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N95s are only to be worn in COVID care areas; please continue to wear surgical or KN masks in common areas.

Universal In-Clinic mask policy: Staff

All staff will be issued one surgical or KN mask upon entry to the health center. This mask should be worn in all patient care areas and all non-clinical areas where you are in close vicinity to other people.

  • When not wearing the mask, it should be kept away from high touch surfaces – placing it in a brown paper bag or onto clean paper towels are better than a common table or desk.
  • While donning and doffing the mask, avoid touching the front panel; use the elastic straps and edges of the mask as much as possible.
  • If at any point the mask becomes visibly soiled or wet, discard and replace with a new mask.

 

Universal DotHouse mask policy: Patients

Every DotHouse visitor and patient over 2 years of age will be issued a surgical or procedural face mask for use if they arrive without a facemask or face covering. This mask should be kept in place the entire time they are at DotHouse. The only exception is when the patient needs to remove it for examinations or procedures in an exam room.

 

N95 Respirator Conservation Statement and Guidance

N95 respirators represent an element of our PPE that is in critically short supply.  As continuous efforts to obtain additional supply are ongoing, it is essential that all staff make every effort to conserve our current supply through careful limited reuse and use of designated recollection bins.  Detailed description and guidance on each of these strategies is available below.

 

Limited Reuse of N95 Respirators

  • Each staff member working in designated areas (Urgent Care, COVID Testing Unit) will receive one N95 respirator at beginning of shift.
  • Before donning N95 for the first time in a shift, all makeup, lipstick or other skin care products like aftershave should be removed to avoid soiling the N95 and limit reprocessing.
  • In between uses, place N95 in a brown paper bag labeled with your name or on a paper towel.
  • Avoid handling N95 by exterior surface. Handle by elastic and edges of mask as much as possible.
  • Perform frequent hand hygiene, particularly before and after handling the mask.
  • If seeing symptomatic or suspected COVID-positive patients sequentially, continue wearing your N95 throughout this time period consistent with extended use. At the end of sequential patient encounters, doff N95 into brown paper bag or onto a paper towel.
  • At the end of the shift, remove N95 and place in designated recollection bin.

 

N95 Recollection and Decontamination

  • DotHouse has partnered with Battelle, which is a company providing decontamination service for N95 respirators to permit reuse up to 20 times.
  • Urgent Care has a designated recollection bin for used N95s in the dirty utility room (see De-contamination procedure)
  • At the end of the shift, the N95 should be placed in this recollection bin.
  • Visible soiling with food product, skincare products, or body fluids will cause the N95 to fail quality checks and be discarded. As such, DotHouse asks the following:
    • Recollection bins should be used for N95s only, no other trash.
    • Avoid use of makeup, lipstick, or aftershave, as these transfer easily to the N95 and will result in it being discarded. Make up remover wipes are available in Urgent Care.

 

Description and Definitions of Isolation Precautions

  1. Enhanced precautions (contact + droplet + airborne)
  • Conditions:  COVID positive or suspect patients likely to require the following aerosol generating procedures :
    • Medication administration via nebulizer
    • Manual ventilation and open suctioning
    • Tracheotomy/tracheostomy procedures (insertion/open suctioning/removal)
  • Environment: negative-pressure room when available

 

  1. Contact + Droplet Precautions
    • Conditions: COVID positive or suspect patients not likely to require any of the specified conditions for Enhanced precautions
    • Environment: room located in geographically-designated COVID care area

 

PPE Use Policy in DotHouse Clinical Areas

o Urgent Care

  • Reusable/disposable face shield, N95, gown, double gloves, shoe covers and bouffant are required.
  • All staff wearing N95s should practice limited reuse. One N95 respirator will be issued per shift and in between uses is to be kept in a paper bag or face down on a paper towel. Hand Hygiene should be performed prior to donning and after doffing the N95. At the end of the shift, the N95 should be placed in a recollection bin.
  • When the N95 is not in use between patient encounters, surgical or KN mask should be continuously worn throughout the shift, as per universal mask in clinic policy. Discard and obtain a new mask if visibly soiled or wet.
  • If seeing patients sequentially, extended use of N95 respirator is recommended (i.e. leave N95 mask on while seeing patients, then remove and place N95 in paper bag or face down on a paper towel for continued limited reuse).
  • PPE can be maintained between patient evaluations for the duration of the healthcare worker’s shift, with the exception of outer layer of gloves, which MUST be replaced between patients.
  • Gowns and gloves are not permitted in the “provider room.”

 

o COVID Testing Unit

  • Reusable/disposable face shield, N95, gown, double gloves, shoe covers and bouffant are required.
  • PPE can be maintained between patient evaluations for the duration of the healthcare worker’s shift, with the exception of outer layer of gloves, which MUST be replaced between patients. Any visible soiling or contamination of PPE warrants removal and replacement of all PPE prior to the next patient encounter.
  • Following completion of shift, N95 should be placed in recollection bin.
  • All other elements of PPE MUST be disposed of by the end of the healthcare worker’s shift with the exception of reusable face shields (which should be removed and disinfected per manufacturer protocol).

 

  • Dental Department
    • Surgical or KN mask should be continuously worn throughout the shift, as per universal mask in clinic policy. Discard and obtain a new mask if visibly soiled or wet.
    • When in direct patient contact without an engineered barrier: Surgical or KN mask AND eye protection (goggles or reusable hard face shield/disposable face shield) OR pre-attached surgical mask and face shield, and gloves.
    • When completing a dental procedure: Reusable/disposable face shield, N95, gown, double gloves, shoe covers and bouffant are required.
    • All staff wearing N95s should practice limited reuse. One N95 respirator will be issued per shift and in between uses is to be kept in a paper bag or face down on a paper towel. Hand Hygiene should be performed prior to donning and after doffing the N95. At the end of the shift, the N95 should be placed in a recollection bin.

 

  • Vision Department
    • Surgical or KN mask should be continuously worn throughout the shift, as per universal mask in clinic policy. Discard and obtain a new mask if visibly soiled or wet.
    • When in direct patient contact without an engineered barrier: Surgical or KN mask and eye protection (goggles or reusable hard face shield/disposable face shield) OR pre-attached surgical mask and face shield, and gloves.
    • When performing an eye exam: Reusable/disposable face shield AND surgical or KN mask OR pre-attached surgical mask and face shield, and gloves.
    • In addition to the above, gown can be used if splash or gross contamination with body fluids is anticipated.

 

  • Primary Care/Medical Specialties
    • When in direct patient contact without an engineered barrier: Surgical or KN mask AND eye protection (goggles or reusable hard face shield/disposable face shield) OR pre-attached surgical mask and face shield, and gloves.
    • In addition to the above, gown can be used if splash or gross contamination with body fluids is anticipated.
    • Surgical or KN mask should be continuously worn throughout the shift, as per universal mask in clinic policy. Discard and obtain a new mask if visibly soiled or wet.
    • Do not obtain NP/OP swabs in clinic; these can be obtained in UC or COVID Testing Unit.

 

  • Laboratory
    • When Drawing patients in the Lab
      • Surgical or KN mask AND eye protection (goggles or reusable hard face shield/disposable face shield) OR pre-attached surgical mask and face shield, and gloves.
      • All elements of PPE MUST be disposed of before exiting patient room with the exception of reusable face shields (which should be removed and disinfected per manufacturer protocol) and face masks.
    • When providing phlebotomy services in Urgent Care, PPE for Enhanced Precautions should be utilized (see Urgent Care PPE).

 

  • Housekeeping/Facilities/Interpreters
    • All staff should follow the PPE guidelines of the department where they are physically working (ex. If interpreting, cleaning or fixing something in UC, you should follow UC PPE guidelines.)

 

  • All Other Departments
    • Surgical or KN mask should be continuously worn throughout the shift, as per universal mask in DotHouse policy. Discard and obtain a new mask if visibly soiled or wet.
    • When in direct patient contact without an engineered barrier: Surgical or KN mask AND eye protection (goggles or reusable hard face shield/disposable face shield) OR pre-attached surgical mask and face shield, and gloves.