As anesthesia professionals are at an increased risk of exposure in caring for patients diagnosed with COVID-19, the American Association of Nurse Anesthetists (AANA), the American Society of Anesthesiologists (ASA), and Anesthesia Patient Safety Foundation (APSF) issued a joint statement on the best use of personal protective equipment (PPE) during the pandemic.
AANA, ASA and APSF believe that the safety of anesthesia professionals is of utmost importance in developing policies related to PPE, they state. When anesthesia professionals will be at an increased risk of exposure, such as caring for patients with diagnosed COVID-19 infection and/or when aerosolization of body fluids may occur, N95 masks or powered air purifying respirators (PAPRs) provide the highest level of protection.
Anesthesia professionals should use properly fitted N95 masks or PAPRs (for those who are not fit-tested, have facial hair, or fail N95 fit-testing) when caring for patients with known or suspected COVID-19 and when performing intubation or other procedures that may generate aerosolized small particles. Surgical face masks protect against COVID-19 droplet transmission but do not protect against aerosolized small particles.
The Centers for Disease Control and Prevention (CDC) has developed a detailed table that describes surgical facemask, N95 mask, and PAPR use, based upon distance from a patient with suspected or known COVID-19 and the use of source control (i.e., masking of symptomatic patients). Criteria for proper donning and doffing, mask disposal (e.g., contaminated with bodily fluids), and additional precautions (e.g., use of cleanable face shields) should be established using CDC recommendations and proper hand hygiene should be reinforced.
The ASA, AANA, and APSF recognize that population density, hospital size and resources, location, staffing models and access to supply chains present unique challenges to hospitals and clinics. They endorse the thoughtful evolution of the Guidelines developed by the CDC, which provide for guidance and flexibility to hospitals’ and clinics’ staffs across the nation. If a facility has a shortage of N95 masks, temporary mitigation plans based on current CDC recommendations should be enacted. These plans should include case-by-case reviews of the potential of patients and procedures to generate aerosolized particles, as well as assessments of respiratory pathogen characteristics (e.g., routes of transmission, prevalence of disease in the region, infection attack rate, and severity of illness) and local conditions (e.g., number of disposable N95 mask available, current respirator usage rate, and success of other PPE conservation strategies). Healthcare facilities may wish to implement extended use and/or limited reuse practices before shortages are observed so that adequate supplies are available during times of peak need and demand.
