key: cord-0710423-wskmzg7d
authors: Fillingham, Yale A.; Grosso, Matthew J.; Yates, Adolph J.; Austin, Matthew S.
title: Personal Protective Equipment: Current Best Practices for Orthopaedic Teams
date: 2020-04-20
journal: J Arthroplasty
DOI: 10.1016/j.arth.2020.04.046
sha: 0d0c579f9fab68caacb0fba15a6c5aef0c59f068
doc_id: 710423
cord_uid: wskmzg7d

Abstract The COVID-19 pandemic caused by the SARS-CoV-2 virus is challenging healthcare providers across the world. Current best practices for personal protective equipment (PPE) during this time are rapidly evolving and fluid due to the novel and acute nature of the pandemic and the dearth of high-level evidence. Routine infection control practices augmented by airborne precautions are paramount when treating the COVID-19 positive patient. Best practices for PPE use in patients who have unknown COVID-19 status are a highly charged and emotional issue. The variables to be considered include protection of patients and healthcare providers, accuracy and availability of testing, and responsible use of PPE resources. This article also explores the concerns of surgeons regarding possible transmission to their own family members as a result of caring for COVID-19 patients.

(COVID-19) caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. 17

Orthopaedic surgeons are being confronted with the challenges of treating patients who 18 have an extremely contagious disease. In 1735, Benjamin Franklin concisely said, "An 19 ounce of prevention is worth a pound of cure." It is paramount that orthopaedic surgeons 20 understand the rapidly evolving recommendations to achieve viral infection control. This 21 article reviews infection control precautions, use of personal protective equipment (PPE), 22 methods to help optimize PPE supplies during the pandemic, and approaches to limit 23 transmission to the family members of healthcare workers. One must understand that the 24 existing evidence is not high level and the recommendations are fluid secondary to the 25 novel and acute nature of this viral pandemic. 26

The United States Healthcare Infection Control Practices Advisory Committee 28 (HICPAC) and Centers for Disease Control and Prevention (CDC) provide the guidelines 29 that hospitals implement across the country to prevent infectious transmission between 30 patients and healthcare workers. [ decontamination of SARS-CoV-2 on DFFP N95 respirators; as such, their ability to 198 decontaminate similar viruses is used as a proxy. [35] The VHP cycle takes approximately 199 6 to 8 hours and whole-room decontamination systems have been described that allows 200 for decontamination of 700 N95 respirators in a 12x12 foot room. [35] The respirators 201 appear to maintain filtration and tight-fit for approximately 20 to 50 cycles. [35] The 202

UVGI process provides a more rapid cycle of only approximately 30 seconds and 203 maintains filtration and tight-fit for approximately 10 to 20 cycles but does not allow for 204 as many DFFP N95 respirators in a single cycle and "shadowing" can lead to incomplete 205 decontamination. [35] The use of moist heat takes approximately 30 minutes depending 206 on the temperature and humidity but it most rapidly degrades the filtration and tight-fit 207 with respirators only withstanding 1 to 5 cycles. [35] Although decontamination with 208 VHP, UVGI or moist heat demonstrates promising results not all manufacturers and 209 models of the respirators have been tested under these conditions. Therefore, the CDC 210 and N95DECON provide recommendations for the type of decontamination and number 211 of cycles for specific manufacturers and models of a DFFP N95 respirator. [34, 35] 

Control Recommendations for Patients with Suspected or Confirmed Coronavirus 268 Disease 2019 (COVID-19) in Healthcare Settings

Treatment Expert Group for C. Clinical Characteristics of Coronavirus Disease

What we do when a COVID-19 patient needs 281 an operation: operating room preparation and guidance

Preparing to Perform Trauma and COVID-19 pandemic: a review of operating room outbreak response measures in a large 288 tertiary hospital in Singapore

Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People's 291 Republic of China

Control Recommendations for Patients with Suspected or Confirmed Coronavirus 295 Disease 2019 (COVID-19) in Healthcare Settings

Considerations for Optimum Surgeon

Nosocomial Transmission of Emerging Viruses via 302

Personal protection system Stryker Instrum Memo 2020

Zimmer Biomet's Personal Protection System PPE 312 Communcation 2020

COVID-19 transmission through asymptomatic carriers is a 315 challenge to containment. Influenza Other Respir Viruses

Clinical characteristics and outcomes of patients undergoing 318 surgeries during the incubation period of COVID-19 infection. EClinicalMedicine

False-Negative Results of

Real-Time Reverse-Transcriptase Polymerase Chain Reaction for Severe Acute 322

Respiratory Syndrome Coronavirus 2: Role of Deep-Learning-Based CT Diagnosis and 323 Insights from Two Cases

Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta

Clinical infectious diseases : an official publication of the Infectious Diseases 335

Strategies for Optimizing the Supply of 346 N95 Respirators

A scientific consortium for data-driven study of N95 filtering 352 facepiece respirator decontamination