Kettering Health Network’s Guidance of PPE for Kettering Physician Network and Other Outpatient Areas

Kettering Health Network follows CDC and OSHA guidance on the recommended infection control and Personal Protective Equipment utilization during the COVID-19 pandemic. The following PPE Guidelines apply to KPN outpatient offices and other ambulatory areas.

Overview: Caring for a patient with COVID-19 Symptoms

• Take the patient directly back to an exam room. Do not place them in the waiting room.
• Limit the number of providers and staff entering the room of a person under investigation for COVID-19 or similar symptoms.
• Provider and direct care staff PPE includes N95, goggles/face shield, gown, and gloves.
• Clean each exam room accordingly to policy. 

Patients and Visitors

Screening:

• All patients and visitors will be screened for fever, cough, and respiratory symptoms upon entrance to the office/facility. 
• When possible, patients who screen positive should be sent home to have a Telehealth visit instead of the in-person appointment.  Visitors who screen positive will be asked to leave.

Masks:

• All patients and their visitors are required to wear a mask and are encouraged to wear a cloth mask from home. 
• If they do not have one, then a mask will be provided during the screening process.
• Exceptions may be noted for pediatric patients.

Waiting rooms:

• Patients being seen for symptoms of COVID-19 should not be placed in a waiting room with other patients or visitors.  They should immediately be escorted into an exam room upon arrival. 

Non-Direct Care Staff

Masks:

• All non-direct care staff are required to wear a mask.
• Masks may be:      
  • Isolation mask
  • Laundered cloth mask in alignment with uniform policy where indicated.
• If a non-direct care staff member states they cannot wear a mask, direct them to contact Employee Health.  
• When eating/drinking or if alone in a fully enclosed office/room, face masks may be removed and stored in an envelope or brown paper bag. 

Providers and Direct Care Staff

Standard Isolation Masks:

• All providers and direct care staff are required to wear a standard isolation face mask unless in a non-clinical area.
  •  If a provider or staff member state they cannot wear a standard isolation mask, direct them to contact Employee Health.  
  • When eating/drinking or if alone in a fully enclosed office/room, face masks may be removed and stored in an envelope or brown paper bag. 

N95 Masks:

• Prior to receiving an N95 the provider or clinical staff member must complete the HealthStream learning module, “N95 Self Fit and Trouble Shooting”.
  • A fit seal check should be performed before each use
  • If you need a refresher, watch the video on how to self-check a N95 Respirator: https://www.youtube.com/watch?v=BnXN1OD6VRw 
• One (1) mask per caregiver per day according to usage guidelines unless replacement is needed due to visible contamination or mask becomes moist.
  • Use of N95 masks will be monitored and assigned daily as needed based on patient symptoms and clinical judgment of providers. 
  • Any clinician performing higher risk procedures should wear an N95, gown, goggle/face shield, and gloves for the following considerations but not limited to:
    • Any type of oropharyngeal exam.
    • Specimen collection such as a flu test.
    • Any type of throat culture.
    • Patients being seen for symptoms of COVID-19 such as fever, cough and or shortness of breath.
• Once you place on the mask, it can be worn in multiple patient rooms.
  • Remove during eating/drinking
    • Doff your mask by the straps, grasp mask on inside, fold in half with inside of mask facing outward, place in brown paper bag or envelope when not in use. Video: https://youtu.be/k7b_nhTtN4M
• Not everyone is able to wear an N95 due to medical conditions that may be made worse when breathing through a respirator. Please contact Employee Health if you have a health condition that would limit your ability to wear an N95.
• KPN Practice Managers will log and report the number of N95 masks currently in the practice on the KPN Daily Covid-19 Inventory List or designated survey tool so we can determine burn rate based on your usage for the day/week.
• All efforts should be made to limit or designate specific clinical staff for use of these masks when possible.
• N95 masks will be collected at the end of the day and the log will be initialed for placement of the N95 mask in the bin for reprocessing or properly disposed of if soiled or damaged.
• Daily review of the log will be done by the Practice Manager or designee for appropriate usage of the N95 mask.

Face shields or goggles:

• Face shields and goggles are provided and available to all clinical staff for use as an added safety measure when caring for patients with COVID-19 symptoms (wear with mask, gown, and gloves).
• After wearing goggles or face shield, disinfect with a KPN or KHN approved disinfectant after each use and at the end of the day.
  • Shields and goggles will be stored inside or hanging in the assigned area. Note, if a face shield is worn, a standard isolation face mask or N95 must always be worn as well under the shield. 
• Front office staff are not required to wear a face shield or goggles but may do so as an additional safety measure. 
• Face shields will be dispensed to KPN practices this week.  Each shield is to be assigned to a direct patient care giver and labeled. 

How to obtain N95 and Goggles/ Face Shields

Leader:

• Goggles
  • Initial order to be based on a week supply based on daily total number of providers and direct care employees. Subsequent orders to be based on usage (burn rate).
    • For example: If you have a total 10 employees a day, order a total of 50 (10 employees x 5 days).
  • KPN has received their goggles.
  • Goggles are multi-use and can be cleaned via KHN or KPN approved cleaner and re-used by different employees. Do NOT discard unless broken.

• Face Shields
  • KPN has already placed the orders for face shields.
  • Face shields are multi-use and can be cleaned via KHN or KPN approved cleaner and re-used by different employees. Do NOT discard unless broken.

• N95
  • Initial order should be based on a week supply based on daily total number of providers and direct care employee. Subsequent orders will be based on usage (burn rate).
    • For example: If you have a total 10 employees a day, order a total of 50 (10 employees x 5 days).
    • KPN has already placed orders for N95 masks for KPN practices.
  • Obtain a collection container for end of shift N95 collection. 
    • A collection bin of a red biohazard bag + with the N95 Collection Sign attached.
    • When approximately 100 N95s are collected, contact Daniels/Stericycle to pick up. Close the box and seal with the provided shipping label.
  • Keep N95s in a secure location and distribute to direct care employees as indicated above with associated tracking log
    • Employees need to sign that they received the N95 and initial when returned to collection bin. See here.
  • Practice Managers will reconcile daily the inventory for N95s and report any additional needs to KPN clinical leadership and the associated reason.