The single most important thing we can do as ED providers in this COVID pandemic is to protect ourselves, our colleagues, our patients, our families and our friends against transmission of the virus; and there is no higher risk of transmission that during the resuscitation of a sick COVID patient. In this podcast we speak with a world expert on PPE, Dr. Laurie Mazurik about protecting against transmission of the virusbefore, during和一种fter你的转变。我们不仅讨论了从头保护到鞋类的所有PPE的细节，但我们也给出了同样重要的非PPE保护的提示。我们触及PPE保护策略，因为我们用耗材斗争，为您提供底线，并讨论核心原则受保护的代码蓝色…
This podcast was recorded on March 20th, 2020 and the information within is accurate up to this date only, as the COVID pandemic evolves and new data emerges. The blog post will be updated regularly and we are working on a weekly update via theEM案件通讯which will be replicated on the EM Cases website under ‘COVID-19’ in the navigation bar.
Protecting against COVID-19 transmission before your shift, during your shift and after your shift
改编自净化清单by Lauren Westafer
Remove jewelry, watches
If you have long hair, tie it up in a tight bun
Obtain clean scrubs at the hospital if possible
Place all your work gear – stethoscope, pens, phone, clipboard etc in a freezer zip lock bag
Take an extra large freezer bag or garbage bag to place your clothes into
Take with you disinfectant wipes (or if they have run out in your community mix 25mL of bleech in 750mL of water in a spray bottle so that you can wipe down your car steering wheel, gear shift and seat).
提示采访和擦拭低风险Covid患者：For isolated low risk patients, consider not entering the patient room initially; rather do a电话采访。Then make an assessment plan. When obtaining swabs,站在患者身边和后面，并要求他们将面具放在鼻子下方，如果他们觉得他们会打喷嚏或咳嗽，请转向你。
Personal protective Equipment (PPE)
Transmission of COVID-19 is approximately 3 x more likely to occur at the ED than elsewhere and certain procedures like intubation create the highest risk. You need to learn about PPE, and how to use it properly. Yours and the lives of others depends on it.
Eat in designated areas, and bring your own snacks and food
只穿PPE下的磨砂膏;No jewelry, watches, or street clothes under PPE.
避免可能在可能的情况下产生气溶胶;Nebulizers, BVM,CPAP,BiPAP, High Flow Nasal Cannula and bronchoscopy.
如何正确洗手：The COVID Scrub
礼服一种re graded in fluid resistance from: Level 1 (~no resistance to fluids), to Level 4 which is impervious. They also vary in coverage, with some covering only the front of you, like an apron with sleeves.
A washable, (reusable) Level 2 gown is the minimum requirement for high risk procedures
March 28th update：一些透明礼服是2级礼服。每个人都应该在本地确认并阅读一种ll the specs在他们的礼服上确认这一点。
大多数透明礼服是1级礼服，这在对Covid 19的情况下不适当保护;一种washable, (reusable) Level 2 gown is the minimum requirement for high risk procedures.
Hoods are not currently recommended and are hard to find. They provide additional head and neck cover.
Tie your gown as high on your neck as possible
After doffing, clean your neck with hand sanitizer or soap and water (and take a shower if there may have been a significant breach during the procedure)
Boot or shoe covers目前尚未推荐谁。您将在中国使用高病毒负荷区域使用，即Covid 19病房，ICU等。
Rubber shoes目前尚未推荐谁。Wear closed shoes, and always leave them at work.
Nitrile gloves come in 2 lengths extended and regular. Reserve the extended if for some reason the others don’t cover the cuff of your gown. Should you wear 1 pair or 2 pairs? Well that depends if you have to wear PPE all shift, you may end up washing your hands so much that your skin breaks down. Some people may choose to wear two pairs, disposing of the outer pair between patients and washing the under pair the same way they would their hands. Check with your IPAC to decide what’s best for you.
N95 respirators安装有SWPF ~ 10,并提供airbo吗rne protection, stopping particles as small as ~0.3 microns. Although COVID 19 is droplet spread (~10 microns), aerosol generating procedures such as BVM, BiPAP, CPAP, HFNC, Bronchoscopy and Intubation, will create smaller droplet nuclei, which are suspended in the air for a period of time. This puts you at greater risk of inhaling and contracting the virus.
动力净化呼吸器provide the highest level of respiratory protection (SWPF 1000+) and are not currently recommended and extremely difficult to obtain in Canada.
这需要实践，并且最好在一个监督下完成指定伙伴or safety officer who uses a清单为了确保您在没有防护的情况下正确执行此操作。
The only hard rules to remember for PPE donning/doffing:
1. Mask/N95 should always be FIRST ON & LAST OFF. 2. Take your dirtiest PPE off first.
If you have a room with an anteroom，除非你的礼服或手套严重弄脏，否则你在旁边的房间里。在患者的房间里脱离污染的泪花板或手套，距离它们至少2米。然后在前厅拍摄你的面具/ n95。
如果你没有赌注房，take everything off except your N95/Mask (and hair cover if you have one) off in the room (at least 2 m/ 6ft from the patient). Take your N95/Mask off outside the patient’s room as it is your most important defence against respiratory infection when you are exposed to the patient.
The risk of transmission is related to the viral load and duration of exposure
PPE.for high risk procedures that generate aerosols
The current recommendation in Canada for performing an aerosol generating procedure is: N95, eye or face protection, gown and gloves.
No head or neck protection is recommended at present. From doing informal glo-germ tests (blow a small amount of florescent powder at someone in PPE before they doff from ~ 1 m away,) we found contamination of neck, ears and hair. In the Middle East where they intubate the much more lethal corona virus MERS, part of their protocol after removing PPE it to always wash their face and neck.