Infection Control within the COVID-19

Infection Control within the COVID-19
Context Recorded April 27, 2021

Presenter: A.U. Bankaitis Smith, PhD
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– All right, everybody. Once again, welcome to the speechpathology.com webinar
today. Infection Control within the COVID-19 Context. Our presenter today is A.U.
Bankaitis Smith PhD, she is an audiologist and is Vice President at Oaktree Products,
the largest multiline distributor of hearing products and supplies. She provides practice
management solutions to SLP and audiology practitioners and businesses. She has
coauthored textbooks and conducted grant-funded research in the area of infection
control, so she is our expert for this topic. A.U. welcome, and thank you so much for
being here today.
– Hey, thank you so much. Hello everybody, A.U. Bankaitis here. And today’s topic is
infection control, a process that involves the conscious management of the clinical
environment for the very specific purposes of minimizing the spread of disease. And
while infection control standards in patient care settings are well established, this
presentation focuses on elements that are most relevant within the context of
COVID-19. So just some very quick disclosures, basically I am receiving an honorarium
for presenting this course. I do work for a distributor that offers infection control
products and I have received grants in the past when I was doing my research on HIV,
but there are no other relevant nonfinancial relationships to disclose. And this learning
event does not focus on any specific products or services, and there is no external
sponsor for this course.
So, you know, since January of 2020, the Centers for Disease Control, or the CDC, has
published over 200 documents advising healthcare professionals on aspects of
infection control with much of the focus put on three things; masks, hand hygiene, and
disinfecting. So our learning outcomes, not to be surprised, actually revolve around
these very topics so that we feel comfortable recognizing, identifying, and analyzing
infection control products that we need to integrate and use in our clinical settings in
order to keep ourselves, our staff as well as our patients safe from the spread of
disease. Now, speech-language pathologists and audiologists have always been
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expected to practice infection control according to standard precautions. Now,
standard precautions are the minimum established measures applicable to all patients
in any type of setting that are proactively applied before, during, and after patient
appointments in order to control the spread of germs as well as the potential spread of
disease.
Established 25 years ago in 1996, standard precautions address fundamentals like
hand hygiene, Personal Protective Equipment or PPE in the form of masks, gloves, eye
protection, gowns, when and how to disinfect versus sterilized, how to manage
different types of waste among a few other precautions that are pertinent to every
health care provider. So infection control represents a standard of care that is relevant
to speech-language pathology and audiology. And while the fundamentals are not new,
when new disease outbreaks happen a few other things also happen along the way,
which is basically best illustrated by this graph that plots the relationship between
one’s knowledge or skillset on the x-axis as a function of their confidence or their
internal state of feeling certain about something which is plotted on the y-axis.
Now, an expert is somebody who possesses a comprehensive knowledge base or skill
set. So being an authority in a particular area inherently comes with a high internalized
confidence level when talking about that particular subject matter. And that high level
of confidence is proportional to the high level of proficiency that an expert has derived
from their education, their training as well as their experience. Now, there are other very
competent individuals with a lot or a significant degree of knowledge or ability that
unfortunately maintain a disproportionately low level of confidence due to this chronic
self-doubting, which is known as the psychological phenomenon, imposter syndrome.
What I am referring to is actually the complete opposite of imposter syndrome, and it’s
referred to as the Dunning-Krueger effect, which occurs when somebody with a little bit
of knowledge overestimates their command of the topic and they freely offer guidance
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and statements with an overinflated degree of confidence despite the fact that what
they might be saying or sharing may not necessarily be accurate.
And unfortunately this creates a lot of noise that can lead to confusion and
misinformation. So the hope is that the principles that we cover during this
presentation today will empower us to make informed decisions about what infection
control products we need to integrate within our own clinics’ infection control plan. So,
even with established infection control guidelines in place, when new diseases emerge,
whether it was the SARS or the MERS epidemics, Ebola in 2014, or even reports of
small community outbreaks of MRSA, you know, end up being reported, it is natural to
take pause and to think about infection control protocols within our own clinics. Now,
this certainly was the case when COVID-19 emerged in the United States in early 2020
because the virus has significantly impacted the way we practice speech pathology
and audiology in the interim, if not for the long haul.
So this is precisely why it is critical for providers to rely on appropriate authorities for
information. So who should we be listening to? Well, in the United States the CDC is
the primary health protection agency of the people, responsible for the public health
response to COVID-19, offering evidence-based mitigation guidance on the pandemic
on a regular basis. While they are not a regulatory agency, they do maintain certain
authorities to implement mandates as it relates to public health, safety, and security,
and they will do it if necessary and as needed. So from this perspective, staying current
and understanding the CDC recommended guidelines related to COVID-19 is important
Infection control policy however, mainly falls within the jurisdiction of state, county
and/our local public health departments, who ultimately dictate stay at home orders,
they determine whether a business is essential, and they also define business
reopening policies and the like.
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So while most do follow the recommendations that are set forth by the CDC, speech
pathologists and audiologists must adhere to infection control policies of their
individual state, county, and/or local health authorities. And what’s important to realize
is that what you have to do in Ohio may be very different than what you have to do in
Missouri. Now in addition, COVID 19 resurgences may be isolated to different
geographic locations. So infection control recommendations and policies can also
differ from one clinical setting to the next that fall within the same state. So this to me is
extremely important because there’s a tendency for I think providers to ask what are
you doing? What are you doing? And you really need to take a step back and
understand policy is dictated by the individual states, county, and/or local public health
authorities.
So from a practical perspective, you know, how is this all gonna play out? So those of
you who are employed in hospitals or in larger organizations, you tend to have access
to an institutional infection control department or infectious diseases department, who
basically have professionals who are responsible for managing and implementing
policy within your organization or your place of employment. For those of you in private
practice and other settings, infection control policy is going to be dictated by local
public health authorities, and it becomes really important to know how to contact the
local public health department within your individual state and to stay connected with
them, to remain up-to-date about what’s going on in your community with regards to
COVID-19.
If you are not sure how to contact your local public health department, the CDC has
created a Public Health Professional Gateway, which provides links to health
department websites for each of the 50 individual states, the district of Columbia, as
well as other territories. So it’s a wonderful resource that should be listed in your
handout. You can also access the same type of information from the National
Association of County and City Health Officials from their website. At the very top of
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the page, there is a horizontal menu, and if you click the LHD directory, the Local
Health Department directory link, it’s gonna take you to this map and you simply just
click on your state, and then it’s gonna direct you to a list of every health department
within your state along with a designated contact person, and their contact
information, including phone number, address, and in most cases, email.
I also like to throw this slide in here to remind us that having information is great, but
it’s not enough. Communication with staff and colleagues within the work setting
remains critical to make sure that everyone is up to date on what they need to be doing
in order to minimize the spread of disease because this is quite a fluid situation and
things can change fairly quickly. Communication with patients and parents outside of
the work setting is equally as important, so they know not only what to expect when
they come to see you for different services, but to also know what is expected of them
when they’re coming in, basically to seek our services. So speaking of work, you know,
when a new disease emerges it can quickly generate a lot of fear and anxiety because
science doesn’t always have immediate answers and it often changes the entire
meaning of getting ready for work whereby infection control precautions are taken to
an unnecessary extreme, and this is a pretty natural reaction.
So I just would like to take a moment to quickly review some of the important
fundamentals of how the COVID-19 virus spreads because it’ll make us better
appreciate why we need to be doing the specific things that we are being asked to do
in our clinical environments. So, coronavirus disease or COVID-19 is caused by the
SARS-CoV-2 virus, which is a nasty cousin of the virus that causes SARS, or severe
acute respiratory syndrome. It is transmitted from person to person via small to large
respiratory droplets when an infected individual coughs, talks, sings, sneezes, or yells
in a close proximity to others who in turn inhale these viral particles. So this is precisely
why the CDC has told us to socially distance by maintaining a distance of at least six
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feet, which is about two arm lengths from one another and the need for us, for the
general public to cover the nose and the mouth.
Now, in laboratory studies, the virus has been found to live on various surfaces up to
three days, and it is theoretically possible to become infected by touching a
contaminated surface or object and then immediately touching your mouth, your nose,
or your eyes. But having said that the risk is extremely low and the CDC has
consistently stated that the primary means of spreading the virus is by contact
transmission via these respiratory droplets. So now, excuse me, in October of 2020, so
about seven months ago, the CDC mentioned growing evidence that SARS-CoV-2
could spread via airborne exposure under certain circumstances. So to clarify, airborne
transmission occurs when microdroplets which are gonna weigh a lot less than the
large or the small respiratory droplets, I previously mentioned, remain suspended in the
air for longer periods of time resulting in potential exposure beyond six feet apart.
Now, reported cases of potential airborne exposure however involved enclosed spaces
with very poor ventilation where the length of exposure extended 30 minutes or
beyond. So once again, the CDC does remain clear and points out that the primary
spread of SARS-CoV-2 occurs from close droplet contact transmission within about a
three to five foot radius, and that airborne transmission is not a primary route. So while
the flu and COVID-19 have some similarities, COVID-19 spreads much more easily and
causes more serious illnesses in some people because of two key differences between
influenza, which is the virus that causes the flu, and SARS-CoV-2, which is the virus
that causes COVID-19. So first and foremost, we have what’s called incubation period,
which is the range of time that spans from infection to the actual development of
symptoms.
So for the flu, this ranges anywhere from one to four days. And for COVID-19, this can
range anywhere from one to 14 to 16 days. The second difference between these two
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is that viral shedding is very different. Viral shedding happens when a virus has
successfully infected a cell, it has replicated itself and now it’s being actively expelled
into the environment by an individual. So for influenza, viral shedding occurs within a
short time window with the majority of it happening after symptoms have already
developed when a person is already gonna be sick, staying at home, and not being
around other people. In contrast, the time window of viral shedding for COVID-19 is
much longer with a good portion of the viral shedding happening when the infected
person has not yet exhibited symptoms, if any, which is one of the few reasons why
COVID-19 spreads so quickly.
So as of April of 2021, just a few weeks ago, the US is approaching nearly 33 million
COVID-19 cases with just under 600,000 deaths. Although, the first COVID vaccine
was administered on December 14th of 2020. And as of about mid April, about 90
million in the United States have been fully vaccinated, which is about 27% of the
population. An additional 140 million have received at least one dose, which equates to
about 40% of the population, which basically means we’re probably, you know,
approaching close to the high sixties in terms of individuals, at least adults being fully
vaccinated within the next I hope month or so. According to most virologist, about 70%
of the population will require immunization to control the spread of disease. Although,
what you need to understand is this is really a guesstimate and things can certainly
change.
Until immunization reaches a critical threshold is something that still needs to be
determined, so the general public is still expected to continue practicing social
distancing, to wear a mask under certain situations, and what have you. In terms of our
own clinical practices, we may be required to do all the things we have been doing in
terms of infection control including the continued use of masks until further notice. So,
again it’s a very fluid situation, it’s really important for us to make sure that we’re
getting the information from the appropriate sources and to ensure that we are
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following the necessary protocols within our clinical environments in order to keep
everybody safe. So, I wanna talk a little bit about Personal Protective Equipment, or
PPE.
Standard precautions outline the use of PPE, which traditionally includes masks,
gloves, eye protection, disposable gowns, although, given speed and the ease in which
COVID-19 is spread and how it is spread, basically most of the focus has been on
masks. As providers, we as well as our staff as well as most of our patients are
expected to wear masks during all clinical interactions. So, you know, the million dollar
question becomes what are the current mask recommendations for speech-language
pathologists and audiologists. So current recommendations for healthcare workers
generally includes using a 3-ply surgical mask, or an N95 respirator mask, which is
sometimes just referred to as a respirator mask. Which mask to wear basically depends
on the management and treatment procedures that you’re gonna be involved in.
So the big question is when are the N95 masks warranted? N95 masks are reserved for
certain procedures including aerosol generating procedures, or AGPs, that produce
minute particles small enough to penetrate surgical masks and known to increase the
transmission risk of respiratory pathogens. So the N95 respirator masks fit tighter than
surgical masks, and they are specifically designed to reduce exposure to these smaller
particles that are known as aerosols. So, you know, according to the World Health
Organization things like intubation, non-invasive positive pressure ventilation,
tracheotomy, cardiopulmonary resuscitation or CPR, bronchoscopy, and even sputum
induction definitely meet the definition of AGP. Now, the CDC also considers most of
these medical procedures as AGP, although the agency clearly states that there is
neither expert consensus nor sufficient data to create a comprehensive list of AGPs.
So with that in mind, when COVID-19 emerged professional academies and
organizations, including ASHA and AAA responded with their own list of guidance
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documents addressing profession specific AGPs, although it’s important to note that
the actual aerosol generation of these procedures has not been formally quantified. On
the other hand, you know, not having a list of potential AGPs can be frustrating and
cause anxiety and create confusion. So some sort of guidance in my personal opinion I
feel is extremely helpful. So both ASHA and AAA, you know, independently mentioned
that they use of N95 masks during procedures that promote or potentially trigger
coughing, emesis and/or associated with a greater potential for respiratory droplet
exposure are situations when you should be wearing an N95 mask.
A list of speech-language pathology procedures that ASHA has provided and they
include, but they’re not limited to swallowing assessment with or without
instrumentation, dysphagia care and treatment, instrumental assessment of voice via
endoscopy with or without stroboscopy, laryngectomy assessment and management
procedures, assessment and treatment of tracheostomies with or without mechanical
ventilation as well as non-invasive ventilation, such as high flow nasal, oxygen, and
nasal cannulae. For audiologists, N95 masks are indicated during dizziness and
balance assessments, intraoperative monitoring, cerumen management, and perhaps
for, you know, either of us, whether you’re an audiologist or a speech-language
pathologist, any close proximity procedure, you know, where a patient can potentially
sneeze or cough on you due to how we understand that COVID-19 is spread.
So with that in mind, what happens if you can’t get ahold of an N95 mask because
there have been significant mask shortages? Both the CDC and the FDA have
identified the use of respirator masks approved under standards used in other
countries in the event of an N95 mask shortage. So the N95 mask is a mask that meets
US standards, it is evaluated, tested, and approved by the National Institutes of
Occupational Safety and Health Administration, or NIOSH. So NIOSH starts with the
letter N, so it’s easy to remember then an N95 mask is a mask that meets US
standards. In contrast, there are masks that are referred to as KN95 masks. These
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respirator masks meet Chinese standards and they are recognized as a viable
alternative to the N95 mask since the performance standards between the two are
essentially equivalent.
Now, the only real difference between these two masks is the fact that the N95 mask is
certified in the United States, whereas the KN95 mask is certified in China. Now,
unfortunately supply shortages have led to a lot of K95 counterfeiting, so acceptable
KN95 masks include those that are manufactured in China, and they meet the
GB2626-2006 or -2019 performance standards. This is something that is gonna be
printed or is required to be printed on the outside of the actual box. So before you
purchase, you know, ask the supplier if that standard is located somewhere on the box.
If it does not indicate that standard on the box it is not considered a viable alternative
and is most likely a counterfeit.
So unless performing an AGP, a 3-ply surgical mask is sufficient in the clinical
environment. Now, in July of 2020, the CDC issued an update on COVID-19 mask
considerations, recognizing that wearing a 3-ply mask may not be possible or
appropriate in every situation, including individuals who interact or care for those who
have hearing loss and other communication disorders due to the challenges that a
solid face covering can impose on communication. In these situations, the CDC has
identified that the use of a mask with some sort of clear face covering or panel is
completely appropriate and a viable alternative. So we’ve seen an influx of some
masks including clear masks, including the communicator that has a clear panel. We
also have something that’s called the ClearMask, both of those are disposable.
And also a reusable Smile Mask, there are many, many other different masks that are
available and out there, but as a result, this is why we’ve seen an influx in different
types of masks with a clear panel of sorts. Now, while mask tasks with clear panels do
offer access to lips and other visual cues of facial expression that will often facilitate
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speech understanding, we still face what I refer to as a masking dilemma for those
individuals with hearing loss. All masks, including clear panel masks, serve as low pass
filters, and they’re gonna be attenuating the very quiet high-frequency consonants
above 1000 Hertz that are so critical for speech understanding. So these high
frequency sounds are already a challenge for individuals with hearing loss in the
absence of a mask.
So when you throw a mask into the mix, it’s gonna further exacerbate some
communication challenges. There are more than a handful of publications that have
quantified the degree in which different masks, you know, medical masks actually
muffle speech from a distance of six feet. And I thought that the work of Ryan Corey at
the University of Illinois in Champaign. He works at the Augmented Listening Lab,
which they’ve been doing some very interesting research for the past year. And his
group basically looked at the acoustic effects caused by a variety of mask made of
different kinds of fabric and clear panels. And I’m not gonna be showing you all of the
different masks that they tested, but just to give you an idea.
You know, masks can attenuate high-frequency speech from anywhere from 3 to 6 dB,
where you see with the medical masks or the respirator masks to as much as, you
know, 10 to 12 dB, including clear type masks as well as face shields. So the big
takeaway when you start looking at all this research is that while all masks do muffle
speech, the clear paneled ones tend to generate actually the greatest challenge in
terms of attenuating high-frequency speech the most, which are the most important
speech sounds for speech understanding. So if you are gonna be integrating a clear
mask, it’s really important to consider some form of remote microphone technology
when you’re working with your patients if that’s what you choose to do.
This same lab, Dr. Corey’s lab, at the University of Illinois in Champaign and Urbana
has also been doing a lot of research about remote microphone technology. And
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essentially, you know, what they found is that when you implement remote microphone
technology, you basically can preserve some of those high frequency sounds,
understanding that you might have to experiment with the placement of the
microphone. Sometimes placing the microphone in traditional placements are not the
most ideal, so there isn’t a one mask fits all approach. And it’s something that you
have to take on a case by case basis when you are providing services to patients,
particularly those with hearing loss. Before we move on to talking about hand hygiene,
a few things, a few other things that you need to keep in mind in the event we get to
the point where we have another mask shortage, as I’m sure many of you have
probably experienced a mask shortage in the past year.
Now, the CDC has outlined strategies for optimizing mask supply, and there’s
something that’s referred to as extended use and limited reuse of disposable masks.
They sound the same, but these two are very different. Both do involve the practice of
wearing the same disposable mask for multiple encounters with different patients.
Okay. Although, extended use involves wearing the same disposable mask without
removing the mask between patient encounters, whereas limited reuse involves
removing and then reusing the same disposable mask between patients. In addition,
extended use requires masks to be disposed of as soon as they are removed the first
time. Whereas limited reuse allows donning and doffing the same mask up to about
five times. Extended use applies to any mask that must be physically tied in the back
of the head as well as to respirator masks.
Whereas limited reuse applies to any mask that has ear loops or cinches in the back
where you don’t have to physically tie it. The one last thing I will tell you about
extended use, while N95 masks as well as KN95 masks are approved for extended
use, as soon as you are involved in an AGP even if it’s the first patient, you basically
need to dispose of that mask immediately and it’s disqualified from being used beyond
that. Now, as in the spring of 2020 when no face masks were available, the CDC
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basically came out and said that a face shield that covers the entire face as long as it
extends below the chin and on either sides of the face was an acceptable option.
Now, as more data came in the CDC issued a clarification in August of 2020 indicating
that face shields should actually be viewed as a form of eye protection only for the
person wearing it. Currently, there isn’t enough evidence to support the effectiveness
of face shields as an alternative to traditional masks. However, the CDC did outline
expectations reiterating these exceptions, sorry, on December 7th of 2020, stating that
face shields do remain a viable alternative when a provider is interacting with a patient
with hearing loss, as long as it wraps around the sides of the wearers face and extends
below the chin, as well as children under the age of two, as well as others with
developmental or mental handicaps, or any other situation where it may be hazardous.
So while face shields in general are not considered a viable alternative to face mask,
there are exceptions that apply to speech-language pathologists and audiologists in
terms of the populations that we serve. Now, there was a lot to cover about masks and
I promise you hand hygiene is gonna be way more straightforward as well as
disinfecting and we won’t have to cover as much information, but as simple as it
seems hand hygiene has always been recognized as one of the most effective ways to
minimize the spread of disease. And basically ,it’s something that we should be doing
in the clinical setting often. We also need to do it before, during, and after
appointments as indicated, anytime we cough, sneeze, or blow our nose we need to
commence with hand hygiene.
You do it before eating as well as before touching the face or touching a mask. These
are the requirements per the CDC by healthcare officials in clinical settings. Now, per
the CDC, the preferred method of performing hand hygiene in patient care settings is
the use of no-rinse hand degermers. Supply disruptions in alcohol-based hand
sanitizers have resulted in the FDA as well as the CDC to provide flexibility to
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manufacturers and other designated professionals to increase the supply of sanitizers.
But it’s important to note, none endorse homemade solutions. What you need to
integrate in the clinic are basically products that are no-rinse hand degermers with the
active ingredient that is 60% higher ethanol or 70% or higher isopropyl.
And this is where it becomes very important to start reading product labels to ensure
what you’re stocking in your clinic is appropriate ’cause there has been a lot of
garbage out there that would not be appropriate for our clinics. As a result of the
pandemic the CDC has also specifically, you know, issued some recommendations
about patient waiting areas. One of which includes giving patients access to no-rinse
hand degermers in the reception or waiting area as well as in the patient rooms. There
are a lot of free posters and brochures on the Clean Hands Count Campaign,
something that you can order from or download free from the CDC in the event that’s
something that you want to basically promote within your waiting areas or in different
patient rooms.
So a few things about disinfectants. These products do come in many forms, including
canister, individually wrapped, as well as sprays, there are some that actually come in
concentrated forms. And by definition, a disinfectant is a product that’s going to kill
germs. It’s also a product that is going to be regulated by the Environmental Protection
Agency, or the EPA. Okay. Currently there is no test available to confirm whether or not
a disinfectant kills the SARS-CoV-2 virus, which causes COVID-19. However, in
response to the pandemic in March of 2020, the EPA created a list of disinfectants that
they deemed qualified against COVID-19, and this list is what’s referred to as List N.
Now at that time, the EPA qualified a product as effective against COVID-19 if it was an
EPA registered product and they happened to put it on their list, but then also
recognizing that they were having a hard time keeping up with their own list.
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It also included any EPA registered product that was effective in killing the human
coronavirus in general. So that was their qualification. Well, shortly thereafter, the CDC
came out with a general statement indicating that any disinfectant that is EPA
registered, which is key, but also hospital grade is considered effective or qualified
effective against COVID-19. So, when it basically comes to integrating disinfectants
within your clinical environment, it is important for you to make sure you are using a
hospital grade EPA registered disinfectant. And the reason hospital grade is important
is the spectrum of kill is gonna be broader and greater and more specific to the kind of
germs that you see in hospital care settings than you would see at home.
And keep in mind that infection control isn’t about combating one germ, it’s all
encompassing. So this is focusing on COVID-19, but infection control is about killing all
the necessary germs that potentially reside in our clinical environments. So basically a
qualified disinfectant is gonna be any EPA registered hospital grade disinfectant. And
for your convenience, there is a list of qualified disinfectants that are readily used by
speech-language pathologists and audiologists that I put together as a resource
document, it’s located in the Oaktree Products website, but we basically were getting,
and I was getting a lot of inquiries as to what am I supposed to be using? Is this
effective against, you know, qualified effective against COVID-19? And it got really
confusing because the EPA’s List N wasn’t complete and the CDC seemed to be
saying something different.
And at the end of the day, there is a comprehensive list. If you don’t see something on
there, my contact information is located at the end of this presentation, and I’m more
than happy to look that information up for you. In terms of what and how to disinfect,
you know, the touch surfaces as well as the splash surfaces, which refer to all the
horizontal surfaces from tables, everything that you and the patient is basically gonna
be touching within the patient care area and that you intend other patients to reuse are
considered touch and splash surfaces. In terms of how it is really important to read the
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instructions because in order to properly disinfect, you must first prepare the surface
by cleaning it, which can be as simple as wiping it down with a paper towel.
And then you have to make sure that you apply the disinfectant and follow the
instructions appropriately because there’s something called dwell time that you need to
be very cognizant of in order to ensure that when you’re using a product and using it
correctly, you’re doing what you think you are doing. So dwell time basically refers to
how long does the disinfecting product have to stay on a surface wet before you
actually wipe it off. And what’s important to keep in mind is the dwell time of hospital
grade disinfectant products can range anywhere from 30 seconds to 10 minutes, and
it’s really important to pay attention to what you’re purchasing because for some busier
clinics having to wait 10 minutes, you know, for something to sit on a surface before
you can reuse it may not be practical, so be sure you read the instructions.
In terms of supply shortages, again as I mentioned, there are different form factors
available in disinfectants, whether it’s spray, or an individual towelette, or towelettes in
a canister. And there are different brands, so if you don’t have access to whatever
you’re used to, be flexible and switch to another comparable brand. And if you don’t
have access to the form factor that you prefer, most people tend to prefer, you know,
wipes in a canister, switch to something that’s a spray so that you at least have what
you need in your clinic, you know, to disinfect what you need to disinfect in between
patients. Now, also be wary of counterfeit or misleading products that illegally use, you
know, any form of false labeling.
So products meeting the definition of a disinfectant must be registered with the EPA.
And that EPA label basically needs to appear on that product. I have overheard some
individuals within the hearing industry, some manufacturers claim that their product is
actually EPA registered, but it doesn’t appear on their label. And the comment back is,
“Well, we’re in process of updating the label.” That is a huge red flag. In order for any
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product to make claims, it has to have an EPA registered number on the product,
there’s no such thing as we’re working on it, that usually means they don’t have it. The
other thing in terms of considerations regarding disinfecting, disinfectants use different
active ingredients, some are mainly comprised of alcohol, there are others that are
alcohol-free.
When we talk about alcohol-free ones they’re primarily made of a quaternary
ammonium, it’s also called a quat. You might see hydrogen peroxide or citric acid, in
addition, you might see a combination of the two. it’s important to keep in mind that
alcohol in general is gonna chemically denature acrylic, plastic, rubber, or silicone,
which is why many manufacturers recommend the use of alcohol-free disinfectants
when you’re cleaning or when you’re cleaning and then disinfecting components that
are comprised of those materials. Now, I do wanna make one final comment about
gloves. Unless state or local authorities mandate glove use, the indications for glove
use remain consistent with pre-pandemic standard precautions, including, but not
limited to situations where there’s possible contact with blood or bodily fluids, mucus
membranes, non-intact skin, or during procedures that are likely to generate splashes
or sprays of blood or other bodily fluids.
At no time has the CDC recommended or endorse double gloving when providing care
to suspected or confirmed COVID-19 cases. Now, during critical supply shortages of
gloves, and we’re still experiencing critical supply shortages in nitrile gloves, if you’ve
noticed the price of nitrile gloves has skyrocketed quite a bit, they’ve tripled. And the
hope is that as things stabilize that, you know, the prices of nitrile gloves is gonna go
back down to normal where you can buy a box of gloves, you know, 200 gloves for
eight bucks instead of 28 bucks right now. But during critical supply shortages of
medical grade gloves, food grade and industrial grade gloves were recognized as
viable alternatives by the CDC. They feel a little bit differently, but honestly, if you have
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to use a glove and you don’t have access to one, you’re gonna figure out a way to use
it pretty effectively.
So in terms of final thoughts before we open it to some questions or comments, what
have you. Make sure your clinical practice does have a written infection control plan
that specifically outlines how speech-language pathology and audiology procedures
are gonna be executed in a manner that’s consistent with minimizing the spread of
disease. OSHA requires profession specific procedures to be outlined in writing and for
providers, and staff, and students engaged in any degree of clinical care to be trained
on how to execute those procedures. So for those of you who work in larger
institutions, oftentimes in the infectious diseases department says, “We have the
written infection control plan for the entire organization and you don’t have to worry
about it.”
I guarantee you, they do not have written procedures that outline how you will be
performing SLP procedures or audiology procedures, and it’s really important to have,
those are called work practice controls. It’s important to have those work practice
controls developed and integrated within your clinical practice so that everybody is on
the same page. The increased demand of infection control products during the
pandemic did result in major shortages of critical supplies. And it’s really important for
clinical practices to maintain appropriate stock of necessary infection control supplies
including masks, gloves, hospital grade disinfectants as well as alcohol-based hand
degermers. In the event of a shortage, make sure that you work with a reputable
supplier that is aware of the CDC guidelines and isn’t just trying to sell ya, you know,
something that they’re trying to move across the shelf.
And make sure that that supplier can not only answer your questions, but provide you
with viable alternatives that are consistent with the CDC recommendations. On-going
clear communication again is key with all parties, communication with clinical providers
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and staff is critical to ensure that the practices are implementing the necessary
infection control procedures, and adapting where they need to and when they need to.
Also communication with patients is also important, as I mentioned before, so that
patients not only know what to expect when they come to see you, but also what is
expected of them. I have provided some resources and before I get there, some simple
takeaways. Basically, you know, we’ve all knew this before COVID, but really if
somebody, if you or somebody on your staff or a patient doesn’t feel well, stay home,
it’s not worth it.
Make sure you review your infection control plan to ensure that you’re integrating
standard precautions within your clinical practice. You need to make sure you modify
your procedures as needed as new information comes in about COVID or new test
procedures are being offered, you need to reassess and make sure you’re delivering
those services in a manner that’s consistent with minimizing the spread of disease.
Make sure you are purchasing and using appropriate product, beware of counterfeits,
learn the latest from the CDC and educate anyone and everyone, including your staff,
your patients, your students, what have you. Once again, there are resources in terms
of health departments as well as resources I’ve provided regarding COVID-19 that’s
specific to speech-language pathologists, and audiologists.
There are some really good references on aerosol generating procedures or HAPs.
Anything that I covered in terms of, you know, guidelines regarding masks and viable
alternatives, I have provided you also with the references, same with hand hygiene and
disinfectants. Please know that if you ever have any questions about infection control, I
am most easily reached via my email, which is au@oaktreeproducts.com. I do also
have a blog that is just, it’s just a blog, it’s not sponsored by anybody, I just provide
information out there and I do have a section on infection control so please feel free to
check it out. And feel free to check out oaktreeproducts.com as well. So at this time, I
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am gonna open it up for any questions or clarifications that any of you may need in the
area of infection control within the context of COVID-19.
– [Amy] Thank you so much, A.U., I wanted to encourage everybody here we’ve got
about five minutes for questions. And actually A.U., I do see a couple of them here.
One person is asking, do you have any suggestions for how to safely use disinfectant
on toys or therapy materials that a very young child might put in his or her mouth?
– That’s a great question, so I’m gonna say two things because as soon as I heard
toys, it set an alarm. The current recommendation in terms of toys in the waiting room
is for there to be no toys in the waiting room as well as no magazines, et cetera. Those
are the CDC recommendations in terms of things that people touch. Regarding
something that… Regarding things that kids put in the mouth. Ideally, you wanna use
toys that obviously have harder surfaces that are made of plastic or acrylic, and it gets
a bit complicated from the perspective that technically if something is being inserted
into an orifice, it has to be sterilized prior to reuse. I am personally gonna have to take
a… ‘Cause I’m sort of torn to tell you the truth how to answer it. There are high level
disinfectants that can be used that are relatively safe, and I’m more than… Please send
me an email, I don’t know them off the top of my head, but I’m more than happy to
provide you with a list. But just keep in mind, you know, these still are chemicals, so
once you use any kind of disinfectant, it may be necessary to then rewash it with soap
and water and water to make sure that the residual product is removed-
– [Amy] Got it.
– or no longer present.
– [Amy] Thank you. Cheryl is asking if you have any recommendations for clear masks
that don’t fog up.
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– Yeah, that Cheryl, that is a great question because I’m gonna be very honest with
you, every vendor that has come to me with a clear panel anything has told me, “It
doesn’t fog.” Then you put it on and you go-
– [Amy] Yes, it does.
– Really? You know, I guess I must be a dragon because it is. There are anti-fog things
that can be used with masks that have clear panels ’cause it’s going to happen. There
is a new mask however, that recently came out called the bended mask, which I
actually put on and wore for quite some time, and it’s in the relatively short period of
time that I wore it, so I didn’t wear it the whole entire day, but I wore it for a good 20
minutes. It did not fog up, and that’s one of the claims that they’re making. Whether it
fogs up, you know, two hours into the day, three hours into the day, I don’t know. But
out of all the clear panel masks that I have tried, I have seen, I have heard about, that’s
the first one, and we, we do carry it because of that. That I think doesn’t fog without
the need of anti-fogging stuff.
– [Amy] Right, and I put a link. I think I’ve found what you’re talking about, I’ve put a link
up in the chat for our audience up there to take a look at that. And I know I, myself, I
have there are anti-fogging type solutions that I’ve used with scuba diving before, so
maybe if people don’t have one of these new less fog-prone masks, maybe those
would be helpful. I don’t know.
– And the other thing I’ll tell you, you don’t have to buy anti-fog solution if you take a
little bit of dishwashing, liquid dishwashing fluid. I usually have Palmolive, If you take a
little bit on your finger and you basically put it on the inside panel and just rub it in and
then you take a tissue, you wipe it off, and you keep wiping it off and wiping it off until
all of it’s gone. That’s a real cheap anti-fog-
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– [Amy] Wow.
– product.
– [Amy] And someone else here is commenting that she has heard that rubbing a little
toothpaste on the inside of the clear mask helps.
– [A.U.] Oh, and it may help
– [Amy] So, who knew?
– [A.U.] with your own breath.
– [Amy] Right, at least you’ll be minty fresh. All right.
– [A.U.] Exactly.
– [Amy] We have one more question here I’d like to answer, and then we will wrap up.
There’s somebody here saying that he got tested for COVID, and at the time he was
wearing a respiratory N95 mask, and he was asked to remove the mask during the
testing because he was told that the valve in it expels my breath and could put the
doctor in jeopardy. Is that a problem with N95’s?
– I know that the N95 is specifically designed to capture those particles, so I guess that
that’s it could be because really you shouldn’t be wearing an N95 mask unless you are
involved in an AGP. The general public should not be wearing an N95 mask and
outside of the clinical environment, so whether that is true or whether that was… I’ll
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have to look into that, I don’t know how to answer that question ’cause I’ve never been
asked. So I don’t know how to answer that.
– [Amy] Yeah, he says like they gave him a 3-ply mask to put on instead.
– Well, and a 3-ply is fine because again, the CDC made it perfectly clear early on that
they did not want the general public. And what that means is we’re considered general
public when we’re not inside our clinical environments.
– [Amy] Right.
– Right. So they did not want the general public wearing N95 masks. And whether or
not that comment was made because it was true or as some passive aggressive
statement I don’t know, but I’ll have to look into it.
– [Amy] All right. Well, thank you so much, I’m gonna go ahead and wrap it up here as
we are just over the top of the hour. A.U., thanks so much. It’s very reassuring to hear
you talk about all of our measures and what we need to be doing and looking at. And
it’s nice to have the most up-to-date information because that’s so important right
now, so we really appreciate you being here today to share this with us.
– [A.U.] Thank you, great being with all of you.
– [Amy] All right everybody, have a great day. We hope to see you at another webinar
before too long. Bye bye.
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