PROTECTED CODE BLUE GUIDELINES

All personnel should don full enhanced PPE (bouffant cap + fluid resistant gown + neck /face shield + gloves + N95) prior to initiating resuscitative efforts.

This may result in delays to CPR but MUST be adhered to.

Consider LMA insertion if unsuccessful intubation on first attempt.

1. Intubation in the ICU for COVID-19

2. Sunnybrook Health Sciences Centre - Protected Intubation

3. BC Emergency Medicine Network - COVID-19: Protected Controlled Intubation & Cardiac Arrest

4. Internet Book of Critical Care - COVID-19

5. Internet Book of Critical Care - Some Additional COVID Airway Management Thoughts

COVID-19 Guidelines for Staff

Effective Mar 23 2020, all those coming to work, regardless of role, are to wear a procedure mask (droplet mask, ear loop) throughout their day/shift. If staff are to provide care to a patient and/or resident on droplet precautions, the staff member shall remove gown and gloves on exit and perform hand hygiene. If the mask was protected from surface contamination (e.g. visor), then the mask does not need to be change.

For more information, see Mask FAQs.

Protected exposure (with proper PPE and hand hygiene) to COVID+ve patients are not considered high risk.

If you experience URI symptoms (even mild) speak with Occ Health, decisions to be made on a case by case basis regarding eligibility to work.

PERSONAL PROTECTIVE EQUIPMENT & DECONTAMINATION

AEROSOL GENERATING PROCEDURES

Based on a systematic review of aerosol-generating procedures and the risk of transmitting SARS to healthcare workers, the following procedures were identified as presenting the highest risk:

• Tracheal intubation

• Non-invasive ventilation

• Tracheotomy

• Manual ventilation before intubation (bag-valve mask ventilation)

Other potentially aerosol-generating procedures include:

• High-flow oxygenation

• Nebulized medications

• Airway suctioning

• Extubation

• Circuit changes

• Bronchoscopy

• Chest compressions

• Defibrillation

• Manipulation of an oxygen mask, and

• Nasogastric or orogastric tube insertion

Reference:

https://first10em.com/aerosol-generating-procedures/

http://www.emdocs.net/personal-protective-equipment-ppe-pearls-covid-19/

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Frespirators-strategy%2Fcrisis-alternate-strategies.html

https://www.emrap.org/corependium/chapter/rec906m1mD6SRH9np/Novel-Coronavirus-2019-COVID-19?MainSearch=%22Novel+Coronavirus+2019+(COVID-19)%22&SearchType=%22text%22#h.12hspcfhqx52

Aerosol & Surface distribution of COVID-19 virus in hospital wards

DONNING/DOFFING PERSONAL PROTECTIVE EQUIPMENT

CAEP Position on PPE

Click on the videos below:

• How to take off PPE

• How to put on PPE

• PPE Conservation Strategies

• Covid Scrub

COVID-19 ED SHIFT DECONTAMINATION CHECKLIST

Before Work

1. Obtain clean scrubs from machine and jacket to work in bag

2. Remove watch and rings

After Work

1. Wash arms with soap

2. Place dirty scrubs in scrub machine

3. Change into clean scrubs (jacket if needed)

4. Wash hands

5. Sanitize badge and phone on way out

6. Sanitize hands

Arrive Home

1. Shoes/work bag in garage

2. Water bottle/lunch container in dishwasher

3. Bag in washing machine (hot water and detergent)

4. Shower with soap and water

CHECK YOUR OWN COVID-19 SWAB RESULTS

Click here to check your results from North York General Hospital