Listening Tube for Audiologists with Hearing Loss – guest post by Laura Schauer, AuD

Posted on August 6, 2020 by AU Bankaitis

As a graduate audiology student with cochlear implants, I struggled with performing listening checks on hearing aids because traditional listening tubes route signals through the ear canal. I tried attaching tubing to FM systems and remote microphones but listening to hearing aids via a second amplifier made it difficult to perform subjective assessments with acceptable accuracy. Eventually I settled with plugging a lapel microphone into the DAI port of my processor and using double belled tubing to couple the lapel microphone to the hearing aid receiver. This worked up until I switched to a new cochlear implant processor that no longer supported this configuration.

Out of frustration, I started contacting earmold manufacturers to share my story, hoping to find someone willing to move the sound bore from the ear canal to one of the microphones of my cochlear implants. This is how I connected with Michael Harvest of Pacific Coast Laboratories. We worked together on creating a solution for me which resulted in what we both called the very first “Laura Listening Tube”. I was floored by the sound quality and how easy it attached to my processor. This configuration provides more natural sound as the listening tube does not re-amplify the hearing aid’s output like other listening tube solutions I’ve tried.

After sharing my experience on some Facebook pages, other students and audiologists with hearing loss reached out and worked with Michael at Pacific Coast Laboratories to create a customized listening tube. As a result, several different listening tubes inspired by the first “Laura listening tube” are now available for different cochlear implants and BTE hearing aids. If one is not currently available for your specific device, you can send in an impression of your cochlear implant or BTE using a non-functioning replica provide by the device manufacturer.

Ordering Your Own Listening Tube

  1. Send an email to Leigh of Pacific Coast Laboratories at Leigh@shoppcl.com. Be sure to include the following:
    1. In the subject line of the email, type in “Listening Tube for Cochlear Implant/Hearing Aid”.
    2. In your email, include the specific model of your cochlear implant or hearing aid.
  2. If an impression has already been made for this model, you just place an order for the listening tube.
  3. If an impression has not been previously made for the specific model of your cochlear implant or hearing aid, contact your local manufacturer’s representative to explain the need to make an impression of your cochlear implant or hearing aid to pursue a customized listening tube. The manufacturer should be able to send you a non-functioning replica to make the impression.
  4. Payment required at the time of order; call (510) 351-2770 to relay credit card information.

Making an Impression

  1. Using earmold impression material and the non-functioning replica, cover the entire panel where your hearing device’s microphones sit and cover the microphone(s) with impression material. Then cover the sides of the device connected to the already covered microphone panel, but do not add impression material all the way around the device (see picture below). Like a normal earmold impression, you do not want gaps or air pockets in contact with the non-functioning replica. Let impression material harden fully.
  2. Gently peel impression material off the replica. Mark the microphone’s indentations with a light-colored permanent marker and be sure to tell Michael that these marks indicate the microphones. If your hearing device only uses the second microphone in certain situations, please indicate which microphone you would like the listening tube sound bore to go to.
  3. Make a second impression except this time include impression material all the way around the replica (making a tube). Let the impression material cure. Make a cut on the underside of the replica and remove the replica.
  4. Send both impressions to Michael.
  5. While not required, it could be beneficial to email pictures of your hearing device with and without the impression material on it, so that Michael has an indication of size/direction of your hearing device.

About the Guest Blogger

Laura Schauer, AuD is an audiologist with a passion for improving the quality of life for those with hearing loss and spreading awareness about the profession. She received her AuD from the University of Northern Colorado in May of 2020. She has recently relocated to California from her home state of Colorado to work in a private audiology practice. For more information, contact her directly at laura.schauer44@yahoo.com.

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ClearMask Clarification

Posted on June 25, 2020 by AU Bankaitis

The ClearMask is comprised of a rectangular piece of anti-fog plastic film with two individual foam pieces (see A and B in the figure on the right) adhered on the inside portion of the mask. The thinner foam piece (A) is the top of the mask and has a nose cutout (C). The more substantial foam piece (B) is the bottom and designed to rest the chin. The EZ-Adjuster version of the ClearMask has a continuous elastic strap (D) that loops at the top and bottom with the EZ-Adjuster located on the bottom strap (E). The top and bottom straps are designed to be placed over the head and positioned above and below the ears respectively. The EZ-Adjuster is then used to adjust the mask by pushing inward to tighten the straps.

Since the availability of this product, it makes sense to share the four most frequently asked questions about the ClearMask to offer clarification to those who have ordered or are planning to order the product from Oaktree Products.

How do I don the ClearMask?

  1. Perform hand hygiene
  2. Peel protective layer on outward-facing side of mask
  3. Position the mask in your hand with the foam facing inward and the nose cutout on top, towards your fingertips. Bring the mask toward your face, such that your nose fits into the nose cutout and your chin rests on the bottom foam piece
  4. With the other hand, take both the top and bottom straps and placed them over your head. The bottom strap sits at the base of the head, below the ears. The top strap rests higher at the back of the head, above the ears (do not crisscross straps).
  5. Use the EZ-Adjuster in the back to adjust the mask by pushing inward to tighten or pulling outward to loosen the straps.

The 20-second video below will quickly show you how to put the mask on. Click HERE for written instructions.

Is it reusable?

As with any mask intended for use in clinical settings, the ClearMask is designed and labeled for single-use only and is not intended to be reused. With critical mask shortages due to COVID-19, the FDA and CDC have issued some interim flexibility about masks in general, indicating extended or limited reuse of masks in some cases (see Masking Dilemma). Check with public health authorities within your state and/or institutional authorities regarding extended or limited reuse of masks.

Does it fog up?

The plastic shield has an anti-fog coating that minimizes fogging when the wearer is speaking or breathing.

Does this mask come in different sizes?

The ClearMask is one size and designed to fit adults’ faces.

For more information or to place an order for the ClearMask (and all your other supply needs including immittance/OAE tips, electrodes, E-A-RLinks, probe tubes, newborn hearing screening supplies), contact Oaktree Products toll free 800.347.1960 and ask for customer service, or via email at otp@oaktreeproducts.com.

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New Clear Mask Called ClearMask™ Available

Posted on June 22, 2020 by AU Bankaitis

Wearing a mask is necessary to minimize the spread of COVID-19. Unfortunately, solid masks covering the mouth introduce significant obstacles for the nearly 40 million Americans with hearing loss.  Depending on the type (e.g. medical vs N95), masks attenuate high frequency speech sounds by 3dB to as much as 12 dB.1 Furthermore, solid face masks hide facial cues, including lipreading which facilitates speech comprehension.2 Basic communication strategies like speaking slowly and reducing ambient noise remain key however, integrating personal protective equipment (PPE) maximizing full-face view becomes a more important issue in the audiology clinic. Procedural masks with clear windows offer visual access of the mouth although window masks are also subject to limitations including insufficient window size and fogging of the window.3,4 The new EZ-Adjuster style ClearMask™ addresses these issues and represents a promising PPE solution for audiologists and other providers/staff to consider.

Designed to block aerosols, fluids and sprays, ClearMask™ is the first fully transparent face mask offering full view of the face. The primary integrated barrier is an anti-fog and anti-glare plastic. It straps over the head and adjusted at the back of the head using the EZ-Adjuster for a customized fit. Since the mask is secured at the back of the head, it eliminates the problems hearing aid or cochlear implant wearers experience when using masks with ear loops, including frustration of losing devices when doffing masks. The patent-pending design optimizes comfort and breathability, while providing the protection a mask is intended to provide. Conditional FDA approval positions ClearMask™ as the preferred clear mask of choice in the clinical setting. Contact Oaktree Products toll free 800.347.1960 or via email at otp@oaktreeproducts.com.

Additional Reminders:

  1. Aerosol generating procedures require the use of N95 or KN95 masks with eye protection; for a basic review, see the previous blog post Masking Dilemma.
  2. 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.5
  3. ClearMask™ is also available in the classic tie-on style; Oaktree Products only offers the EZ-Adjuster Style (item# CM24).
  4. Refer to ClearMask™ EZ-Adjuster Instructions for Use for a quick but important video on how to properly use the EZ-Adjuster; the ClearMask™ does close around the face when the EZ-Adjuster is properly used.

References

  1. Goldin A., Weinstein B., and Shiman N (2020). How Do Medical Masks Degrade Speech Reception? Available: https://www.hearingreview.com/hearing-loss/health-wellness/how-do-medical-masks-degrade-speech-reception
  2. ASHA (2020). ASHA to CDC: Recognize Need for Clear Face Masks, Flexible Communication Methods to Protect Those with Hearing and Other Communication Disorders. Available: https://www.asha.org/News/2020/ASHA-to-CDC–Recognize-Need-for-Clear-Face-Masks,-Flexible-Communication-Methods-to-Protect-Those-With-Hearing-and-Other-Communication-Disorders/
  3. Spangler C. (2020). Considerations of Face Shields as a Return to School Option. Available: https://cdn.ymaws.com/www.acialliance.org/resource/resmgr/files/aci_paper_face_shields1.pdf
  4. American Cochlear Implant Alliance (2020). ACI Alliance Published “Considerations of Face Shields as a Return To School Option:. Available: https://www.acialliance.org/news/512538/ACI-Alliance-Publishes-Consideration-of-Face-Shields-as-a-Return-to-School-Option.htm
  5. CDC (2020). 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
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Maximize Distance During Otoscopy

Posted on May 29, 2020 by AU Bankaitis

Otoscopy is an essential and routine procedure performed by audiologists that inherently places the provider’s face in close proximity to the patient’s face. With the ongoing emphasis of social distancing during the COVID-19 pandemic, invest in a video otoscope if for no other reason than to maximize the distance between you and you patient during otoscopy. The most popular video otoscope has been the Firefly Digital Video Otoscope, and easy-to-use and affordable product that made my list of “Favorite Things” way back in 2012.

Starting now and through the month of June 2020, Oaktree Products is offering FREE ground shipping in the US when purchasing any Firefly Digital Video Otoscopes (coupon code MAX). Three versions are available:

Great tool for telepractice too! If you have questions, contact customer service at 800.347.1960 or via email at otp@oaktreeproducts.com.

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Masking Dilemma

Posted on May 28, 2020 by AU Bankaitis

Implemented in 1996, Standard Precautions represent the minimum precautions applicable to all patients in any type of setting, and include guidelines on the use of masks.1 Unfortunately, the speed and ease in which the COVID-19 virus spreads among people has resulted in the need for providers, staff, and patients to wear masks during clinical interactions, at least in the interim. This is certainly uncharted territory, and when you add the current critical supply shortages of masks to the mix, audiologist may find themselves experiencing a new “masking dilemma.” This post is intended to assist with making informed decisions about respirator and surgical masks use within the context of the audiology clinic.

When To Use N95 Masks:

Aerosol generating procedures (AGP) are associated with potentially higher concentrations of infectious respiratory droplets than coughing and sneezing.2 AGP procedures audiologists may be associated with include (but are not limited to) activity in the surgical suite,3 cerumen management, and vestibular testing.4 The guidance issued by the Center for Disease Control and Prevention (CDC) recommends the use of a N95 respirator (mask) during AGP procedures because this mask is tight-fitting and designed to reduce exposure to small particle aerosols.5

Viable Option During N95 Respirator Shortage:

With critical shortages of N95 masks, both the CDC and the FDA have identified the use of respirators (masks) approved under standards used in other countries similar to NIOSH-approved N95 respirators is acceptable.6,7  Given this issued interim guidance, the use of KN95 masks manufactured in China meeting GB2626-2006 or GB2626-2019 performance standards are considered suitable alternatives.8 NOTE: safety glasses, goggles, or a face shield are also indicated to protect the eyes from exposure to droplet nuclei during AGP.

N95 Mask vs KN95 Mask Meeting GB2626-2006 Performance Standards:

The difference between an N95 and a KN95 mask is where the product is certified. The N95 mask is evaluated, tested and approved by the National Institute for Occupational Safety and Health (NIOSH) and meets the US Standard for respirator masks.4 The KN95 mask meets Chinese standards for respirator masks. At the onset of the COVID-19 pandemic, heightened concerns over counterfeiting of imported respirator products resulted in NIOSH and other federal agencies to identify imported products meeting similar standards of NIOSH-approved N95 masks.6-8 KN95 masks manufactured in China with GB2626-2006 or GB2626-2019 performance standards labeling are essentially equivalent to N95 standards as both are capable of capturing capture 95% of small airborne particles (0.3 micron).9

Medical Masks

Medical masks (also called surgical or procedure masks) are fluid-resistant masks cleared by the FDA that provide protection against large droplets, splashes, or sprays of bodily or other hazardous fluids, and designed to protect others from the wearer’s respiratory emissions.4 Surgical masks affix to the head with either ties or elastic ear hooks. These masks do not provide a seal and are not necessarily adequate for use during AGC.10

Extended Use vs Limited Reuse of Masks

In response mask shortages during COVID-19 pandemic, the CDC outlined strategies for optimizing supply including extended and limited reuse of masks. Both involve the practice of wearing the same mask for multiple encounters with different patients. Extended use involves wearing the same mask without removing the mask between patient encounters whereas limited reuse involves removing and reusing the same mask between patients.11,12

N95 and KN95 Masks

Extended use of respirator masks (K95 and KN95 masks) is favored over reuse because it involves less touching of the respirator and therefore less risk of contact transmission.6,12 While extended use increases the period of time the same masks can be used, respirator masks must be discarded following use during AGP; if contaminated with blood, respiratory or nasal secretions or other bodily fluids from patients; and following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.12

If public health or institutional authorities allow reuse, respirator masks must be discarded according to extended use recommendations. Furthermore, respirator masks should be stored in a designated area when not in use and hand hygiene performed before and after touching or adjusting the respirator.12 Currently, there is no way of determining the maximum number of safe reuses for respirator masks with data suggesting reuses to no more than five per device.13

Surgical Masks

Not all surgical masks are suitable for reuse. According to the CDC, extended use applies to all tie-on masks whereas masks with elastic ear hooks may be more suitable for reuse.11

Face Shields

As mentioned in an earlier blog post, per the CDC, 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.14 NIOSH has also offered recommended guidance for providers to consider using a face shield when feasible.12

References

  1. Bankaitis, A.U. (2018). Infection Control.  In: B. Taylor (Ed). Audiology Practice Management, 3rd edition. Thieme Medical Publishers, New York: NY
  2. CDC (2020). Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19_ in Healthcare Settings. Updated May 18, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
  3. AAA (2020). Surgical Monitoring Safety: COVID-19 and Beyond. Posted May 19, 2020. Available: https://www.audiology.org/news/surgical-monitoring-safety-covid-19-and-beyond
  4. AAA (2020). Vestibular Testing Safety: COVID-19 and Beyond. posted May 19, 2020. Available: https://www.audiology.org/news/vestibular-testing-safety-covid-19-and-beyond
  5. CDC Infographic. Understanding the Difference. Accessed May 28, 2020. Available: https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf
  6. CDC (2020). Strategies for Optimizing the Supply of N95 Respirators. Posted April 22, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html
  7. FDA. Non-NIOSH Approved Respiratory Emergency Use Authorization (EUA). Available: https://www.fda.gov/media/136664/download
  8. NIOSH (2020). NPPTL Respirator Assessments to Support the COVID-19 Response. Updated May 13, 2020. Available: https://www.cdc.gov/niosh/npptl/respirators/testing/ NonNIOSH.html
  9. 3M (2020). Technical Bulletin: Comparison of FFP2, KN95, and N95 and Other Filternig Facepiece Respirator Classes. Accessed: May 26, 2020. Available: https://multimedia.3m.com/mws/media/1791500O/comparison-ffp2-kn95-n95-filtering-facepiece-respirator-classes-tb.pdf
  10. WHO (2014). Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care. Annex A, Respiratory Protection. Available: https://www.ncbi.nlm.nh.gov/books/NBK214348/
  11. CDC (2020). Strategies for Optimizing the Supply of Facemasks. Posted March 17, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
  12. NIOSH (2020). Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Setting. Posted March 27, 2020. Available: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
  13. Bergman, M.S., D.J. Viscusi, Z. Zhuang, A.J. Palmiero, J.B. Powell, and R.E. Shaffer (2012). Impact of multiple consecutive donnings on filtering facepiece respirator fit. American Journal of Infection Control 40(4): 375-380.
  14. A.U. Bankaitis (2020). Infection Control Anxiety: Acceptable Alternatives to Critical Supplies. Posted May 4, 2020. Available: https://aubankaitis.com/infection-control-anxiety/

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Patient and Parent Anxiety During COVID-19

Posted on May 19, 2020 by AU Bankaitis

More than a handful of colleagues have asked for advice on how to respond to questions posed by patients or parents about properly cleaning hearing aids in the midst of COVID-19. It is perfectly normal to feel anxiety during these uncertain times. Anxiety is an emotional signal alerting us to pay attention and to be aware of things that may be potentially harmful. These questions reflect a need for our patients or the parents of our patients to feel safe, certain, and in control. Audiologists have the opportunity to offer guidance and assurance by offering information and practical answers. For your convenience, a sample communication has been provided below; modify verbiage were necessary to make it applicable to your practice.

Sample Communication To Patients/Parents about Cleaning Hearing Aids

In response to the COVID-19 outbreak, patients/parents have been asking about how to best clean and disinfect hearing aid/earmold surfaces.  Based on what is currently known about COVID-19, spread from person-to-person of this virus happens among close contact (within 6 feet) when someone sneezes or coughs.  Per the Centers for Disease Control and Prevention (CDC), the transmission of the virus causing COVID-19 to individuals as a result of touching surfaces contaminated with the virus has not been documented.1  The CDC has not issued any specific guidelines beyond general cleaning and disinfecting household surfaces beyond traditional house hold cleaners and disinfectants available over-the-counter. Based on this general information, the recommendations for hearing aid maintenance at home stay the same.

Cleaning hearing aids every day is important for many reason, including the fact that the ear is a dark, warm, moist place where bacterial and other germs, some good and some bad, like to grow. It is important to always clean and then disinfect your hearing aids before putting them in the ear. AudioWipes is a product specifically designed to clean hearing aids. While this product cannot make claims about killing germs, the ingredient used to saturated the towelettes is an EPA registered disinfectant (EPA Reg. No. 1839-94-71111) that kills germs, including the specific virus that causes COVID-19.  

Hospital grade disinfectants for home use is not recommended; these are potent, toxic chemicals that should be reserved for controlled environments, such as clinics and hospitals, and mainly reserved for hard surfaces like table and counter tops, and other common touch surfaces in healthcare environments. Hearing aids and earmolds are intended to reside in the ears and, when not in use, in an appropriate storage container. For home use, AudioWipes is sufficient for your hearing aid and/or earmold care.

Food for Thought:

Modify the above information as needed and use it to:

  • share with teachers in school settings who may need to handle hearings aids, earmolds, or shareable remote microphones but don’t have access to disinfectant wipes;
  • formulate a relevant and helpful blog post for your practice website;
  • create an educational video showing how to clean hearing aids and to use what your audiologists recommends;
  • generate more traffic to your practice’s e-shop;
  • bring traffic to your e-shop where Audio Wipes are available for purchase;
  • create an educational piece for patients to read while in designated reception/waiting areas and patient rooms, making sure your clinic has some stock available for immediate sale;
  • use the product in your office and counsel patients to purchase product from you to properly clean their hearing aids, earmolds, and anything else they may stick in or near their ears (Smartphones, earphones, custom ear plugs).

If you do not have an e-shop or if you prefer not to maintain stock of product in your office, refer patients to buy AudioWipes from a reputable website like AudiologySupplies.com to purchase AudioWipes in a 30 wipe pouch or a canister of 160 wipes at retail price. Audio Wipes are available from Oaktree Products for your practice in mini-canisters, large canisters, pouch of 30 wipes, box of 100 singles, and box of 30 singles.

REFERENCES

CDC (March 28, 2020). Cleaning and Disinfecting for Households. Accessed April 17, 2020. Available online: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fcleaning-disinfection.html

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Skip the Kit: Quick Access to Products is Key

Posted on May 14, 2020 by AU Bankaitis

As business resumes, demand for key infection control products outpaces supply. While many are looking for the same things, the majority only need one or two particular items. Rather than offering an infection control kit at this time, Oaktree Products created temporary waitlist item numbers as a stop-gap to get you what your individual practice currently needs as quickly as possible. Here’s how it works:   

GLOVES:

Given current supply unpredictability, use our available GLOVE WAITLIST item numbers when placing glove orders. As we receive ANY gloves, whether latex, vinyl or nitrile, we will ship whatever arrives first, in the size indicated, as quickly as possible. Keep in mind, when a gloved hand touches a surface, it may become contaminated and cross-contaminate anything else it contacts. Refrain from adjusting masks or face shields with gloved hands1 and remember that the use of gloves alone is not a substitute for hand hygiene.2

MASKS:

If you are in need of cloth or clear masks, the CDC has stated when no masks are available, a face shield (without also wearing a mask) is an option.3 Currently, face shields are easier to keep in stock. The quickest way to get masks from Oaktree Products is to use available CLOTH MASK WAITLIST and/or CLEAR MASK WAITLIST item numbers. As we receive ANY cloth masks, we will ship whatever brand arrives first as quickly as possible. Similarly, as we receive any clear masks, we will ship whatever brand arrives first as quickly as possible.

DISINFECTANTS:

Since the release of the EPA’s List N of qualified disinfectants,4  the CDC announced ANY EPA-registered, hospital-grade disinfectant is appropriate for use against COVID-19 in the healthcare setting.5  For your convenience, the Oaktree Products website provides an updated list of qualified disinfectants we sell that meet these guidelines.  

As the supply of qualified disinfectants in the form of wipes in a canister remain unstable, the fastest way to get disinfectant wipes from Oaktree Products is to use the WIPES-WAITLIST item number. As we receive ANY qualified disinfectant wipe, we will ship whatever arrives first as quickly as possible.  Another option is to ask for any in-stock qualified disinfectant sprays as these products are currently more readily available.  

FINAL THOUGHTS:

During these unprecedented supply shortages, Oaktree Products is working hard to source and acquire stock of critical products, and get it to you as quickly as possible without bundling it in a one-size-must-fit-all infection control kit. So, for now, order the critical items you still need using our WAITLIST item numbers and skip the kit.

Check out the IN STOCK IC & PPE of the Oaktree Products website for updates on available stock; for the most accurate status, contact us at 800.347.1960 and ask for customer service.

REFERENCES

  1. CDC. Using Personal Protective Equipment (PPE). Updated April 3, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
  2. CDC. Strategies for Optimizing the Supply of Disposable Medical Gloves. Updated April 30, 2020. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/gloves.html
  3. 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
  4. 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
  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
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Infection Control Anxiety: Acceptable Alternatives to Critical Supplies

Posted on May 4, 2020 by AU Bankaitis

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

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