Novel Coronavirus FAQs for Medication Assisted Treatment Providers

This document contains information about COVID-19, testing and reporting information, personal protective equipment, and additional resources.

News Update:

Updated May 29, 2020, 4:00 pm

• COVID-19 is a respiratory disease caused by a new strain of coronavirus (SARS-CoV-2), which has spread globally.
• While anyone can be infected, most people develop mild symptoms.
• Common symptoms are fever (over 100.4), cough, shortness of breath/difficulty breathing, chills, muscle pain, sore throat, new loss of taste or smell, diarrhea, extreme exhaustion, and fatigue.
• Severe symptoms can include bronchitis, pneumonia, severe acute respiratory syndrome, kidney failure, and even death.
• People most at risk for severe disease are adults over 60 and those with underlying conditions such as heart disease.
• Cases of COVID-19 have been reported in Kansas.
• Sedgwick County Health Department is closely monitoring this issue and is coordinating with the state health department, Kansas Department of Health and Environment (KDHE)
• We anticipate more cases of COVID-19 in Sedgwick County in the coming days or weeks.

Every day, the Sedgwick County Health Department investigates reports of diseases from whooping cough and chickenpox to tuberculosis and HIV. You can help. COVID-19 is a new disease but it spreads the same way as the flu, through respiratory droplets. Many of the actions to prevent flu are the same needed to prevent COVID-19.

General Information

What recommendations can I give to patients to protect themselves from COVID-19?

• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces.
  • A list of products approved to kill coronavirus can be found HERE.
• Currently, there are no vaccines available to prevent novel coronavirus infections.

How soon after exposure do symptoms start?

In general, symptoms appear 2 – 14 days after exposure.

Is there a vaccine?

There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to avoid being exposed to this virus (See “What recommendations can I give to patients to protect themselves from COVID-19”)

Is there a treatment?

There are no medications specifically approved for this novel coronavirus, although some, like Remdesivir, are being considered.  Most people with mild coronavirus illness will recover on their own by drinking plenty of fluids, resting, and taking pain and fever medications.  However, some people have developed pneumonia and require medical care or hospitalization.

Guidance Specific to Opioid Treatment Programs:

Infection Control and Social Distancing

Ask patients who have symptoms, are quarantined, or diagnosed with COVID-19 to call the program so the opioid treatment program can plan accordingly.

What can opioid treatment programs do to assist with social distancing?

Consider ways to limit close contact of both patients and staff. Close contact is defined as being within 6 feet of another person for 10 or more minutes.

• Limit staff and client interactions using
  • glass windows
  • tele-communications devices within that same facility
  • telehealth if appropriate
• Maximize Take Home Doses
  • SAMSHA exemption allows for up to 28 days of take home medication for patients who are stable and up to 14 days for those who are less stable but whom the program believes can safely handle this level of medication.
  • Allow all patients with “earned take-homes” to use them. While it can be an incentive to draw patients to attend counseling, please reduce patient appearance at the clinic as much as possible by maximizing take-home doses at the prescriber’s discretion.
    • When possible, please include the “earned time” at other opioid treatment programs, providing there is clear and consistent documentation that the patient met the requirements of that program.
  • Consider expanding hours to reducing waiting room congestion and lines.

Can programs dose someone in a separate room if they present with a fever or cough?

Yes. Develop procedures for staff to take patients who present with respiratory symptoms such as fever and cough to a location other than the general dispensary or lobby, to dose patients in closed rooms as needed. Provide masks for patients with symptoms. Follow CDC guidelines for infection control in a healthcare setting.

Can existing patients be seen through telehealth?

Yes

What SUD services by billing code are approved by KDHE for telephonic delivery in the home for KanCare SUD, Kansas Block Grant, and DUI providers?

SUD Providers: H0001, H0004, H0005 U5, H0006 U5, H0015 U5, H0038, H0038 HQ

Kansas Block Grant and DUI Providers: H0001 GT, H0004 GT, H0005 U5/GT, H0006 U5/GT, H0006 U5/HV/GT, H0007 GT, H0015 U5, H0015 U5/HA, H0038 GT/HF Individual, H0038 GT/HQ/HF Group.

Can opioid treatment programs provide take-home doses of prescriptions to stable patients?

Yes, SAMHSA has issued a blanket exemption to states that allow for up to 28 days of take home medication for patients who are stable and up to 14 days for those who are less stable but whom the program believes can safely handle this level of medication.

By regulation (42 CFR Section 8.12(i)(2)), the medical director shall make treatment program decisions on dispensing opioid treatment medications to patients for unsupervised use. An exemption request to SAMSHA will be needed if another physician takes responsibility for making decisions regarding unsupervised take home medication orders or dosing changes.

What if I cannot obtain written consent to disclose information because I am seeing a patient through telephone or telehealth technology?

KDADS has release guidance for SUD providers stating verbal consent obtained over the phone or the internet will be acceptable in place of signed consent where normally required.

42 CFR part 2 allows for a disclosure without consent to the extent necessary to meet a bona fide medical emergency in which a patient’s prior informed consent could not be obtained. Such disclosures must be documented the patient’s record. Providers determine whether a bona fide medical emergency exists for purposes of providing needed treatment to patients.

Can a new patient be admitted to an Opioid Treatment Program using telehealth?

• Yes if patient is treated with buprenorphine and an adequate evaluation can be accomplished via telehealth as supervised by the program physician.
• No, if patient is treated with methadone since patients would likely be taking a sub-therapeutic dose for an extended period.

What should an opioid treatment program do if a patent is under quarantine or isolation with the coronavirus?

1. Document that the patient is medically ordered to be under isolation or quarantine. When possible, confirm source of information. The Sedgwick County Health Department can be reached at 316-660-7300.
2. Identify a trustworthy, patient-designated, uninfected member of the household to deliver the medications using the OTP’s established chain of custody protocol for take home medication. OTPs should obtain documentation now as to who is designated permission to pick up medication for each patient.
3. If a trustworthy member of the household is unavailable, then the OTP should prepare a “doorstep” delivery of take home medications. Any medication taken out of the OTP must be in an approved lock box. Contact the Kansas Opioid Treatment Authority (785-296-4079) to learn more about approved lock boxes. Contact the Medical Society at 316-683-7557 if you need assistance obtaining supplies due to shortages.

The OTP should always communicate with the patient prior to delivery to reduce risk of diversion. This may involve, but is not limited to: 

1. Call placed to the patient prior to staff departure to deliver the medication ensuring that the patient or their approved designee (who must be a member of the patient’s household) is available to receive the medication at the address provided by the patient and recorded in the patient’s OTP medical record.
2. Upon arrival, medication is delivered to the patient’s residence door and another call is made to the patient/designee notifying that the medications are at the door.
3. The OTP staff is to retreat a minimum of 6 feet to observe that the medications are picked up by the patient or the designated person to receive the medications. The OTP staff person must ask the person who is retrieving the medication to identify themselves. Staff should determine that the person appearing to retrieve the medication is the patient or the household member named by the patient as having permission to do so. The OTP staff who deliver the medication shall remain until they have observe the retrieval of the medication by the patient or household member, and then document confirmation that medications were received by the patient or household member identified as permitted to pick up the medication.
4. Do not leave medication in an unsecured area. OTP staff must remain with the medication until the patient or designated household member arrives and retrieves the medication.
5. If the person who is to receive the medication is not at the designated location, an attempt should be made to reach that person. If the person does not arrive in a reasonable period of time, then the staff person must bring the medication back to the OTP where it will be stored in the pharmacy area until a determination is made whether another attempt will be made. Any medication returned to the OTP must be logged in. The medication delivery and pick up by the patient or designated household member, or return of medications to the OTP, must be documented in the patient’s OTP record and appropriate pharmacy records.

Business Continuity Planning

Opioid treatment programs (OTP’s) are an essential service. Programs should be prepared for staffing shortages as more people become sick and to provide more services should the capacity of other opioid treatment programs decrease.

If the supervising provider becomes sick or can otherwise no longer provide supervision, can mid-level practitioners continue to dispense and administer opioid agonist medications?

Yes, as long as the mid-level provider is a pharmacist, registered nurse, licensed practical nurse, or any other healthcare professional authorized by Federal and State law to administer or dispense opioid drugs; however, the mid-level provider would be acting as an “agent” of the supervising provider. The supervising provider would still assume responsibility for administering all medical services performed by the opioid treatment program.

May an OTP request an exemption to allow mid-level practitioners to perform functions that are required to be performed by an OTP physician or the medical director (under 42 C.F.R. § 8.12) in the event the medical director or physician cannot perform the regulatory functions?

Yes, an OTP may request an exemption from the requirements of 42 CFR § 8.12 in order to have midlevel providers perform functions related to admitting patients, ordering unsupervised take home medication, or changing medication doses during the COVID-19 emergency if consistent with applicable state law and the midlevel provider’s scope of licensure. 

If the OTP has received an exemption from SAMHSA for a mid-level practitioner to perform designated functions of the medical director from SAMHSA and subsequently that mid-level practitioner becomes unavailable, does the OTP need to submit another exemption request identifying the new midlevel by name?

No, if the mid-level exemption request has been approved, but the mid-level practitioner is no longer able to perform the designated duties, for instance due to illness, the OTP is not required to submit another request identifying the new mid-level practitioner. Program sponsors should contact SAMHSA’s Division of Pharmacological Therapies (DPT) in order to request OTP extranet system access for a provider.

When should staff return to work?

• DO NOT require a provider’s note for sick leave. This will put unnecessary burden on already burdened providers’ offices.
• Currently, those with COVID-19 cannot return to work until
  • a) 10 days after the onset of symptoms or
  • b) 72 hours after symptoms have stopped without taking fever-reducing medications,

whichever is longer.

• Those with household members who have COVID-19 or otherwise quarantined will be asked to remain at home to monitor for symptoms for 14 days after their last exposure, often the time the other household member no longer has symptoms.

What else should my opioid treatment program be doing for our response to COVID-19?

• Contact the Kansas Opioid Treatment Authority with questions specific to opioid treatment programs:
  • Cissy McKinzie: mckinzie@ks.gov (785)296-4079.
  • Andrew Brown: brown@ks.gov (785)291-3359
• Ensure you have up-to-date and readily available emergency contact information for your employees and your patients.
  • Update the cell phone and carrier of your patients weekly as part of the dosing and medication pickup process.
• Develop a plan for possible alternative staffing/dosing scheduling in case you experience staffing shortages due to staff illness. Develop a plan for criteria for staff members who may need to stay home when ill and/or return to the workforce when well.
• OTPs are required to have enough medication inventory onsite for ten days’ worth of patient medication. This language is likely to be revised to 15 days or more (medication safe size permitting) in case neighboring OTPs close due to staffing shortages.

 Testing and Disease Investigation:

When is someone a Person Under Investigation (PUI) and should be tested for COVID-19?

Testing Approval Form

If a patient fits the above criteria, order tests, tell the patient to remain at home until results are obtained, and report positive tests through the KDHE Epidemiology Hotline (1-877-427-7317).

How are patients tested for COVID-19?

First, a medical provider can collect a sample using a nasopharyngeal swab and a media (saline or viral media) following KDHE instructions posted on their website. Facilities and providers should prioritize using internal or commercial laboratory testing for COVID-19. The following reference labs offer COVID-19 testing:

• Quest Diagnostics (test code 39433),
• LabCorp (test code 139900),
• Mayo Clinic Laboratories (test code ZW282), and
• Viracor (test code 8398).

If a patient is in a priority group mentioned in the previous question, a provider can complete the testing form on the KDHE website to send a sample to the Kansas Health and Environment Laboratories (KHEL). KHEL testing will be at no cost to the patient.

What do health department staff do to investigate people who may have COVID-19?

1. If a person is identified as a Person Under Investigation (PUI) (see criteria above) the person is tested and is instructed to remains at home. The Sedgwick County Health Department is notified and remains in contact with the person.
2. While waiting for test results, health department staff will interview the PUI to create a detailed timeline of where he or she went while potentially infectious. Officials will create a contact list of people who had close contact with the PUI.
   1. If the test result comes back positive (virus is present), health department staff will contact those who had close contact with the PUI. Contacts will be asked to self-monitor and quarantine for fever, cough, and difficulty breathing for 14 days after the last time they were in close contact with the positive case.
   2. If the test result are negative, the PUI can return to normal activities.

What is a confirmed case?

A confirmed case is defined as a person who has tested positive at the state health department laboratory or at a commercial laboratory. Confirmation with the Centers for Disease Control and Prevention (CDC) is no longer required.

When can a person who tests positive resume normal activities?

A person can resume normal activities when 10 days after the start of symptoms or 72 hours (3 days) after symptoms have ended without taking fever-reducing medications, whichever is longer.

How will people be informed if they have been in contact with a case?

If a person is identified as a contact of a case, the Sedgwick County Health Department will call them. After the initial call, the Sedgwick County Health Department contacts the person via an automated text message or email system every day for 14 days.

How does the automated text message system work?

The text message will prompt the person to press a button if they are experiencing a fever and respiratory symptoms.

• If yes, either a Sedgwick County Health Department employee will call for further evaluation.
• If no, the message will end.
• If no response or incorrect contact information, then health department staff will contact by other means.

Personal Protective Equipment

Who should I contact if I need help obtaining medical equipment and PPE?

Contact the Medical Society of Sedgwick County at 316-683-7557.

What Personal Protective Equipment (PPE) is required for Healthcare Providers Collecting Specimen Swabs from a Patient Suspected of Having COVID-19

Review CDC recommendations HERE.

• Gloves
• Gowns
• Eye Protection (goggles or faceshield)
• Respiratory Protection – use a fit-tested N95 respirator

(facemasks are an acceptable alternative for collecting sample swabs when the supply chain of respirators cannot meet the demand)

What testing and standards should I consider when looking for CDC-recommended protective clothing?

• CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids outlines the scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare.
• Many organizations have published guidelines for the use of personal protective equipment (PPE) in medical settings. The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI): describes the liquid barrier performance and a classification of surgical and isolation gowns for use in health care facilities.
• As with any type of PPE, the key to proper selection and use of protective clothing is to understand the hazards and the risk of exposure. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks to be performed by the user of the PPE.
• For gowns, it is important to have sufficient overlap of the fabric so that it wraps around the body to cover the back (ensuring that if the wearer squats or sits down, the gown still protects the back area of the body).

What type of gown is recommended for patients with suspected or confirmed COVID-19?

• Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by patients with suspected or confirmed COVID-19.

What types of gowns are available for healthcare personnel to protect from COVID-19?

• While the transmissibility of COVID-19 is not fully understood, gowns are available that protect against microorganisms. The choice of gown should be made based on the level of risk of contamination. Certain areas of surgical and isolation gowns are defined as “critical zones” where direct contact with blood, body fluids, and/or other potentially infectious materials is most likely to occur.
• If there is a medium to high risk of contamination and need for a large critical zone, isolation gowns that claim moderate to high barrier protection can be used.
• For healthcare activities with low, medium, or high risk of contamination, surgical gowns, can be used. These gowns are intended to be worn by healthcare personnel during surgical procedures.
• If the risk of bodily fluid exposure is low or minimal, gowns that claim minimal or low levels of barrier protection can be used. These gowns should not be worn during surgical or invasive procedures, or for medium to high risk contamination patient care activities.

What is the difference between gowns and coveralls?

• CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids provides additional comparisons between gowns and coveralls.
• Gowns are easier to put on and, in particular, to take off. They are generally more familiar to healthcare workers and hence more likely to be used and removed correctly. These factors also facilitate training in their correct use.
• Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. Surgical/isolation gowns do not provide continuous whole-body protection (e.g., they have possible openings in the back, and typically provide coverage to the mid-calf only).
• The level of heat stress generated due to the added layer of clothing is also expected to be less for gowns when compared to coveralls due to several factors, such as the openings in the design of gowns and total area covered by the fabric.

How do I put on (don) and take off (doff) my gown?

• Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
• If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.
• Healthcare providers should perform hand hygiene before and after removing PPE. Hand hygiene should be performed by using alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Is it acceptable for emergency medical services to wear coveralls as an alternative to gowns when COVID-19 is suspected in a patient needing emergency transport?

• Unlike patient care in the controlled environment of a healthcare facility, care and transport by EMS present unique challenges because of the nature of the setting. Coveralls are an acceptable alternative to gowns when caring for and transporting suspect COVID-19 patients.  While no clinical studies have been done to compare gowns and coveralls, both have been used effectively by healthcare workers in clinical settings during patient care. CDC’s Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids guidance provides a comparison between gowns and coveralls, including test methods and performance requirements. Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well.  This added coverage may be necessary for some work tasks involved in medical transport. However, coveralls may lead to increased heat stress compared to gowns due to the total area covered by the fabric. Training on how to properly remove (doff) a coverall is important to prevent self-contamination. Comparatively, gowns are easier to put on and, in particular, to take off.

Gloves

What type of glove is recommended to care for suspected or confirmed COVID-19 patients in healthcare settings?

• Nonsterile disposable patient examination gloves, which are used for routine patient care in healthcare settings, are appropriate for the care of patients with suspected or confirmed COVID-19.

What standards should be considered when choosing gloves?

• The American Society for Testing and Materials (ASTM) external has developed standards for patient examination gloves.
• Standard specifications for nitrile gloves, natural rubber gloves, and polychloroprene gloves indicate higher minimum tensile strength and elongation requirements compared to vinyl gloves.
• The ASTM has developed standards for patient examination gloves. Length requirements for patient exam gloves must be a minimum of 220mm-230mm depending on glove size and material type.

Is double gloving necessary when caring for suspected or confirmed CoVID-19 patients in healthcare settings?

• CDC guidance does not recommend double gloves when providing care to suspected or confirmed 2019-COVID patients.

Are extended length gloves necessary when caring for suspected or confirmed COVID-19 patients in healthcare settings?

• According to CDC guidance, extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. Extended length gloves can be used, but CDC does not specifically recommend them at this time.

How I do put on (don) and take off (doff) my gloves?

• Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
• If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.
• Healthcare providers should perform hand hygiene after removing PPE. Hand hygiene should be performed by using an alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Respirators

Should I wear a respirator, such as an N95 respirator, in public?

• CDC does not recommend the routine use of respirators outside of healthcare settings. Instead, CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching your eyes or nose, and covering your cough or sneeze with a tissue.
• People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.
• If you are sick and must leave your house, please wear a mask to keep your germs from spreading to others.  The Centers for Disease Control and Prevention (CDC) recommends everyone who will be in a public settings where other social distancing measures are difficult to maintain (e.g. grocery stores and pharmacies, especially in areas of significant community-based transmission, to wear a cloth face covering.
• Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
• Homemade face coverings/masks are another tool to keep people from unknowingly spreading the virus. 
• Use this acronym when considering safe homemade mask use:
  • Multi-layered, tightly-woven 100% Cotton.  Use a thread count of 180 or higher. Don’t buy surgical or N95 masks.  
  • Avoid your face and remove it from behind.  Never touch the front of the mask, and always remove it from behind your head.  
  • Scrap it if it’s damaged, soiled, or doesn’t fit.  Make sure it’s breathable and fits snug. Don’t use it while it’s damp, wet, or dirty.  
  • Keep the mask and your hands clean.  Wash your hands before you put the mask on/after you take it off. Wash or dispose the mask after every use.
• The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

What is a respirator?

• A respirator is a personal protective device that is worn on the face or head and covers at least the nose and mouth. A respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases or vapors. Respirators, including those intended for use in healthcare settings, are certified by the CDC/NIOSH.

What is an N95 filtering facepiece respirator (FFR)?

• An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.

What are the two main types of masks for medical use?

There are two main types of masks for medical use – N95 or “facemasks” (also called surgical or earloop masks)

• N95 respirator masks are used by healthcare employees to protect from exposures to respiratory pathogens.
• Facemasks (also called surgical, procedure, or earloop masks) are only to be used by people who are ill to reduce risk of spreading disease to others.

What is an N95 respirator?

N95 respirators are used by healthcare employees that have exposures to respiratory pathogens.

• They are tight-fitting respirators that filter out at least 95% of particles in the air, including large and small particles.
• Before using an N95 respirator, workers must have a medical evaluation and be fit-tested to make sure that they are able to wear a respirator safely and confirm a proper seal.
• When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.

What is a facemask (also called a surgical mask, procedure mask, or earloop mask)?

• Facemasks are used by patients with confirmed or suspected COVID-19 or other respiratory virus. Patients should wear a facemask until they are isolated away from others.
  • Facemasks are used for patient source control, to prevent contamination of the surrounding area when a person coughs or sneezes.
  • They are loose-fitting and provide only barrier protection against droplets, including large respiratory particles.
  • No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent leakage around the edge of the mask when the user inhales.

What is a Surgical N95 respirator and who needs to wear it?

• A surgical N95 (also referred as a medical respirator) is recommended only for use by healthcare personnel who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings. In times of shortage, only personnel who are working in a sterile field or who may be exposed to high velocity splashes, sprays, or splatters of blood or body fluids should wear these respirators, such as in operative or procedural settings. Most personnel caring for confirmed or suspected COVID-19 patients should not need to use surgical N95 respirators and can use standard N95 respirators.
• If a surgical N95 is not available for use in operative or procedural settings, then an unhalved N95 respirator may be used with a face shield to help block high velocity streams of blood and body fluids.

My employees complain that Surgical N95 respirators are hot and uncomfortable – what can I do?

• The requirements for surgical N95 respirators that make them resistant to high velocity streams of body fluids and help protect the sterile field can result in a design that has a higher breathing resistance (makes it more difficult to breath) than a typical N95 respirator. Also, surgical N95 respirators are designed without exhalation valves which are sometimes perceived as warmer inside the mask than typical N95 respirators. If you are receiving complaints, you may consider having employees who are not doing surgery, not working in a sterile field, or not potentially exposed to high velocity streams of body fluids wear a standard N95 with an exhalation valve.

My N95 respirator has an exhalation valve, is that okay?

• An N95 respirator with an exhalation valve does provide the same level of protection to the wearer as one that does not have a valve. The presence of an exhalation valve reduces exhalation resistance, which makes it easier to breathe (exhale). Some users feel that a respirator with an exhalation valve keeps the face cooler and reduces moisture build up inside the face piece. However, respirators with exhalation valves should not be used in situations where a sterile field must be maintained (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.

How can I tell if a respirator is NIOSH-approved?

• The NIOSH approval number and approval label are key to identifying NIOSH-approved respirators. The NIOSH approval label can be found on or within the packaging of the respirator or sometimes on the respirator itself. The required labeling of NIOSH-Approved N95 filtering face piece includes the NIOSH name, the approval number, filter designations, lot number, and model number to be printed on the respirator. You can verify that your respirator approvals are valid by checking the NIOSH Certified Equipment List (CEL).

How do I know if my respirator is expired?

• NIOSH does not require approved N95 filtering face piece respirators (FFRs) be marked with an expiration date. If an FFR does not have an assigned expiration date, you should refer to the user instructions or seek guidance from the specific manufacturer on whether time and storage conditions (such as temperature or humidity) are expected to have an effect on the respirator’s performance and if the respirators are nearing the end of their shelf life.

What do I do with an expired respirator?

• In times of increased demand and decreased supply, consideration can be made to use N95 respirators past their intended shelf life. However, the potential exists that the respirator will not perform to the requirements for which it was certified. Over time, components such as the strap and nose bridge may degrade, which can affect the quality of the fit and seal. Prior to use of N95 respirators, the healthcare personnel should inspect the respirator and perform a seal check. Additionally, expired respirators may potentially no longer meet the certification requirements set by NIOSH. For further guidance, visit Release of Stockpiled N95 Filtering Face piece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response.

Eye Protection

• Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Remove eye protection before leaving the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.  Disposable eye protection should be discarded after use.

What methods should healthcare facilities consider in order to avoid unintentional loss of PPE during COVID-19?

• Educating staff on proper use of PPE and monitoring PPE supply inventory and maintaining control over PPE supplies may help prevent unintentional product losses that may occur due to theft, damage, or accidental loss. Inventory systems should be employed to track daily usage and identify areas of higher than expected use. This information can be used to implement additional conservation strategies tailored to specific patient care areas such as hospital units or outpatient facilities.  Inventory tracking within a health system may also assist in confirming PPE deliveries and optimizing distribution of PPE supplies to specific facilities.

Can healthcare workers and EMS staff wear facemasks if N95 masks are not available due to supply shortage?

According to CDC guidance updated on March 10, 2020, based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.  During this time, available N95 respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to healthcare workers and EMS staff.

When the supply chain is restored, facilities and agencies with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19.

Online Resources:

Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/index.html

CDC Infection Control Recommendations in Healthcare Setting:  

[https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html]

Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/medication-assisted-treatment

Kansas Department of Health and Environment: http://www.kdheks.gov/coronavirus/index.htm

Kansas Department for Aging and Disability Services: https://www.kdads.ks.gov/covid-19