Dear Colleagues: Welcome to my Thursday, May 21 report – now in the fifth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19 You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.
Today, we continue our focus on PPE and proper usage. We appreciate the following article and video prepared by Dr. Jeff Powis, chief of infection prevention and control at Michael Garron Hospital. I also want to comment on how impressed we are with his expertise, commitment and dedication to staff and patients wellbeing.
Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19?
Dr. Jeff Powis used a black light to demonstrate the potential self-contamination risks when donning and doffing a surgical earloop mask and a mask with horizontal straps (N95 mask). Results found that self-contamination was higher with the use of an N95 mask.
When it comes to the use of personal protective equipment (PPE), Dr. Jeff Powis has one goal in mind: Do whatever it takes to keep health care workers and patients safe.
While PPE has always been a cornerstone of health care worker safety, it’s never been more critical, in higher demand, or publicly debated than during the COVID-19 pandemic.
One of the most widely deliberated PPE topics across the health care system continues to be around the appropriate use of masks, more specifically, when to wear a surgical mask with ear loops versus an N95 mask.
Both surgical earloop masks and N95 masks filter small particles (between 0.1 and 0.3 microns) at greater than 95 per cent efficiency. N95 masks have a tight seal with the healthcare worker’s face and are the preferred mask when performing aerosol-generating medical procedures (AGMPs). Aerosols are small enough that they float freely in the air, and as a result a tight seal is required to keep them out.
Surgical earloop mask (left) and mask with horizontal straps (N95 mask) (right).
The great debate: Which masks should health care workers wear during COVID-19?
According to Dr. Powis, it is clear that COVID-19 is transmitted through droplets; it is not an airborne illness. As a result, droplet/contact precautions (earloop mask, face shield, gown and gloves) are the best way to keep health care workers safe when providing routine care for individuals with suspected or confirmed COVID-19.
An N95 mask is required when AGMPs are performed on patients with suspected or confirmed COVID-19, for example during tracheotomy, intubation and noninvasive positive-pressure ventilation, to name a few. Ontario hospitals have guidance and access to the full list of AGMPs from Ontario Health.
Often the greatest risk to healthcare workers is related to self-contamination at the time of doffing their PPE.
“After watching people don and doff their N95 masks, I noticed that people struggle with the horizontal straps so I thought I would test the theory,” says Dr. Powis.
In this short video, Dr. Powis used a black light to demonstrate the potential self-contamination risks between donning and doffing an earloop surgical mask and mask with horizontal straps (such as an N95).
“What we found is that earloop masks are easier to doff in comparison to a mask with horizontal straps. Masks with horizontal straps can actually predispose the user to self-contamination,” says Dr. Powis.
According to Dr. Isaac Bogoch, an infectious disease expert at University Health Network (UHN), “Human factors research provides a pragmatic window to real-world issues. In this case, there may be greater risk of self-contamination while donning and doffing N95 masks compared to surgical masks, based on their strap design.”
“Policymakers and front-line healthcare workers should consider these findings when choosing to use and re-use personal protective equipment,” says Dr. Bogoch.
Healthcare workers need to do a point-of-care risk assessment (PCRA) to ensure they make the right decision regarding their use of masks. This video demonstrates that the risk of self-contamination is likely greater with an N95 mask.
“When choosing a mask it’s important to choose the right one for the job,” according to Dr. Powis.
“There are times when you need an N95 mask, but using one for routine patient care when it’s not necessary won’t make you safer, it paradoxically may increase your risk.”
Your messages: Voices and responses
Each day we receive numerous messages and phone calls. Each day we also welcome new readers to this daily report: Thank you deeply for the work you do always and especially during this public health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionalsFeel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.
Nurses in specialty care: Foot care services
As mentioned in this report, we have received a number of emails from nurses who provide foot care services in a variety of settings (home care, retirement homes, long-term care, community clinics, etc.) who are seeking information about the opening of services and how they will be able to resume their practice safely. Many of these nurses are in independent practice, while others work in community funded programs. To address the needs expressed by the nurses in this specialty area of practice, members of the IABPG and policy teams will be hosting a webinar on Thursday May 28th at 3:30 - 4:30 pm EDT. This webinar is open to any foot care nurses and others who would like to join us for dialogue and discussion. If you are interested and available to attend, please register here: https://us02web.zoom.us/meeting/register/tZUpcOuqqjMrGNB1b4JWVuUZUB3jeoZVTDqM
RNAO response to announcement of an independent commission into Ontario's long-term care system
TORONTO, May 20, 2020 – The Registered Nurses’ Association of Ontario (RNAO) welcomes the Tuesday, May 19 announcement by Dr. Merrilee Fullerton, Minister of Long-Term Care, of an independent commission into Ontario's long-term care (LTC) system.
“RNAO appreciates Premier Doug Ford saying on various occasions that the long-term care system in Ontario is broken, a phrase Minister Fullerton repeated on May 19,” RNAO President Dr. Angela Cooper Brathwaite says. “For the past decade, we have been urging the government to institute robust funding and staffing reform, but this must be done as part of a broader conceptualization of community care as central to health care, as we detailed in our ECCO 3.0 report.”
Together we can do it
MOH EOC Situational Report #116 here for Wednesday, May 20
EOC report #116 for May 20 informs of the following actions taken:
EOC report #115 for May 19 informs of the following actions taken:
Staying in touch
Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at email@example.com. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!
Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!
Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions.
Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
RECENT RNAO POLICY CORNER ITEMS:
19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here
14 May - Nursing Week update – go here
14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here
14 May - Disappointment for not being included in pandemic pay – go here
13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here
13 May - End racism and prejudice – go here
11 May - Nurses share their successes and challenges during National Nursing Week – go here
10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here
7 May - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here
5 May - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here
5 May - Addressing differential access to virtual care due to technology inequities – go here
3 May - Being person-and-family-centred during COVID-19 – go here
1 May - Migrant agricultural workers and the COVID-19 crisis – go here
30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here
28 April - Supporting First Nation Communities during COVID-19 – go here
27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here
25 April - Lessons learned through a COVID-19 nursing home outbreak – go here
25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here
23 April - Working with seniors in long-term care requires specialized knowledge – go here
22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here
21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here
20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here
18 April - COVID, Trump and the World Health Organization – go here
16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here
15 April - COVID-19 and the Challenges in Homecare – go here.
14 April - Reprocessing Of N95 – An Update – go here.
14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here.
13 April - Practical Tips for Safe Use of Masks – go here.
10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.
10 April - RNAO Action – Supporting Long-Term Care – go here.
10 April - Update For Nursing Students – NCLEX Exam – go here.
9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.
9 April - Guidance on use of N95 mask – go here.
7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.
7 April - Reprocessing of n95 – safe? – go here.
5 April - We must change the way we do testing and case definition – go here.
5 April - Ringing the alarm bells on critical care beds – go here.
4 April - COVID-19, stay at home and domestic violence – go here.
We have posted earlier ones in my blog here. Please go and take a look.
Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.
Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.
Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.
You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.
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