Infection Control Anxiety: Acceptable Alternatives to Critical Supplies

updated May 6, 2020 with updates appearing in bold italics (originally posted May 4, 2020)

As preparations are made to reopen clinical practices, many may be experiencing a new source of anxiety about workplace safety due to delayed access to key infection control supplies. With critical shortages of face masks, disinfectants, and alcohol-based hand sanitizers, here are acceptable alternatives per the Centers for Disease Control and Prevention (CDC):

CLOTH/CLEAR MASKS:

In a recent communication to federal, state, and local public health officials, including leaders responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings, the CDC outlined specific strategies for optimizing the supply of face masks based on evidence provided by the Division of Viral Diseases within the National Center for Immunization and Respiratory Disease (NCIRD). When no face masks are available, the use of a face shield that covers the entire front (extending to the chin or below) and sides of the face with no face mask is an option.¹

For audiologists waiting for either cloth or clear masks, face shields have been easier to source, are more readily available, and more likely to be in stock for immediate purchase. In addition, face shields are comfortable to wear than cloth or clear masks. They may be reused indefinitely (if the material is not torn or worn out, creating gaps between the shield and the forehead headpiece,)² and easily cleaned and disinfected. Unlike some masks, face shields offer the ability to more effectively communicate with patients because the clear shield allows patients to see lips and full facial expressions without the need for face shield removal.

 DISINFECTANTS:

The Environmental Protection Agency (EPA) recently released a list of disinfectants qualified for use against SARS-CoV-2, the specific coronavirus that causes COVID-19, referred to as List N.³ In addition, the agency outlined other criteria to help identify qualified, EPA-registered disinfectants that do not appear on List N.⁴  Many products commonly used in audiology clinics have been deemed qualified but not all; for your convenience, a list of disinfectants sold by Oaktree Products meeting EPA’s criteria is available to assist audiologists in making informed product purchase decisions quickly and confidently. The CDC issued its own recommendation (most recently updated on April 13, 2020) stating that any EPA registered hospital-grade disinfectant (regardless if appearing on List N) is appropriate for SARS-CoV-2 in healthcare settings.⁵

For audiologists waiting for delivery of product, keep in mind that qualified disinfectants are available in different forms ranging from individually wrapped single wipes to sprays and gallon solutions. If the preferred form of disinfectant (e.g. canister of wipes) is not available, make the switch to something that is available. For instance, if the canister of disinfectant towelettes typically used in your office is not available, consider switching to a spray disinfectant, even if it means switching to another brand. Also, as suppliers try to source product, new brands are being identified so be sure to ask if there are any new brands available qualified against SARS-CoV-2. Per the CDC, one major step in getting your clinic ready to reopen is to stock up on necessary supplies now and on a regular basis.⁶ Ask your supplier what is currently in stock and buy when you can.

ALCOHOL-BASED HAND SANITIZERS:

Supply disruptions in alcohol-based hand sanitizers have resulted in the Food and Drug Administration (FDA) to provide flexibility to manufacturers and other designated professionals to increase the supply of sanitizers, none of which endorse home-made solutions.^7,8 While the use of alcohol-based hand sanitizers is the preferred method of hand hygiene in healthcare settings,⁹ the use of soap and water meets infection control standards and represents an acceptable form of hand hygiene.  For audiologists waiting for alcohol-based hand sanitizers, plain or anti-microbial soap is acceptable.¹⁰

RECAP:

1. When no face masks are available, the use of a face shield that covers the entire front (extending to the chin or below) and sides of the face with no face mask is an option;¹
2. Refer to List N³ and other EPA-established criteria⁴ to identify disinfectants qualified effective against SARS-CoV-2; NOTE: per the CDC, the use of ANY hospital-grade, EPA-registered disinfectant is also acceptable and effective against SARS-CoV-2⁵;
3. Consider different brand and/or form of disinfectant (e.g. spray instead of canister of towelette) to acquire needed supplies more readily in stock;
4. Plain or anti-microbial soap is an effective alternative to alcohol-based hand-sanitizers.⁹

NOTE: The information is based on current CDC recommendations which are supported by evidence and science. It is critical for audiologists to follow state, county, and local mandates, including the direction provided by the public health department of your individual state. Be sure you know how contact the health department of your individual state and stay connected with them along with other state, county and local authorities to keep informed about COVID-19 in your community.

For a summary of this blog post via video, click IC ALTERNATIVES VIDEO SUMMARY.

REFERENCES

1. CDC. Strategies for Optimizing the Supply of Facemaks. Published online March 17, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
2. Perencevich EN, Diekema DJ & Edmond MB. Moving Personal Protective Equipment Into the Community: Face Shields and Containment of COVID-19 AMA. Published online April 29, 2020. Available: https://jamanetwork.com/journals/jama/fullarticle/2765525
3. EPA. List N: Disinfectants For Use Against SARS-CoV-2. Accessed April 10, 2020. Available: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
4. Bankaitis, A.U. Qualified Disinfectants Against COVID-19. Published online April 14, 2020. Available: https://aubankaitis.com/qualified-disinfectants-for-covid-19/
5. CDC. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Updated April 13, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
6. CDC. Get Your Clinic Ready for Coronavirus Diseasze 2019 (COVID-19). Updated March 11, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinic-preparedness.html
7. FDA. Guidance for Industry: Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (COVID-19). Published online March 2020. Available: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-temporary-policy-preparation-certain-alcohol-based-hand-sanitizer-products-during
8. FDA. Policy for Temporary Compounding of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency. Published March 2020. Available: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/policy-temporary-compounding-certain-alcohol-based-hand-sanitizer-products-during-public-health
9. CDC. Hand Hygiene Guidance. Updated January 20, 2020. Available: https://www.cdc.gov/handhygiene/providers/guideline.html
10. CDC. Hand Hygiene. Published March 1, 2016. Available: https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-hygiene.html