Respiratory Therapy Guidance During COVID 19 Response |
This document provides guidance for the safe delivery of respiratory therapeutics during the COVID-19 pandemic. Updated 05.07.20
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Clinical Guidance and Forms (General), PPE, PPE Signage-Clinical |
Guidelines for the Use of Different Models of N95 Respirators at Duke Health |
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
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PPE, Periop Management |
Recommended PPE for Outpatient Management of Asymptomatic Patients |
This document provides recommendations for the required PPE for a variety of visits in outpatient settings with differential risk. Providers should follow Standard and Transmission-Based Precautions in addition to the precautions recommended in the Ambulatory Infection Prevention Policy. Uploaded 05.07.20
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PPE, Ambulatory DPC, Ambulatory PDC |
Criteria for Adequate Eye Protection |
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
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PPE, Eye Protection |
Forever Face Shield Instructions |
New “forever” face shields are available from the Duke Pratt School of Engineering. This document provides instructions for the appropriate use, assembly and cleaning of these new face shields. Updated 06.02.20
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PPE, PPE Signage-Clinical |
Chemotherapy-Tested Exam Glove Comparison |
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
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PPE |
Special Droplet and Special Droplet & Contact Sign Ordering Reference |
Special Droplet and Special Droplet & Contact signs are now available for order in Eprint. This document is a reference that provides guidance to order these signs. Uploaded 06.05.20
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PPE Signage-Clinical, PPE, Clinical Guidance and Forms (General), High-risk Populations |
Universal Masking Guidelines – Double Masking Review |
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.
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PPE, Clinical Guidance and Forms (General) |
Patient & Visitor Face Covering Reference Sheet |
This patient and visitor face covering reference sheet outlines key takeaways regarding our universal masking policy for patients and visitors. It also includes guidance for acceptable face coverings. This is for internal use only by Duke Health team members. Uploaded 08.18.20
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PPE, Patient Communication and Signage |
Reusable Cloth Gown Process at Duke Raleigh Hospital |
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
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PPE, Duke Raleigh Hospital |
Reusable Cloth Isolation Gown Process at DRH |
This document outlines the Duke Regional Hospital process for using reusable cloth isolation gowns. The reusable cloth gowns are for one-time use only and should be discarded in the “gown only” linen bag immediately after each use. Updated 06.10.20
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PPE, PPE Signage-Clinical, Duke Regional Hospital |
Tip Sheet for Reuse and Extended Use of N95s/PAPR Hoods/Face Masks/Face Shields |
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
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PPE, N95, PAPR, PPE Conservation |
Proper Configuration for Versaflo PAPR Unit and Yellow Isolation Gown |
This document outlines the proper configuration for the Versaflo PAPR unit and the yellow isolation gown. Uploaded 06.30.20
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PPE, PPE Signage-Clinical, Duke Raleigh Hospital |
DUHS Inmate Patient PPE Guidelines |
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
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PPE |
Recommended Eye Protection |
The attached document contains information from the Centers for Disease Control and Prevention (CDC) regarding healthcare workers caring for asymptomatic patients in areas of moderate to high community transmission wear eye protection in addition to face masks. Uploaded 09.25.20
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PPE, Eye Protection |
Frequently Asked Questions about Duke Health’s Use of Hydrogen Peroxide Vapor for Decontamination of N95 Respirators |
This document is an FAQ about Duke Health’s process for decontaminating N95 masks. Uploaded 04.21.20
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PPE, FAQs and Talking Points, N95 |
DRH Recommended Eye Protection |
The attached document for Duke Regional Hospital contains information from the Centers for Disease Control and Prevention (CDC) regarding DRH healthcare workers caring for asymptomatic patients in areas of moderate to high community transmission wear eye protection in addition to face masks. Uploaded 07.02.20
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PPE, Duke Regional Hospital |
Face Shield Tip Sheet |
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
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PPE |
Instructions for Performing Seal Check with a Valved N95 Respirator |
This document illustrates N95 seal check instructions for healthcare workers. This guide was made by the for performing seal check with a valved N95 respirator. Uploaded 07.07.20
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PPE |
Head Covering PPE Recommendations |
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
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PPE |
Recommended Eye Protection FAQs |
This document provides answers to frequently asked questions regarding recent recommendations regarding eye protection for healthcare workers. Uploaded 09.25.20
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PPE, Eye Protection |
PAPR Instructions for Donning, Doffing and Disinfection (Combined) |
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
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PPE Signage-Clinical, PPE, Donning & Doffing |
Duke Health Masking Care Package Insert |
This document was mailed to all Duke Health employees as a reference for when to wear a face covering in the community and in our facilities. It was provided in a package to all employees along with cloth masks and hand sanitizer. Uploaded 07.10.20
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PPE |
PPE Observer Standard Work |
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
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PPE, PPE Signage-Clinical |
DRAH Recommended Eye Protection |
The attached document for Duke Raleigh Hospital contains information from the Centers for Disease Control and Prevention (CDC) regarding DRAH healthcare workers caring for asymptomatic patients in areas of moderate to high community transmission wear eye protection in addition to face masks. Updated 07.14.20
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PPE, Duke Raleigh Hospital |
Reusable Cloth Gown Process at Duke University Hospital |
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
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PPE Signage-Clinical, PPE, Duke University Hospital |
Duke Raleigh Hospital COVID-19 EVS Room Cleaning Procedure |
This document includes guidelines for Duke Raleigh Hospital EVS team members on cleaning procedures for inpatient rooms during the COVID-19 response. Uploaded 7.22.20
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PPE, Clinical Guidance and Forms (General), Duke Raleigh Hospital |
Duke Health Policy for Providers Managing Cardiopulmonary Arrest and RRT in COVID-19 Patients |
The document provides guidance to providers on appropriate PPE for CPR and/or RRT on COVID positive patients or PUIs. Uploaded 04.03.20
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PPE, Clinical Guidance and Forms (General) |
Duke Raleigh Hospital COVID-19 EVS Room Cleaning Checklist |
This document provides a checklist for Duke Raleigh Hospital EVS team members on the cleaning procedures for inpatient rooms during the COVID-19 response. Uploaded 7.22.20
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PPE, Clinical Guidance and Forms (General), Duke Raleigh Hospital |
N95s and Face Shields: Instructions for Extended Use and Re-Use |
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
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PPE, N95 |
N95 Seal Check Instructions |
This document illustrates N95 seal check instructions for healthcare workers. While this guide was made for the 3M brand of N95 respirators, the same principles of fit testing apply to other types of respirators. Uploaded 03.30.20
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PPE, N95, Donning & Doffing |
N95s: FAQs and Key Takeaways on Decontamination and Reuse |
This document includes FAQs and key takeaways on our decontamination process for respirators such as N95s. Updated 04.17.20
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FAQs and Talking Points, PPE, N95 |
PAPR Hoods: Instructions for Extended Use, Re-Use and Disinfection |
This document provides important clarifications on the extended use, re-use, and disinfection of PAPR hoods for all healthcare workers providing care to patients with known or suspected COVID-19 infection. Updated 04.14.20
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PPE, PAPR |
Recommendations for Negative Pressure Rooms and/or HEPA Filtration |
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
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Clinical Guidance and Forms (General), PPE |
Infographic: Appropriate PPE During COVID-19 Response |
This updated infographic provides concise and simplified recommendations for what PPE healthcare workers should wear during the COVID-19 response. This also includes reasonable accommodations for patient/provider masking compliance. Updated 09.25.20
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PPE, Eye Protection |
Face Masks and Face Shields: Instructions for Extended Use and Reuse |
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
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PPE |
Masking Protocols for Team Members |
This document provides instructions for our universal masking initiative at our hospital and clinic sites. It also includes answers to questions from colleagues and patients. Updated 06.02.20
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PPE, FAQs and Talking Points, Employee Health |
PPE Doffing Procedure: No anteroom, no gloves and/or disinfectant in room at threshold |
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
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PPE, Donning & Doffing |
Transport of Patients on Special Airborne Contact Precautions |
This document is for healthcare workers responsible for transporting patients on special airborne contact precautions and includes information about the transport of vented patients. Updated 04.09.20
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PPE, Operations and Visitation, Special Airborne Contact |
Waste and Linen Disposal COVID-19 Guidelines |
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
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Operations and Visitation, PPE |
Duke Primary Care PPE and Lab Supplies Takeaways and FAQ |
This document for managers clarifies their responsibilities related to supplies, including PPE, during the COVID-19 pandemic. Uploaded 04.02.20
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Ambulatory DPC, PPE, FAQs and Talking Points |
Recommendations for Discharging COVID-19 Positive Inpatient Who Continues to Require Isolation Precautions |
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
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PPE, Clinical Guidance and Forms (General), Discharge Instructions |
Suspending Use of Contact Isolation for MRSA and VRE Colonization Patients |
This document is for healthcare workers and explains DUHS' discontinuation of contact precautions for MRSA and VRE colonization patients. Uploaded 03.18.20
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PPE, PPE Conservation |
PPE Conservation Strategies for COVID-19 |
This document is for healthcare workers and includes recommendations to limit unnecessary mask use. Uploaded 03.21.20
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PPE, PPE Conservation |
ENT/Otolaryngology: PPE Safety Protocols for ENT Clinical Care |
This document is for healthcare workers and outlines the current recommendation for clarifying PPE safety protocols for ENT / otolaryngology clinical care. Uploaded 05.11.20
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Specialty Specific Guidance, PPE |