SHEA Pediatric Leadership Council commentary: Supporting well child care during the coronavirus disease 2019 (COVID-19) pandemic with personal protective equipment in the ambulatory setting

• Published in: Infection control and hospital epidemiology 2021-08, Vol.42 (8), p.985-988
• Main Authors: Schaffzin, Joshua K, Bartlett, Allison H, Logan, Latania K, Guzman-Cottrill, Judith A, Caughell, Carolyn, Ravin, Karen A, Rubin, Lorry G, Kociolek, Larry K, Muller, Martha L, Lake, Jason, Ramirez-Avila, Lynn
• Format: Article
• Language: English
• Subjects: Aerosols; Bronchoscopy; Child; Child Care; Coronaviruses; COVID-19; Disease transmission; Extubation; Eye protection; Humans; Influenza; Inhalers; Intubation; Leadership; Medical supplies; Occupational health; Occupational safety; Pandemics; Pathogens; Patients; Pediatrics; Personal Protective Equipment; Primary care; Protective equipment; Respirators; Risk assessment; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tuberculosis
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2021.240

Studies consistently showed that prolonged exposure, especially during intubation, extubation, and bronchoscopy, was a significant risk factor for patient-to-HCP transmission and that protection from airborne transmission reduced the risk.6,7 This evidence is the rationale for the World Health Organization (WHO) and CDC recommendations to use N95 respirators and AII rooms while performing AGPs on patients with COVID-19.4 A continued challenge during this pandemic is defining an AGP. Past studies have shown that a medical face mask and eye protection are not inferior to N95 respirators when caring for patients with laboratory-confirmed viral respiratory infections including coronaviruses.11 To date, the use of surgical masks has not been identified as a risk factor for healthcare-associated occupational transmission of COVID-19, with no reported increased incidence among providers who perform procedures, such as NG tube placement, or providers who care for children who are coughing or crying. The CDC is equivocal on the subject due to limited evidence and cites a theoretical association of proximity and the result of nebulized treatments.18 The WHO does not include nebulized treatments in its March 19, 2020, infection control guidance19 or its April 6, 2020, PPE use guidance,8 but it does list nebulized treatments in its March 19 HCP exposure risk assessment instrument.20 Many institutions have chosen to not classify nebulized treatments as an AGP due to a lack of evidence. The use of fitted respirators is meant to be bundled in a comprehensive, Occupational Safety and Health Administration (OSHA)–mandated respiratory protection program,24 which few practices are likely to be able to support.