COVID-19 Document Library

As many are aware, the Centers for Disease Control and Prevention (CDC) updated its guidance for persons who have been fully vaccinated for COVID-19. Given these updated recommendations, we have updated our masking guidance for team members who are fully vaccinated. This document outlines these updates. Uploaded 03.17.21

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

This document outlines the proper configuration for the Versaflo PAPR unit and the yellow isolation gown. Uploaded 06.30.20

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

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

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

This document provides answers to frequently asked questions regarding recent recommendations regarding eye protection for healthcare workers. Uploaded 09.25.20

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

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

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

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

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.

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

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

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

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

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

This document for managers clarifies their responsibilities related to supplies, including PPE, during the COVID-19 pandemic. Uploaded 04.02.20

This document is for healthcare workers and explains DUHS' discontinuation of contact precautions for MRSA and VRE colonization patients. Uploaded 03.18.20