List of high-contact care activities
High-contact care activities should not involve reuse or extended use of PPE. These high-contact resident care activities may increase transfer of pathogens to the hands or clothes of providers:
- Dressing
- Bathing/showering
- Transferring
- Providing hygiene
- Changing linens
- Changing briefs or assisting with toileting
- Device care or use
- Wound care
Gowns
- Reuse or extended use of cloth isolation gowns, which are usually made of polyester-cotton fabrics, may be safely laundered according to routine procedures and reused.
- Extended use of isolation gowns (disposable or cloth) may occur such that the same gown is worn by the same staff member when interacting with more than one resident, if those residents are known to be infected with the same infectious disease, and they are housed in the same location (i.e. COVID-19 residents residing in an isolation cohort).
- This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as C. difficile) among residents.
- If the gown becomes visibly soiled, it must be removed and discarded as per usual practices.
- In the event that no gowns are available, the CDC (accessed May 16, 2020) provides ideas on alternative clothing options that can be considered as a last resort for care of COVID-19 residents as single use. However, none of these options can be considered PPE, since their capability to protect HCP is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.
- Disposable laboratory coats
- Reusable (washable) resident gowns
- Reusable (washable) laboratory coats
- Disposable aprons
- Combinations of pieces of clothing can be considered for activities that may involve body fluids and when there are no gowns available:
- Long sleeve aprons in combination with long sleeve resident gowns or laboratory coats
- Open back gowns with long sleeve resident gowns or laboratory coats
- Sleeve covers in combination with aprons and long sleeve resident gowns or laboratory coats”
The CMS
toolkit (accessed May 16, 2020) gives this recommendation: To increase the supply of personal protective equipment (PPE) at the nursing home level, visit hardware stores, which have large supplies of PPE (coveralls to supplement gowns, eye protection, face shields, shoe covers, masks, and gloves)
Purchasing reusable cloth gowns that can be laundered is likely the most sustainable solution during this shortage. The CDC does have some recommendations on extended use and laundering.