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Hey everyone, we were provided some important COVID-19 information from HSCL by CLBC, and are passing along to you — check it out:

Hi all, I hope you are all doing well.  I’m sending along a reminder regarding Aerosol Generating Medical Procedures (AGMP) as a courtesy for you to consider passing along to your service providers.  Please see the information below and also attached.  This information is already available on your CLBC website (as mentioned in the link provided at the bottom of this email), however our HSCL team thought it might be valuable to highlight to your providers who may have clients with equipment/procedures that require this level of PPE and procedures in order to prevent transmission of COVID-19.   If you have any questions at all regarding this information, please don’t hesitate to contact your local HSCL Nurse and we will be glad to provide any further support.  Please forward this on to anyone I may have inadvertently missed.    ________________________________________________________________________________________________________________________________________________Many individual’s who are supported in the community by CLBC have Aerosol Generating Procedures (AGMP) performed daily  and in light of COVID 19 special routine precautions are required for infection prevention and control.  HSCL nursing may or may not be involved with these clients.    These recommendations are for COVID negative clients only.  If a client is suspected or confirmed  COVID + then staff would need extra precautions such as  N95 masks for the clients isolation period.    This information would apply to clients that use CPAP or have other Aerosol Generating Procedures (AGMP).  Aerosol Generating Procedures include:

• Bi-level positive Airway Pressure (BIPAP)
• Continuous Positive Airway pressure (CPAP)
• Nebulized medication therapy
• Suctioning airway (deep suctioning and open airway)
• Tracheostomy care

During AGMPs smaller droplets are produced that can remain airborne and travel further distances from the client. Without appropriate PPE these aerosolized droplets could be inhaled, potentially causing infection.  If the client tests positive for COVID then additional precautions would be needed such as N95 masks.   Staff to wear full PPE (Gown, gloves, surgical mask and eye shield) when assisting clients who have AGMPS even if no COVID infection present.  With CPAP the precautions need to be followed for set up and duration of therapy as well as 2 hours after CPAP has stopped. CPAP is a more common AGMP and here are some specific recommendations to take with CPAP use. Environmental controls to take:

• Keep the door to clients room closed when the CPAP is running and for 2 hours after it is stopped
• Use PPE as described above when entering clients room while the CPAP is running and for 2 hours after it has stopped.  (remove PPE after leaving room to prevent spread to rest of house)
• Leave window open during CPAP use if possible. Once CPAP completed and client has left his room then open the window wide and keep the door closed to allow air exchange.
• Clients bedroom door should remain closed during CPAP use and for the 2 hours after if possible.   
• Limit amount of night checks if possible and consider a video monitoring system if approved for use to further reduce need to enter room while CPAP running. (Check with family physician around how often the client should be checked on during the night)

Here is the link to CLBC website that contains the attached document and further information about AGMPs and the appropriate PPE needed:   https://www.communitylivingbc.ca/for-service-providers/information-about-the-novel-coronavirus-covid-19-for-clbc-funded-service-providers/information-for-clbc-service-providers-on-covid-19/   If a client that has an AGMP in place and then contracts COVID then staff need to use N95 masks.  As a proactive measure those caregivers working with clients who have AGMPs should be FIT tested for N95 masks.    

Sincerely,     Becky Rugolo RN BSN

Clinical Practice Educator – Health Services for Community Living Hospital’s and Communities Integrated Services (HCIS) Interior Health Authority 519 Columbia Street, Kamloops. BC V2C 2T8 DIRECT: 250-819-5147 OFFICE: 250-851-7537   FAX: 250-851-7301 EMAIL: becky.rugolo@interiorhealth.cawww.interiorhealth.ca