- The recommendations for Minimum Personal Protective Equipment (PPE) depend on several factors:
- Procedure-related factors: AGMP (Aerosol Generating Medical Procedure) or non-AGMP
- Patient-related factors: symptomatic or asymptomatic
- COVID-19 test results: COVID positive, negative or unknown
- Asymptomatic patients undergoing AGMP should be screened for COVID-19 before the procedure, since the PAPR [Powered Air-Purifying Respirator] is required in COVID-19 positive cases.
- The flowchart guiding the decision-making process in minimum PPE can be summarized in the decision-tree available in this link: https://www.entcanada.org/wp-content/uploads/Protocol-for-COVID-and-AGMP-3-iw-mailer.pdf
- Surgical procedures known to be AGMP include airway procedures, intra-nasal and sinus surgery, head and neck mucosal surgery and mastoid surgery.
These statements come from the guideline published by the Canadian Society of Otolaryngology – Head & Neck Surgery (CSO-HNS) Executive Committee. The recommendations are also based on the BC Centre for Disease Control. Below is the description of each PPE level:
Level 1 PPE: Surgical mask + gown + gloves + eye protection (face shield or goggles)
Level 2 PPE: N95 respirator + fluid repellent gown + head cover including neck protection + double gloves + eye protection (face shield or goggles)
Level 3 PPE: Negative pressure room with minimum personnel + powered air-purifying respirator (PAPR) (if available) OR N95 (or N99) mask with second surgical mask and attached face shield or goggles + double fluid repellent gown + head cover including neck protection + double gloves.
Sources:
- Canadian Society of Otolaryngology – Head & Neck Surgery (CSO-HNS) Executive Committee (March 26, 2020). Guidance for Health Care Workers Performing Aerosol Generating Medical Procedures during the COVID-19 Pandemic. https://www.entcanada.org/wp-content/uploads/Protocol-for-COVID-and-AGMP-3-iw-mailer.pdf
- BC Centre for Disease Control (March 06, 2020). Personal Protective Equipment. http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/infection-control/personal-protective-equipment