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The mission of the Iowa Physical Therapy Association (IPTA) is: To serve the membership and the public with excellence and integrity by advancing and promoting the practice of physical therapy through the coordination of advocacy, education and resources. During this COVID-19 pandemic, IPTA has provided a variety of resources, educational opportunities, and advocacy calls to action for members. As phased re-opening is occurring in Iowa, we have received an increase in inquiries regarding the use of personal protective equipment (PPE), best practices for patient and employee screening, and other recommended safety measures.    

IPTA supports guidelines provided by the Centers for Disease Control (CDC). There is a large volume of ever-changing information being shared regarding measures to be implemented in healthcare settings. The purpose of this blog post is to highlight key CDC resources and summarize information available as of today.  

The CDC web page COVID-19 Guidelines for Healthcare Personnel provides consolidated information. A key message includes: “Because the effects of COVID-19 vary among communities, healthcare systems will also need to consider the local level of COVID-19 transmission when making decisions about the provision of medical services.”  

PPE
It is important to differentiate between standard precautions for all patient care versus transmission-based precautions (which are recommended for known or suspected infections). Standard precautions are appropriate when interacting with individuals without known or suspected infection with COVID-19. Transmission-based precautions are recommended in the presence of known or suspected infection.  

CDC guidelines for standard precautions PPE:

Healthcare facilities should consider implementing policies requiring everyone entering the facility to wear a cloth face covering (if tolerated) while in the building, regardless of symptoms. 

Patients and visitors should, ideally, be wearing their own cloth face covering upon arrival to the facility. 

Healthcare personnel (HCP) should wear a facemask at all times while they are in the healthcare facility. When available, facemasks are generally preferred over cloth face coverings for HCP as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others. 

CDC guidelines for transmission-based precautions PPE:

Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required. 

Additional specific PPE recommendations for HCP caring for patients with known or suspected COVID-19 infection can be found here: Transmission-Based PPE for COVID-19

Screening and Environmental Control Measures: 
Masking alone is not the sole preventative measure recommended. It is important to include daily screening of all patients and staff for symptoms of COVID-19. The CDC recommends screening all entering a clinic or facility for fever and symptoms consistent with COVID-19. Respiratory symptoms consistent with COVID-19 include cough, shortness of breath, and sore throat. 

Finally, HCP are advised to reconfigure provider schedules and environments to follow social distancing guidelines, and to continue with frequent and high-quality hand hygiene. Examples of environmental controls include physical partitions, curtains to separate treatment area, adequate air flow systems, and frequent cleaning of surfaces.  

Research continues and may lead to changes in CDC recommendations. For example, the University of Iowa has recently identified potential benefits of face shields over face masks including increased protection for the wearer, easier cleaning, improved comfort, and improved ability to communicate with patients and colleagues. The link to the article can be found here: https://jamanetwork.com/journals/jama/fullarticle/2765525

Additional references:

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