Isis Lamphier, MPH, CIC, is a board-certified infection preventionist. Currently, she is the Manager of Infection Prevention and Control at Tampa, Fla.-based Moffitt Cancer Center. Her passion for infection prevention and control was ignited after successfully attaining a Bachelor of Science in Health Education and a Master of Public Health in Epidemiology from the University of Florida. Prior to her current role in the hospital setting, Lamphier gained valuable experience working at both the county health department and a long-term care facility.
Healthcare Purchasing News had the opportunity to speak with Lamphier about all things personal protective equipment (PPE), including the current state of COVID and education when it comes to reusing PPE.
What is happening right now with COVID?
We are still seeing an increase in COVID, and the trend is we're seeing consistent cases of COVID. It hasn't declined as much as the public might think. The only thing that has decreased is our active detecting at the beginning of the pandemic. We saw a lot of testing centers that offer testing and now testing isn't as readily available. The primary method that individuals are getting tested is through home test or if they go to the hospital instead.
I could get a COVID PCR through a hospital, so we're still seeing COVID cases happening as well as a mix of respiratory viruses as well. We're seeing flu AB, RSV, and some of our other viruses, like parent influenza as well.
We are seeing an increase of flu and it’s important that if a patient tests positive for COVID or any respiratory virus that they wear a surgical mask. If they have to go out to the public or if they have to go to a hospital or clinic visit, it is very important that they wear one because we know our respiratory viruses and COVID are spread through droplet particles and that way they can protect other healthcare workers or other individuals around them.
We haven't had any PPE shortages recently that I'm aware of, especially in the state of Florida, and one thing that I think the PPE shortages affected when we started the pandemic is we were reusing PPE. That's something that I've been working a lot to educate the staff on, is that we don't need to reuse PPE since we're not in a shortage so we don't need to reuse our single use surgical mask or our single use KN95s because it's also important that we have a clean mask on as well when we're taking care of patients or if we're putting it on ourselves if we're sick.
What I have seen instead is a shortage of medical supplies or medical equipment that are non-PPE. I know right now we were notified that there was a shortage of our temperature-sensing foley catheters, and we've also had some alcohol wipes that we use in the hospital that we had a shortage of. So we're seeing a shortage instead of other items due to manufacturing delays, but I haven't seen any PPE shortages, and I think the reason why we haven't seen a shortage of PPE is because so many individuals during the pandemic started making PPE and their companies previously didn't make PPE and now they do.
Has education on not reusing PPE been a challenge for you?
Yes, definitely. Staff tend to think it's wasteful to use it only after one use. For example, let's say a nurse is to go into a room where a patient is in isolation for respiratory virus. They have to put on that PPE, and they were so used to wearing that one mask that whole day and that's not the recommendation—they should put on a clean mask every time they go into that isolation room.
They think it's wasteful because they were used to prolonged use of PPE and wearing that one surgical mask that whole day or unfortunately sometimes even a week, they would wear that one surgical mask. But once they exit that patient’s isolation room, they can remove that mask and then don a new one if they need to go to another isolation room or wear it for another purpose.
What are some other best practices surrounding PPE?
Another best practice regarding PPE is to ensure that you perform hand hygiene before putting on PPE, and that's because we don't want to contaminate the PPE that we're putting on, or even the packaging. If you're reaching into a glove box, you don't want to contaminate all those gloves for other people.
That's something that's very important that we educate our staff on and we try to do education at my facility during orientation and also continuous education that any time we put on PPE, we should perform hand hygiene as well as when we remove it, so we don't contaminate ourselves or contaminate that clean PPE when we're putting it on.
And again, keeping PPE single use if that's its intent. If the instructions for use say that it is a single use item, ensuring that we're doing single use. Also, making sure that we establish a clean environment, it's important where we store our PPE in our healthcare facilities. Sometimes we'll see nurses that might put a bunch of gloves in their pockets or on their cart and remove them out of the glove box and just leave them in like a caddy or something similar in order to make it easier to put on that PPE. It's very important that we have that PPE in a clean environment and keep it in its packaging because, if not, we could contaminate the PPE further by taking it out of its box and putting it somewhere else just for ease of use and convenience.
What are some important aspects that individuals employed at hospitals should be aware of when evaluating purchasing PPE?
It's important that, depending on the PPE, it is certified. For example, N95 masks should be the NIOSH [National Institute for Occupational Safety and Health] approved ones through OSHA [Occupational Safety and Health Administration].
Maybe someone that's ordering might not be familiar with the different levels of protection. Level 1 is less protective than a Level 3 gown or mask, and depending on its intended use, is what you should look for.
Some surgical masks should be splash resistant; that's an added feature in certain surgical masks. In level, the surgical mask and those masks would be beneficial for someone that is at risk for splashes—for example, technicians and sterile processing.
It's important that you're evaluating what the healthcare worker is doing because that will determine what level of PPE they need. My biggest recommendation for anyone that is in supply chain and purchasing is that they're working with their infection prevention departments as well as occupational health in order to protect their healthcare workers. These workers should put in their input as well as nursing on the level that's needed and the type of PPE that's needed because we want to make sure that they're protected from pathogens and splashes and body fluids.
Also, we want to make sure that it's comfortable as well. Sometimes we might want to offset costs and choose something that might be more beneficial to our organization’s costs, but we also want to make sure it's good quality and that it is not going to break because when things start breaking, you'll need to get more, and so that changes costs.
