Jocelyn Datud Glister
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Post by Jocelyn Datud Glister on Jul 29, 2020 8:48:36 GMT -5
1. We do try to follow the same procedure. It just sometimes gets complicated when the patient goes back to ICU and we don't have enough staff. Doffing properly and transporting immediately the patient back to icu should be coordinated with the other anesthesia team so that they could assist with transport. 2. It is unfortunate that we need to reuse N95 masks - definitely had a lot of resistance and anxiety during the beginning. I wonder if having everybody have their own drager respirator will be cost efficient in the end.
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Post by Dahlia Rouchon on Jul 29, 2020 10:32:38 GMT -5
Thank you Sarah for a good article for review during the COVID crisis are we are all ultimately going to be exposed to a patient or scenario where we will have to take these measures into consideration. 1. The article enforces mask covering for patients during transport, to limit aerosol shedding by having intubated patients be transported via RT and for those needing intubation in the ICU to have them intubated prior to transport with viral filters in use. At our facility, a viral filter should be used at all times and I would enforce no transport without it. Working in RT, we typically clamp an ETT with each disconnect and connect and with ambu bags this is even more critical. A safety officer is very helpful to clear hallways and elevators to remove any staff not wearing N95 and to make easy passage for transport to follow a designated route for desired destinations. 2. Reuse of N95 masks puts health care providers at risk as the seal cannot be guaranteed when frequently removing and putting them back on (between eating, between cases, when not in use, etc.) as the elastic can be stretched and not offer protection. It is an important consideration however in the event N95s may not be available in the future that reuse and care must be taken to keep them in the best condition possible.
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Post by aileenm4 on Jul 30, 2020 15:05:12 GMT -5
1. transportation of COVID positive patient has been just a patient mask in the hallways from the ER for example for peds patients. If intubated postop I have use the filter attached to babysafe or ambu bag for transport as well. we have been extubating if appropriate patients deep as to avoid coughing at end of case or cover patient with plastic sheet as to avoid the sputum from coughing to spray out to othrs 2. we have been reusing our N95 masks for weeks..... as long as covered by additional surgical mask and face shield. Not sure the effectiveness of an N95 aftyer wearing it for hours
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July FY21
Jul 30, 2020 15:40:23 GMT -5
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Post by Ben Waldbaum on Jul 30, 2020 15:40:23 GMT -5
1. What are the recommendations for transport of a COVID positive patient listed in this article? How does this differ from practice at your facility, if at all?
Best practices for this are constantly evolving even according to the author. Masks for spontaneously breathing patients and viral filters for intubated patients.
2. The article discusses reuse of N95 masks - what are your thoughts regarding reuse of N95 respirator masks?
Personally I think no one is really comfortable with PPE reuse but it is forced into this one uncomfortable position due to the unprecedented times and PPE shortage. Doesn’t mean it is good practice
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Post by clawry on Jul 31, 2020 14:28:15 GMT -5
1. What are the recommendations for transport of a COVID positive patient listed in this article? How does this differ from practice at your facility, if at all?
They recommend extubating the patient in the covid ICU destination. They also recommend using the ICU ventilator so the CRNA does not have to ventilate patient which may cause aerosolization of virus particles. They recommend having a designated transport route for covid patients. They recommend covering patient with a clean sheet before traveling. Last night I had to take over a case for a young female who was admitted from ER. She had tested positive for covid on 7/7. There was no bed available for patient, so we were told to recover the patient in the room so she was extubated at the end of the case. After 2 hours, I transported the patient to a negative pressure room in the PACU. We called for a safety officer to guide us with our transport. He opened the elevators and doors for us. The patient was transported with clean blankets and a face mask covering her mouth and nose. Once in the PACU, we settled the patient in the negative pressure room, doffed in the ante room and gave report to the "clean nurse" outside the room.
2. The article discusses reuse of N95 masks - what are your thoughts regarding reuse of N95 respirator masks?
I was always under the impression that they were single use, but now we are encouraged to reuse the n 95 masks as long as possible. Depending on how many days I work, I try to change the mask out for a new one every week. I use a PAPR for high risk procedures such as ENT, bronchs, and known covid positive patients. When I was in the ICU working with covid patients, I preferred to wear the PAPR.
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Post by Amy Swank on Jul 31, 2020 14:49:18 GMT -5
Always good to read what is an ever-evolving situation with Covid, our knowledge of it, and how we deal with it within our practice. April's fund of knowledge as compared to what soon will be August's knowdedge - what we've now become used to and learned about - continues to amaze me as well as impress me with this team.
1. Transport recommendations from the article are absolutely something to strive toward, but not perfectly utilized to the letter in real life here, it seems. Best practice efforts are made, but it seems that depending on the safety officer as well as other team members accompanying the patient, techniques may vary. I cannot tell you the differing opinions, techniques, and waste that occurred when taking a deceased patient to the morgue - many, many gowns and gloves later, as well as ccs of perspiration later, I realized, that we all just do the best we can do to protect others and ourselves during an imperfect process, leaving the room, transporting through hallways and elevators, corridors and ramps.
2. Reusing of N95 masks aren't optimal, but the ability to go the Bloomberg to replace a mask after multiple uses due to a broken elastic strap isn't always an option. So once again, we do the best we can.
The article mentioned the use of ultraviolet light. Do we have this within the facilities and ceilings now? I know that many medical offices and practices are using this low key approach without many patients or staff being aware. Just wondering.
thanks again.
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Post by Belinda Gardner on Jul 31, 2020 22:14:12 GMT -5
This is a nice article to read and understand how other institutions are handling Covid patients in the OR. 1. Differences in the article recommendations- we did have donning and doffing education and practice available to us early on to help get used to the process. We do have an area in our health data to quickly review Covid testing prior to coming to the OR. We do have a specific Covid route to the OR from the ICU accompanied by Safety officers who do wipe equipment down prior to travel from unit. All patients traveling in the hospital are required to wear a mask. All intubated patients are ventilated via an ambu bag with a filter instead of traveling to the OR with vent. Our Ventilators in the OR have extra filters. We do not routinely intubate Covid patients coming to the OR if not already intubated but we have specific negative pressure rooms to care for known Covid cases. We do have PPE equipment available to OR staff in each negative pressure room for Covid case but do not have the "Clean" and "Dirty" provider but assume everything in the OR is dirty after the case and have much less equipment in these ORs. We should change our scrubs after care for a Covid positive patient. 2. Previously the N95 mask was a one time use because it was rare to need to use them for the occasional infectious patient and didn't make sense to reuse. Thus far we seem to be able to replace them as we see fit which seems better than many hospitals. The PAPR is always a safe and available back up when caring for know Covid patients and those with pending Covid tests.
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Post by Lu Lin on Jul 31, 2020 23:00:33 GMT -5
1) What are the recommendations for transport of a COVID positive patient listed in this article? How does this differ from practice at your facility, if at all?
a)I think if the patient is breathing spontaneously during transport, the patient should wear a mask to prevent aerosolized viral particle spread. We do this for patients already intubated and on ventilators, the patient should be kept on his/her ICU ventilator for transport to the operating room. Anesthesia has been transporting with am ambu bag and a filter, no ventilator and no RT on the transport. the ICU team should intubate the patient in the ICU and then transport to the OR. Anesthesia has been intubating, I've only known of a handful of times in the ICU room before OR.
2)The article discusses reuse of N95 masks- what are your thought regarding reuse of N95 respirator masks? It has been challenging to find and keep a good fit when resuing the N95 all week, because they get wet with our breath all day. We are able to go to the office for new PPE. I have been eating Ricola to enjoy the air I breathe as well, and remembering to sneeze with my mouth firmed and close.
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