- Associated Press - Monday, May 4, 2020

BISMARCK, N.D. (AP) - Julie Jacobson’s job recently got a lot more challenging.

As an infection prevention manager at Sanford Health in Bismarck, she’s tasked with helping protect patients and staff from the new coronavirus, which causes the COVID-19 disease.

Jacobson recently took The Bismarck Tribune inside the hospital’s “COVID war room,” where she demonstrated how doctors and nurses treating patients with coronavirus properly wear special equipment to keep themselves safe.

What is PPE?

Personal protective equipment, or PPE, “acts as a barrier between infectious materials such as viral and bacterial contaminants and your skin, mouth, nose, or eyes,” according to the Food and Drug Administration. “When used properly and with other infection control practices such as hand-washing, using alcohol-based hand sanitizers, and covering coughs and sneezes, it minimizes the spread of infection from one person to another.”

Medical staff put on protective equipment anytime they deal with a potential infectious disease, but the level of PPE worn “depends on the actual situation that’s out there,” Jacobson said.

“Anytime time you have an unknown virus — you know, this (coronavirus) is such a new one, we’re still trying to figure it out — you take those extra precautions,” she said.

Levels of protection

The first step is putting on a surgical gown and gloves. The gloves are worn over the top of the gown to create a seal.

“You put it on over the top (of the gown) so you have that protection on your wrists,” Jacobson said.

The next steps depend on the level of contact a health worker is going to have with the patient.

If the worker is just going to assess the patient and not have close contact, a regular surgical mask should be worn along with a face shield, according to Jacobson.

The mask offers a basic level of protection for breathing, and the face shield helps prevent airborne particles from coming in contact with the eyes and nose.

However, if a doctor determines that a patient warrants a COVID-19 test, either an N95 respirator or a powered air purifying respirator, known as a PAPR, must be worn by medical staff collecting the sample, per recommendations from the federal Centers for Disease Control and Prevention.

Explaining the acronyms

The “N” in N95 stands for “not oil resistant,” and the number refers to the minimum percentage of particles filtered out by the mask. N95 respirators are certified to filter at least 95% of airborne particles.

N95 respirators are made with High Efficiency Particulate Air material, known as HEPA, that traps particles with a size of 0.3 microns. For comparison, a single human hair averages about 70 microns in diameter.

Employees are fit tested every year to ensure a tight seal with their N95 respirators. There is a bit of suction that occurs when wearing the N95 properly, so having a tight seal is crucial to ensure every breath inhaled is filtered, according to Jacobson.

“Every year we have to fit test this to the person and make sure that they didn’t gain weight, or they didn’t some type of facial surgery or dental surgery that caused this to not fit well anymore,” she said. “If you would wear one that doesn’t fit you, it could leak.”

Proper breathing

Wearing the N95 ensures each breath is purified, but the face shield still must be worn in conjunction to prevent fine particles from coming in contact with the eyes and nose.

Equivalent in protection to that is the powered air purifying respirator, or PAPR. A PAPR device is worn on the back, similar to a scuba tank, and pumps purified air through a hose into a hooded face mask.

“We used these when we had Ebola,” Jacobson said, referring to the virus outbreak in 2014.

The fabric on the hooded face mask is porous, allowing the wearer to breathe out normally while still offering protection. The PAPR provides a bit more cooling due to the air flow than the N95 respirator, a nice side benefit, Jacobson said.

Each PAPR is dedicated to a specific person who uses it around coronavirus patients if they have one. The hooded face masks are disposable, but since they’re in such short supply these days, Jacobson declined to wear the hood during the demonstration.

“They’re so precious right now. I can’t use it,” she said.

Final steps

After a COVID-19 test is performed and medical staff leave the patient’s room, the next step is for workers to remove the dirty PPE without exposing themselves to the virus.

Jacobson tore the gown at the shoulders and pulled it off her body, bundling it up while pulling off her gloves to avoid touching the contaminated front side.

Workers must wash hands with soap and water or sanitize them with 60% alcohol sanitizer or greater before removing any of the facial PPE. It’s important to avoid touching the front of an N95 respirator when removing it, “because that’s the dirtiest part of it,” Jacobson said.

Cautious confidence

By taking the necessary precautions, Jacobson feels confident she’s protected around coronavirus patients. She noted that the virus is spreading in the community and health workers could get exposed out there as well, not just in the hospital.

“Everyone was a little tentative at first” when the new virus showed up, she said, “but we know that the N95s have been successful in other places.”

Jacobson is excited to see more widespread testing become available to indicate how many people got the virus without knowing it.

“There’s people that don’t have a lot of symptoms, have mild symptoms, and that’s what the testing is going to show us,” she said.

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