COVID19 Personal Protective Equipment PPE All Staff Training

COVID-19 Personal Protective Equipment (PPE) All Staff Training

Objectives Upon completion of this presentation, participants should be able to: 1. Identify the types of PPE necessary for working with COVID-19 2. Describe conventional, contingency, and crisis surge capacities related to PPE usage This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Disease Transmission COVID-19 • Primary mode of transmission – person to person – Small droplets from nose or mouth when a person with COVID-19 coughs, sneezes and even speaks – These droplets can also land of surfaces and other objects https: //www. cdc. gov/coronavirus/2019 -ncov/faq. html#Coronavirus. Disease-2019 -Basics This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

STANDARD PRECAUTIONS “Standard precautions represent the infection prevention measures that apply to all resident care, regardless of suspected or confirmed infection status of the resident, in any setting where healthcare is being delivered. ” https: //www. cms. gov/Regulations-and-Guidance/Manuals/downloads/som 107 ap_pp_guidelines_ltcf. pdf This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

TRANSMISSION-BASED PRECAUTIONS “Transmission-based precautions must be used when a resident develops signs and symptoms of a transmissible infection, arrives at a nursing home with symptoms of an infection (pending laboratory confirmation), or has a laboratory confirmed infection and is at risk of transmitting the infection to other residents. ” This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

For a Resident with Known or Suspected COVID-19 • “Staff wear gloves, isolation gown, eye protection and an N 95 or higher-level respirator if available. A facemask is an acceptable alternative if a respirator is not available. When COVID-19 is identified in the facility, staff wear all recommended PPE (i. e. , gloves, gown, eye protection and respirator or facemask) for the care” https: //www. cms. gov/files/document/qso-20 -38 -nh. pdf This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

PPE • PPE includes gloves, gowns, facemasks, respirators, and eye protection (face shields or goggles) • PPE provides safety for both residents and staff • PPE must be used correctly in order to provide this safety This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Use A Facemask at Work All the Time • Someone can spread the virus causing COVID-19 without having symptoms • “Source control” means wearing a facemask to prevent spreading your germs • Facemasks will also provide protection for you being exposed to another person’s germs This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Use Your Facemask the Correct Way DO DON’T • Clean your hands before you put on and take off your facemask • Make sure your facemask covers your mouth and your nose • Remove your facemask by touching only the straps • Store your facemask in a paper bag • Don’t touch your facemask or face • Don’t wear your facemask: – On the top of your head – Around your neck – Under your nose • Don’t store your mask on your arm or in your pocket This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

When to Wear PPE for COVID-19 You should be wearing full PPE when you are caring for a resident with suspected or confirmed COVID-19 – Positive test for COVID-19 – Symptoms – Fever, shortness of breath, new or different cough, sore throat, muscle aches, chills, new or worsening discomfort or tiredness, new dizziness or headache, diarrhea, change in taste or smell – Older adults may not show typical symptoms This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

PPE Donning (Putting On) Sequence • Gown – Fully cover torso from neck to knees, arms to end of wrists, and wrap around back – Fasten in back of neck and waist • Mask or Respirator – – Secure ties or elastic bands at middle of head and neck Fit flexible band to bridge of nose Fit snug to face and below chin Fit check respirator (N 95) • Goggles or Face Shield – Place over face and eyes and adjust to fit • Gloves – Extend to cover wrist of isolation gown This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

PPE Doffing (Taking Off) Sequence Conventional Usage When Preserving PPE • Gloves • Gown • Gloves, gowns, face shields or goggles, respirators or facemasks might be used for multiple residents • Follow facility specific protocols based upon the assessment of available supplies • The protocols may change frequently; so pay attention to announcements – Exit resident’s/client’s room – Perform hand hygiene • Face shield or Goggles • Respirator or face mask – Perform hand hygiene again This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Surge Capacity Conventional capacity: Follow general standard precautions and transmission-based precautions. Contingency capacity: While the current PPE supply may meet the facility’s current or anticipated usage rate, there may be uncertainty if the future supply will be adequate and, therefore, contingency capacity strategies are needed. Alternatives (for example, surgical masks rather than N 95 respirators) Extended use (for example, using face masks or respirators for multiple shifts) Crisis capacity: Strategies that are not commensurate with U. S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies are only implemented after considering and implementing conventional and contingency capacity strategies. Facilities can consider crisis capacity strategies when the supply is not able to meet the facility’s current or anticipated usage rate. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Who Makes the Decision if Running Low on PPE? This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Ways to Conserve PPE to Avoid Running Out • Facemasks, N 95 Respirators, and Eye Protection • Gowns • Gloves • Personnel who do not interact with residents or who do not clean resident/client rooms or living areas, do not need to wear PPE except as part of universal masking This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

PPE Conservation • Insert facility specific methods for PPE conservation This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Summary This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Questions This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Training Resources • Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Strategies for Optimizing the Supply of Isolation Gowns. Updated Jan 1, 2021: https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/ppestrategy/isolation-gowns. html • Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Strategies for Optimizing the Supply of Facemasks, Updated Nov. 23, 2020: https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/ppe-strategy/facemasks. html • Centers for Disease Control and Prevention. “Strategies for Optimizing the Supply of N 95 Respirators” Updated Feb. 10, 2020, at: https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/respirators-strategy/index. html This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Training Resources • Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Optimizing Supply of PPE and Other Equipment during Shortages. July 16, 2020: https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/ppestrategy/index. html • Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Strategies for Optimizing the Supply of Eye Protection, Updated Dec. 22, 2020. https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/ppestrategy/eye-protection. html • Centers for Disease Control and Prevention. Strategies for Optimizing the Supply of Disposable Medical Gloves, Updated Dec. 23, 2020: https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/ppestrategy/gloves. html#conventional-capacity This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Training Resources • Centers for Medicare and Medicaid Services. Nursing Home Reopening Recommendations for State and Local Officials (QSO-20 -30 -NH) (May 18, 2020) (Revised September 28, 2020) • https: //www. cms. gov/files/document/qso-20 -30 -nh. pdf-0 • Centers for Medicare and Medicaid Services. Interim Final Rule (IFC), CMS 3401 -IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID 19 Focused Survey Tool (QSO-2038 -NH) (August 26, 2020) • https: //www. cms. gov/files/document/qso-20 -38 -nh. pdf • Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities: https: //www. cms. gov/Regulations-and. Guidance/Manuals/downloads/som 107 ap_pp_guidelines_ltcf. pdf This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Training Resources • Occupational Safety and Health Administration. Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit. Testing for N 95 Filtering Facepieces During the COVID-19 Outbreak (March 14, 2020) • https: //www. osha. gov/memos/2020 -03 -14/temporary-enforcementguidance-healthcare-respiratory-protection-annual-fit • Occupational Safety and Health Administration. Transcript for the OSHA Training Video Entitled Respirator Fit Testing • https: //www. osha. gov/video/respiratory-protection/fittesting/transcript • Video at: https: //www. osha. gov/respiratory-protection/training This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Training Resources • U. S. Food and Drug Administration. Enforcement Policy for Face Masks and Respirators During the Coronavirus Disease (COVID-19) Public Health Emergency (Revised) (May 2020) https: //www. fda. gov/regulatoryinformation/search-fda-guidance-documents/enforcement-policy-face-masksand-respirators-during-coronavirus-disease-covid-19 -public-health • U. S. Food and Drug Administration. Face Masks, Including Surgical Masks, and Respirators for COVID-19 (Current content as of 11/24/2020) • https: //www. fda. gov/medical-devices/coronavirus-covid-19 -and-medicaldevices/face-masks-including-surgical-masks-and-respirators-covid-19 • U. S. Food and Drug Administration. Personal Protective Equipment EUAs (Current content as of 12/4/2020) This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Disclaimer “This presentation provided is copyrighted information of Pathway Health. Please note the presentation date on the title page in relation to the need to verify any new updates and resources that were listed in this presentation. This presentation is intended to be informational. The information does not constitute either legal or professional consultation. This presentation is not to be sold or reused without written authorization. ” This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only