Practical Personal Protective Equipment Guidelines for Healthcare Professionals

Personal Protective Equipment Guidance Updated March 2021 Roberta Kelly, C h i e f N u r s i n g O f f i c e r S V P , N Y C O p e r a t i o n s

Cloth Face Covering over Medical Mask CDC has recommended several ways to improve the fit and filtration of masks, including covering a medical facemask with a cloth mask. However, layering masks requires special care in healthcare settings. Cloth masks are not personal protective equipment (PPE). They should not be used in place of medical facemasks or NIOSH approved respirators as part of Standard or Transmission-based Precautions. Wearing a cloth mask over an N95 respirator is not recommended for healthcare personnel in healthcare settings during Aerosol Generating Procedures; Using a surgical mask over an N95 is acceptable to protect the N95 for extended use during times of supply shortage Wearing a cloth mask under an N95 respirator or other medical mask is never recommended as it will interfere with the seal. Wearing a medical mask under an N95 respirator is also never recommended. Once put on, healthcare personnel should not touch their medical facemask or cloth mask. If they touch or adjust their medical facemask or cloth mask, they must perform hand hygiene before and after contact. Cloth masks, used for source control should be removed and laundered after each workday. If they cannot be laundered, staff must not use the cloth mask for source control https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/mask-fit-and-filtration.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Infection-Control Cloth Face Covering over Medical Mask

PPE Use PPE Use Locations Direct Patient Contact Clinical and Dental, Non- clinical care Locations Direct Patient Contact- - Personnel Physicians, Mid-levels, Clinical Staff (Nurses, MA, MT) Dental Staff ( Dentist, DH, DA) Patient Representatives, D & S Specialists, Behavioral Staff, Optometrist, and Podiatrist Physicians, Mid-levels, Clinical Staff (Nurses, MA, MT), Phlebotomist, Optometrist, and Podiatrist Personnel PPE Use Procedure Mask or KN95 Full Face Shield, Goggles, or Googles Gloves for non-contact clinical activity (specimen handling, etc) PPE Use Instructions Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene Instructions Direct Patient Contact Care Direct Patient Contact- - Clinical Procedure Mask, KN95, or N95 Full Face Shield, Goggles, or Googles Gloves for patient contact Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene Double masking with an approved cloth face covering or medical procedure mask is allowed but not required Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene Do not use a cloth face mask to protect the medical mask Direct Patient Contact Dental Aerosolization, High risk of body fluid exposure Direct Patient- - Contact Dental or Medical Dental Staff (Dentist, DH, DA), Medical Staff conducting aerosol generating procedures (ie: Nebulizer treatment, High flow O2 delivery) Disposable fluid resistant gowns N95 Mask Surgical/Procedure Mask over N95) Full Face Shield or Goggles or Googles Gloves or Medical

PPE Use PPE Use Locations Direct Patient Contact Non-Clinical Locations Direct Patient Contact- - Personnel Patient Representatives, Patient Navigators, Care Managers, and ADHC Staff Personnel PPE Use Procedure Mask or KN95 Googles with Frames and Lenses PPE Use Instructions Mask upon entry During Work Hrs @ desk and on floor Hand Sanitize before first patient and after each patient Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene Instructions Embedded Agencies HRHCare Health Centers Embedded Agencies HRHCare Health Centers WIC, Suffolk County Chest and TB Department Procedure Mask or KN95 (inside Administrative or Clinical Space) Administrative/Non - -Clinical Locations Administrative/Non Clinical Locations All Employees Procedure Mask or KN95 or Approved Cloth Mask Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Follow 5 Moments of Hygiene

PPE Use Situation Center or Mobile Van Department with NO Direct Patient Care PPE Use Situation- - Inside Health Center or Mobile Van Department with NO Direct Patient Care Inside Health Personnel Personnel PPE Use PPE Use Instructions Instructions IT, Help Desk, Training, and Call Center Staff Procedure Mask or KN95 or Approved Cloth Mask Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Department with NO Direct Patient Care (providing services in health center) Department with NO Direct Patient Care IT and Help Desk Procedure Mask or KN95 Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Staff may use cloth face covering over medical mask Patient/Non Delivery Personnel, Vendors will be provided) Situation Work orders Company Tenants Must Notify Facilities if self-quarantine Patient/Non- -employee, Delivery Personnel, Vendors (procedure mask employee, Concierge Procedure Mask, Cloth Face Covering, or KN95 Mask upon entry During Work Hrs @ desk and on floor Wash or Sanitize Hands after removal of mask Situation- -Special Projects Work orders- - Preservation Company Special Projects Preservation Personnel Facilities Personnel PPE Use PPE Use Instructions Mask upon entry into building and tenant s home Wash or Sanitize Hands after removal of face shield/mask and gloves Clean and Disinfect face shield for reuse Staff may use cloth face covering over medical mask Instructions Face Shield, Procedure Mask or KN95 GLOVES Work orders to Provide to Repair & Do Environmental Rounds Work orders to Provide to Repair & Do Environmental Rounds Facilities Procedure Mask or KN95 GLOVES Mask upon entry into Building Wash or Sanitize Hands after removal of mask and gloves Staff may use cloth face covering over medical mask

PPE Use at PPE Use at Pop Pop- -UP UP Testing Sites Testing Sites Situation Arrival Station Situation- -Special Projects Arrival Station Special Projects Personnel Patient Representatives, Business Development Staff, Clinical Staff Personnel PPE Use Procedure or KN95 Mask Googles with Frames and Lenses PPE Use Instructions Mask upon entry into work area during work hrs. Wash or Sanitize Hands after removal of mask and gloves Mask upon entry into work area during work hrs. Wash or Sanitize Hands after removal of mask and gloves Mask upon entry into work area during work hrs. Wash or Sanitize Hands after removal of mask and gloves Mask upon entry into work area during work hrs. Wash or Sanitize Hands after removal of mask and gloves Instructions Second Check Station Drive Thru/Walk Up Second Check Station- - Drive Thru/Walk Up Patient Representatives, Business Development Staff, Clinical Staff Procedure or KN95 Mask Googles with Frames and Lenses Escort Walk up Escort Walk up Patient Representatives, Patient Navigators Procedure or KN95 Mask Googles with Frames and Lenses Follow up Appointment Follow up Appointment Patient Representatives, Patient Navigators Procedure or KN95 Mask Googles with Frames and Lenses

PPE Use at Collection Situation Specimen Processing & Data Entry PPE Use at Pop Collection Pop- -UP UP Testing Sites and Specimen Testing Sites and Specimen Personnel Clinical PPE to use NIOSH N95 Approved or KN95 with procedure mask Full Face Shield, Goggles or Googles with Frames and Lenses Fluid resistant gowns GLOVES Instructions Mask upon entry into work area during work hrs. Gloves are to be worn and changed with each patient Don and Doff PPE in accordance with CDC guidelines Disposal of gowns and gloves in regular trash unless visibly soiled Specimen Processing & eCW Data Entry eCW Specimen Collection Specimen Collection Physician, Advanced Practitioner (PA, NP, MW or Nurse) NIOSH N95 Approved or KN95 with procedure mask Full Face Shield Fluid resistant gowns GLOVES Mask upon entry into work area during work hrs. Gloves are to be worn and changed with each patient Don and Duff PPE in accordance with CDC guidelines Disposal of gowns and gloves in regular trash unless visibly soiled

PPE Use for Infectious and PUI PPE Use for Infectious and PUI Inside Health Center Influenza Season, COVID 19 Surge, Unidentified or Identified Infectious Disease Non Inside Health Center Influenza Season, COVID 19 Surge, Unidentified or Identified Infectious Disease Non- -Clinical Personnel Patient Representatives, Patient Navigators Personnel PPE to use Procedure Mask, KN95 Goggles or Googles with Frames and Lenses PPE to use Instructions Mask upon entry During Work Hrs @ desk and on floor Disinfect googles after use Wash or Sanitize Hands after removal of mask Instructions Clinical Influenza Season, COVID Unidentified or Identified Infectious Disease Clinical- Collecting and Processing Specimens Influenza Season, COVID- -19 Surge, Unidentified or Identified Infectious Disease 19 Surge, Physicians, Advanced Practitioners, Nurses, Clinical Team (MT, MA), Isolation Hotel Staff NIOSH N95 Approved or KN95 with procedure mask Full Face Shield, Goggles, or Googles with Frames and Lenses Water resistant gowns GLOVES Don and Doff PPE in accordance with CDC guidelines Disposal of gowns and gloves in regular trash unless visibly soiled

PPE Exceptions PPE Exceptions 1. 1. A face mask is not required if you are working in your office alone. You must wear a face mask when stepping out of your office or when another person enters your office. A face mask is not required if you are working in your office alone. You must wear a face mask when stepping out of your office or when another person enters your office. 2. 2. A face mask is not required when eating or drinking in a lunch/break room or designated area. A face mask is not required when eating or drinking in a lunch/break room or designated area. 3. 3. Maintain 6 feet of distancing during eating. Stagger lunch breaks among staff as much as possible. Maintain 6 feet of distancing during eating. Stagger lunch breaks among staff as much as possible.

Training Training Annual training on PPE donning and doffing is required, courses are assigned in relias. User-Seal Checks are required for all clinical staff wearing an N95 NIOSH approved respirator or above, every time the mask is donned.

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