The content on this site is for general information purposes only. This information is not intended to substitute for any professional medical or other professional advice or the direction of workplace clinical directors. Always seek the advice of your qualified healthcare provider with any questions that you may have regarding a medical condition. We have gathered information from various sources. The information comes from each of the sources and inclusion here should not imply SEIU-UHW’s endorsement of its contents. While we have made every effort to provide you with the most accurate information that is available to us now, you should visit the sites below for the most up to date information. 

All healthcare workers are on the frontlines of the fight against COVID-19. But respiratory care practitioners and respiratory therapists occupy a very special role in this fight. We are lung specialists directly confronting a respiratory disease that spreads with alarming speed and intensity. We are literally saving the lives of our patients every hour while putting ourselves at great risk. And every day we are discovering crucial practices for treating and healing our patients.

In SEIU-UHW, we are committed to ensuring that all RCPs and RTs stay safe and healthy on the job and have a platform to communicate with each other. The more we’re able to share our experiences and knowledge during this epidemic, the better positioned we’ll be to heal our patients.

Below you will find the most current guidance and resources to help RCPs and RTs guide our state and nation through this epidemic.

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INTERNATIONAL GUIDELINES
FEDERAL GUIDELINES
STATE GUIDELINES

 

INTERNATIONAL/GLOBAL GUIDELINES

World Health Organization (WHO)

The WHO declared COVID-19 to be a Public Health Emergency of International Concern on January 30. It provides rolling updates on COVID-19 for the public, most recently announcing a Healthy at Home campaign. To date, there are no updates specifically directed at Respiratory Therapists.

 

FEDERAL/NATIONAL GUIDELINES

Centers for Disease Control (CDC)

The CDC has published several guidance documents relevant to RCPs and other frontline workers caring for COVID-19 patients. According to the CDC, these include:

  • Using PPE when caring for COVID-19 Patients (4/3/2020): Factsheet on when and what PPE is necessary, how to don and doff, limitations, and proper care maintenance, and disposal.
  • Interim Infection Prevention and Control (4/1/2020)Key concepts in the guidance include limiting the ability of germs to enter the facility, isolating symptomatic patients as soon as possible, and protecting healthcare personnel through an emphasis on hand hygiene, physical barriers at triage, housing COVID-19 patients separately, limiting staff who are caring for them, prioritizing respirators, AIIR for aerosol generating procedures, and optimizing use of PPE to extend supplies.
  • Decontamination and Reuse of Filtering Faceplate Respirators (FFR) (3/31/2020)This document summarizes the research about decontaminating FFR before reuse, identifying ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat as the most promising methods.  The guidance also recommends a strategy of providing workers caring for COVID-19 patients a minimum of five masks to be used in rotation (i.e., providing a minimum of five days between mask usage).  The recommendations build on an Emergency Use Authorization from the FDA on March 28 approving the use of the “Battelle Decontamination System” to decontaminate N95 or N95-equivalent respirators.

 

American Association for Respiratory Care (AARC)

Multiple Patients Per Ventilator (3/26/2020) — also signed by Society of Critical Care Medicine, American Society of Anesthesiologists, Anesthesia Patient Safety Foundation, American Association of Critical-Care Nurses, American College of Chest Physicians.

The AARC’s guidance advises against sharing mechanical ventilators among multiple patients with COVID-19 because it cannot be done safely with current equipment, potentially leading to worse outcomes for all patients.  The AARC’s full statement can be found here.

The accompanying AARC Guidance Document includes general advice to maintain infectious disease precautions and weighs in on when or whether to consider high-flow nasal oxygen or non-invasive ventilation. According to the AARC, in the case of mechanical ventilation, Respiratory Therapists should follow ARDSnet recommendations.

 

National Board for Respiratory Care (NBRC)

The NBRC page redirects visitors to WHO, CDC, and AARC guidance.

 

American College of Chest Physicians (CHEST)

Surviving Sepsis Campaign (3/27/2020)These CHEST guidelines regarding the management of critically ill adults with COVID-19, derived from a study published in Critical Care Medicine, address several issues, including the proper application of aerosol generating procedures, resuscitation in COVID-19 patients, the use of norepinephrine in cases of persistent shock with evidence of cardiac dysfunction, application of supplemental oxygen, and adherence to customary ARDS care  for mechanically ventilated COVID-19 patients.

 

Society of Critical Care Medicine (SCCM)

SCCM guidelines, developed with the European Society of intensive Care medicine and published in the journal Critical Care Medicine, include 54 statements on COVID-19 treatment from a panel of 36 experts from 12 countries. This is a summary of best practices and strong recommendations from SCCM:

SCCM Best practices

  1. Recommend that healthcare workers use fitted respirator masks, as opposed to surgical or medical masks, when performing aerosol-generating procedures on COVID-19 patients in the ICU. (Infection Control).
  2. Recommend that negative pressure room be used when performing aerosol-generating procedures on COVID-19 patients in the ICU. (Infection Control).
  3. Recommend that endotracheal intubation of patients be performed by worker most experienced with airway management. (Infection Control).
  4. Recommend close monitoring of COVID-19 adults receiving NIPPV or HFNC for worsening respiratory status and early intubation in controlled setting if worsening occurs (Ventilation).

SCCM Strong Recommendations

  1. Recommend against using hydroxyethyl starches for acute resuscitation of adults with COVID-19 and shock (Hemodynamics).
  2. Recommend against using dopamine for adults with COVID-19 and shock if norepinephrine is available
  3. Suggest starting supplemental oxygen for adults if peripheral oxygen saturation is <92%, and recommend doing so if <90% (Ventilation).
  4. Recommend that peripheral oxygen saturation be maintained at no higher than 96% for COVID-19 adults with acute hypoxemic respiratory failure on oxygen (Ventilation).
  5. Recommend using low tidal volume ventilation over higher tidal volumes in mechanically ventilated adults with COVID-19 and ARDS (Ventilation).
  6. Recommend targeting plateau pressures of <30 cm H2O for mechanically ventilated adults with COVID-19 and ARDS (Ventilation).
  7. Suggest using higher PEEP strategy over lower for mechanically ventilated adults with COVID-19 and moderate to severe ARDS.  For PEEP > 10cm H2O, monitor for barotrauma (Ventilation).
  8. Recommend against using incremental PEEP if recruitment maneuvers are used (Ventilation).

 

Asthma and Allergy Foundation of America

According to AAFA, as of mid-March, there is little evidence that patients with asthma are at increased risk of contracting COVID-19 or experiencing more severe outcomes from the disease.  However, the AAFA notes that the worsening of asthma has been associated with other coronaviruses.

Regarding control of asthma, the AAFA recommends:

  • Inhaled and oral steroid are not a risk for people with asthma.
  • Nasal cortical sprays release fewer particles than sneezing and so do not have to be avoided
  • If using quick relief such as albuterol, using an inhaler is preferable to a nebulizer. When using a nebulizer, limit the number of people in a room or use alone

 

The American College of Allergy, Asthma and Immunology (ACAAI) also offers recommendations to cope with a potential shortage of inhalers.

  • Don’t panic. Check if inhaler still has medicine.
  • Can use expired inhalers as they are partially effective.
  • There are alternatives to metered dose inhalers that can be prescribed by your provider.
  • Don’t overuse current inhaler.

 

STATE/LOCAL GUIDELINES

California Society for Respiratory Care (CSRC)

The CSRC page redirects visitors to other organizations.

 

California Thoracic Society (CTS)

Nothing current. Check CTS guidance updates.

 

Respiratory Care Board of California (RCB)

No guidance in particular. Here is a list of FAQ from RCB of CA (4/1/2020).

 

UCSF Medical Center

Check their guidance updates.

 

National Institute for Occupational Safety and Health (NIOSH) / The National Personal Protective Technology Laboratory (NPPTL)

In response to several requests received by NIOSH, the NPPTL has developed assessment plans to test respirators that:

 

The Society for Healthcare Epidemiology of America (SHEA)

SHEA directs visitors to WHO and CDC guidance on infection prevention and control and hygiene.