New Extended-Use and Re-Use PPE Guidelines

New Extended-Use and Re-Use PPE Guidelines

We appreciate your flexibility as we continue to assess and revise our personal protective equipment (PPE) recommendations during the continued evolution of COVID-19.

While we currently have enough PPE to keep our caregivers safe, these resources are finite. As an organization, Cleveland Clinic is more positively positioned than other health systems and hospitals when it comes to our PPE supply. However, it’s also important that we continue to preserve our PPE supply to protect our caregivers for the long-term since we anticipate this pandemic will go on for a while.

We are using the best available information to direct how appropriate PPE is provided for all caregivers as we prepare for a potential surge of patients with COVID-19.  As part of this, we have a plan to manage our PPE resources in a predictable manner that keeps our caregivers’ safety at the center of our focus.

To continue keeping you safe and being responsible stewards of our PPE, we are implementing the following guidelines in cohort units of patients with COVID-19. Cohort units are hospital locations designated to house only lab-confirmed COVID-19 patients.

Extended-use 

  • Caregivers working in cohort units of patients with COVID-19 may practice extended use for face masks and eye protection.
  • These caregivers will wear the same face mask and eye protection during repeated close contact with different patients, without removing the face mask and eye protection between patient encounters.

Limited re-use

  • Caregivers working in COVID-19 cohort units or with select high-risk populations regardless of COVID-19 status  (e.g. those performing procedures with aerosolized risk, respiratory therapists, emergency physicians, anesthesia providers, surgeons and proceduralists performing procedures at high risk for aerosolization) may practice limited re-use for N95 masks.
  • These caregivers would use the same N95 mask for multiple encounters with different patients, then remove the mask after each encounter.
  • Eye protection (goggles or face shields) can also be re-used with cleaning and disinfection every time eye protection is removed. 

Guidance for Extended-use or Limited Re-use PPE

Face mask (ear loop/surgical) extended-use guidelines

  • Follow proper donning sequence for the face mask.
  • During your shift, wear the face mask until the mask becomes:
    • Contaminated with respiratory secretions
    • Damp, soiled or damaged
  • If performing an aerosol generating procedure:
    • Remove eye protection and disinfect.
    • Discard face mask.
    • Then, don the N95 plus cleaned eye protection.
  • Follow proper doffing sequence.

N95 mask extended-use guidelines

  • Caregivers who wear an N95 mask must remove makeup before donning the mask. This includes foundation, tinted moisturizers, lipstick, lip gloss, etc.
  • Assigned one mask per day per caregiver
  • Extend use of N95 while in cohort unit as tolerated
  • Follow proper donning sequence for the N95 mask. (e.g. gown, mask, eye protection and gloves)
  • During your shift, wear N95 mask until mask becomes:
    • Contaminated with respiratory secretions
    • Damp, soiled or damaged
    • Integrity of mask is compromised (e.g. loose straps, failed seal check)
  • Follow proper doffing sequence. (See limited re-use guidelines if N95 mask will be stored and re-used.)

N95 mask limited re-use guidelines

Refer to page two of this donning and doffing sequence flyer for details.

  • Caregivers who wear an N95 mask must remove makeup before donning the mask. This includes foundation, tinted moisturizers, lipstick, lip gloss, etc.
  • Label storage bag with user’s name.
  • Follow proper donning sequence for first use of the shift.
  • During your shift, discard mask if any of the following occur, and obtain a new N95 mask:
    • Contamination with respiratory secretions
    • Obvious soilage or damage to mask
  • Donning process will need additional steps:
    • Perform hand hygiene and don clean gloves.
    • Don N95 mask and perform seal check.
    • Doff gloves and perform hand hygiene.
    • Don gown and new clean gloves.
    • Don clean eye protection.
  • N95 mask storage between use:
    • Loop strap of N95 mask onto handle of storage bag to keep straps from contamination.
    • Keep your N95 mask (in storage bag) with you for the day.
  • End of shift:

Eye protection extended-use or limited re-use guidelines

  • Follow proper donning sequence for eye protection.
  • During your shift, use disinfectant wipes to thoroughly clean all surfaces of the eye protection:
    • If contaminated with respiratory secretions or obvious soilage
    • After any aerosol generating procedure
    • With each removal
  • Follow proper doffing sequence at end of shift.

Refer to this donning and doffing sequence flyer.

Your health and well-being is our top priority. Thank you for the compassionate care you continue to provide our patients every day as we navigate this difficult situation together.

Please reach out to your manager if you have PPE-related questions or concerns.

Daily CEO Update

Daily CEO Update

Fellow Caregivers,

You have always pushed forward to solve the problems of our patients. This innovative culture is flourishing and visible in our teams’ creative responses to the pandemic. We observed this last week when visiting the intensive care unit.

We have also innovated through the use of technology.  A month ago, less than 10% of patient visits were virtual. Within a few weeks, more than 75% of visits are now virtual. The remainder are necessary in-person appointments supplemented by virtual care and phone calls.

We are reminding everyone to stay SAFE:  Six Away From Everyone, or the amount of feet for social distancing.

Caregivers who provide direct patient care in Ohio and Florida and wish to shelter away from high-risk family members can apply for our housing program. Cleveland Clinic covers the cost of the room at several regional housing sites.

Surge planning throughout the enterprise continues.  Our planning is based on several models to predict the worst case scenario for peak patient activity.

In Florida, we are working on plans to increase capacity up to a 250% expansion of beds. In Ohio, we have plans to significantly increase our system’s nursing floor and ICU beds. We care for patients with COVID-19 at the main campus, Akron General, and Fairview, Hillcrest and Marymount hospitals.

Starting today, Marymount Hospital will transfer all current inpatients who do not have COVID-19 to either South Pointe or Lutheran hospitals. Marymount will only care for patients with the disease, or those who are suspected to have it, for the foreseeable future. This temporary plan will allow our health system to manage the treatment process and staffing needs anticipated with this pandemic.

Please know that you are appreciated.  Beth Mooney, Chair of Cleveland Clinic’s Board of Directors, shares this message with all caregivers:

“People around the world are drawn to Cleveland Clinic because of its mission. Now more than ever, we are putting our belief in caregivers to lead us through challenging times. You have the full support of the combined boards of directors and trustees. We have complete confidence in Cleveland Clinic’s leadership. We are all in this together. I am proud to be part of the Cleveland Clinic team. Thank you for inspiring hope.”

Thank you,

Dr. Mijahlevic |  Cleveland Clinic

Tom Mihaljevic, MD
CEO and President

How to Identify and Report Cybersecurity Incidents

How to Identify and Report Cybersecurity Incidents

Information is one of our organization’s most valuable assets. Protecting our patient, caregiver and partner information is always important, but especially now, during this COVID-19 situation.

Our goal is to continuously ensure we avoid cybersecurity incidents, which can have serious consequences for our organization. These incidents are defined as an occurrence that could expose the confidentiality, integrity or availability of digital information (e.g. information stored on computers and other digital media) or information systems, such as Epic.

All Cleveland Clinic caregivers have a responsibility to report suspected or already occurred cybersecurity incidents. Outlined below is the criteria of what, when and how to report these incidents.

What to report

Any suspected or already occurred cybersecurity incident, whether there is complete information or not. Examples of incidents to report, include, but are not limited to:

  • Violation of any Cybersecurity policies
  • PII/PHI sent to an incorrect, external email address
  • Receipt of a suspicious email, phone call or text message
  • An information breach notification from a third party provider
  • Equipment theft, loss or found unattended (e.g. laptop, tablet, hard drive, USB, iPhone)
  • A desktop, laptop or server that is infected with malware
  • A computer or smart device that was accessed without permission
  • Receipt of a ransomware notification
  • Computer cursor moving by itself

When to report

  • If an incident will result in a significant loss of information, system availability or control systems
  • If it will impact a large number of patients or caregivers
  • If there is a presence on critical technology systems of unauthorized access or malicious software that can impact critical business functions or patient safety

How to report

Report cybersecurity incidents to the ITD Service Desk at 216.444.4357.

Provide specific details, including:

  • Your name, institute/department, contact phone number
  • Name of the person experiencing the incident, if different than the incident reporter
  • Time, date and description of the incident
  • If the incident has been reported, to whom and any current actions taken

To report a suspicious email, please use the Blue Fish button or, if you don’t have the Blue Fish button or are on a mobile device, send to [email protected].

REMINDER -- Social Distance When Entering Buildings for Work

REMINDER -- Social Distance When Entering Buildings for Work

To help protect yourself and your colleagues, please practice social distancing when you are in line for temperature screening. We are taking that step to help keep everyone safe. Do your part by standing six feet from your fellow caregiver. Social distancing is critical as we try to contain the spread of COVID-19.

Update on COVID-19 Care in the Region

Update on COVID-19 Care in the Region

As we continue to prepare for a potential surge of patients with COVID-19, Cleveland Clinic has designated areas within our health system to care for these patients at several locations including main campus, Akron General, Fairview, Hillcrest and Marymount hospitals.

Beginning April 6, Marymount Hospital will transfer all current non-COVID-19 inpatients to either South Pointe or Lutheran hospitals and will only care for suspected or confirmed COVID-19 patients for the foreseeable future.

This temporary plan will allow our health system to manage the treatment process and staffing needs anticipated with this pandemic. All caregivers working at these locations will remain employed at their current location.

As the number of patients we are caring for increases, we may designate additional areas as needed throughout our health system to best serve our community during this time.

We will continue to update our practices in order to care for patients in the safest way possible while also protecting our caregivers as this situation evolves.

This is a temporary change to address the current need and Marymount Hospital will resume normal operations following the pandemic.

Caregiver Support Housing Program established

Caregiver Support Housing Program established

We care deeply about our caregivers and their families. Part of our commitment is helping caregivers to protect their families and loved ones during the COVID-19 pandemic. That is why we have established a housing program for well caregivers providing direct patient care.

To accommodate caregivers across Northeast Ohio and Florida, housing sites are organized into the following regions — Main Campus, East, West, South and Florida.

Caregivers are eligible for the Caregiver Support Housing program if they meet the following criteria:

  1. Caregiver provides direct patient care as defined by the CDC (hands-on, face-to-face contact with patients for the purpose of diagnosis, treatment and monitoring); and
  2. Caregiver lives with someone who is at higher risk for developing severe illness from COVID-19, defined as:
    1. Age 65 and older
    2. Chronic lung disease or moderate to severe asthma
    3. Serious heart conditions
    4. Immunocompromised
      1. Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
    5. Severe obesity (body mass index [BMI] of 40 or higher)
    6. Diabetes
    7. Chronic kidney disease undergoing dialysis
    8. Liver disease; and
  3. Caregiver has no way to isolate in their own household; and
  4. Caregiver is symptom-free.

If you wish to apply for the Caregiver Support Housing program and meet the above criteria, please complete this survey. You will be able to select your preferred regional housing site. Note that it can take up to 72 hours after you apply to be assigned an accommodation.

Cleveland Clinic will cover the cost of the room for the duration of a caregiver’s stay. The caregiver will be responsible for all other costs (e.g., food and beverage, other services offered at housing site).

You may have questions about the Caregiver Support Housing program. Please refer to these FAQs. If you have additional questions, reach out to the Strategic Space Plan team.