That makes issuing recommendations for mitigating the spread of the coronavirus in health-care settings a difficult task, especially considering the issues with shortages of personal protective equipment (PPE). That was the message of a webinar by the Infectious Diseases Society of America (IDSA) this week, which featured two physicians on the Infection Prevention Guidelines Expert Panel.
“The goal of the Infectious Disease Society of America committee is to provide the best possible evidence based recommendations for infection prevention and control in healthcare settings,” said Dr. John Lynch, chair of the IDSA COVID-19 Infection Prevention Guidelines Expert Panel, on the webinar.
Lynch pointed out that the coronavirus is a new disease and that so many of the recommendations are really pragmatic and based on the best available observations and experience thus far. “It’s really critical that part of the guidelines’ purpose is to point out where there are gaps and where there are potential opportunities for both funding and research and specific study types,” he said.
Dr. Allison McGeer, also on the IDSA COVID-19 Infection Prevention Guidelines Expert Panel, said the process for developing and recommending guidelines may look easy to pick apart and question, but clinicians would do well to read and understand what background information evidence went into developing the guidelines.
“A lot of what we have to talk about is from what we know about other viruses and other circumstances,” she said. “This makes it difficult, but it makes it valuable to have different groups of people who are used to gathering evidence to pull together this largely indirect evidence that expert panels and public health officials are using to make recommendations to protect health-care workers.”
“We’ve called upon the rest of our community to align around specific guidelines, but we recognize there are some deviations, and our goal is to really come to one evidence-based recommendation for how health-care workers protect themselves and their patients,” he said.
The panel has also had to develop guidelines in dealing with the shortage of PPE. “When we think about these tools, we realize hospitals ran into shortages and we had to figure out what evidence was out there for safe reuse of tools like respirators and other PPE that is designed for single use.
With a shortage of N95 masks, it was critical to understand how health-care workers could extend the use of these masks, or clean and reuse them. One guideline that surfaced was extended use, where the heath-care worker would use the same mask when treating two patients instead of one patient.
Another way to save PPE, such as masks, is to reprocess them. That may involve storing the mask until the virus dies and then reusing, or treating it with chemicals.
“There are very good reasons why there are intensive regulations about how you do it and what you do,” McGeer said. “Every piece of the composition — it may look simple: a mask and a couple of bands — but in fact how those pieces respond to different types of reprocessing is very different and what you can do to reprocess is hard to tell.”
