loose-fitting headgear (e.g., head cover, shrouded hood) with and without an anteroom. Updated 06.15.20

This chart provides guidance for the trained observers standard work to support the clinical staff to ensure the safe practice and use of personal protective equipment while providing care to highly infectious patients. Uploaded 05.05.20

Duke University Hospital has provided reusable cloth gowns for team members when caring for COVID-19 positive patients or PUI patients suspected of having COVID-19. This document outlines the approved process for reusable cloth gowns after each use. Uploaded 05.04.20

The document provides guidance to providers on appropriate PPE for CPR and/or RRT on COVID positive patients or PUIs. Uploaded 04.03.20

This document provides important clarifications on donning and doffing for extended use and re-use of N95s and face shields for all healthcare workers providing care to patients with known or suspected COVID-19 infection. It now includes a table on page 3 of high-risk and low-risk aerosol-generating procedures and what to do with the N95 mask following those procedures. Updated 04.14.20

This document includes FAQs and key takeaways on our decontamination process for respirators such as N95s. Updated 04.17.20

This one-pager highlights the importance of wearing appropriate PPE during aerosol-generating procedures. It also explains the role of negative room pressurization, and recommendations for what to do if a HEPA filter is not available. Uploaded 04.10.20

This document provides important clarifications on donning and doffing for extended use and reuse of face masks (including surgical masks, tie masks, and earloop/procedural masks) and face shields for all healthcare workers providing care to patients with known or suspected COVID-19 infection. Updated 04.20.20

This document provides instructions for safely removing PPE in inpatient and ED environments where there is no anteroom or where gloves and/or disinfectant wipes are not available in room at the threshold. Uploaded 04.03.20

This document is for EVS team members and provides guidance on how to treat medical waste, PPE and linen in rooms of patients with suspected or confirmed COVID-19. Uploaded 03.16.20

This document includes recommendations for healthcare workers to safely discharge a COVID-19 positive inpatient who continues to require isolation precautions. Uploaded 04.03.20

This document is for healthcare workers and includes recommendations to limit unnecessary mask use. Uploaded 03.21.20