Transcript

Covid-19 Basics: PPE

Covid-19 Basics: PPE

I want to introduce myself in case you didn’t see the first broadcast by the National Center. I am Mary Striegel. I am a Conservation Scientist with the National Center for Preservation Technology and Training, and I’ll be talking to you today about personal protective equipment, or PPE, which it is commonly referred to. We’re going to talk about what you need if you work near people or places that might be exposed to COVID-19.

Our discussions and recommendations today are going to be based on the currently available knowledge and we need to remember that this pandemic is still emerging and it’s a rapidly evolving situation.

In the first of our broadcast, we discussed what the COVID-19 virus is and what we can do to deactivate it on surfaces, and also consideration for cultural resources. This includes isolating, cleaning or disinfecting a site. We emphasize, and I want to strongly emphasize to you, that if you are responsible for cultural sites you want to first approach the situation as an isolation. We want to emphasize isolation is the preferred method to control the virus within cultural sites and it helps protect the resources, which of course is our job.

In our second Facebook Live we’re going to discuss with you the need to protect yourself if you need to address a known contamination, or if you’re enlisted to help someone who might be sick with the COVID virus.

In a cultural resource environment if your collections are closed off and isolated, if they’re in display cases and not being touched, if they’re in storage units, you don’t need to do anything. But if you are in a situation where you’re open to the public and there might be a known contamination, then you’re going to need to understand your personal protective equipment. Additionally, we’re going to offer advice to you on how you may help your community and their first line responders.

So, today I’m going to talk about personal protective equipment, and we’re going to answer these following six questions. We’re going to talk about risk assessment. We’re going to address some of the reservations that people have about homemade masks. Finally, as conservators, we’re going to talk about how we can help our communities. So these are the six areas that we’re going to discuss today.

In any crisis situation the first thing is to do a risk assessment. What are the risks to you? What are the risks to people around you? How much protection do we really need? I’m going to talk about a risk assessment approach to determine our personal protective equipment depending on the situation you are facing.

We are fortunate at the National Park Service to have had what was called occupational leadership training. And this was for safety protection in our work environment. Out of that came a series of tools that we use, and NCPTT has created a risk assessment app. This is the information on the risk assessment

app. This risk assessment app can be found on our website and can be downloaded to your Apple iPhone or your android phone or device.

We’re going to talk about using an SPE model. That is the severity, the probability, and exposure. Based on the severity, probability, and exposure, we can then determine how much of a risk we’re taking and what we need to do to protect ourselves.

So when we talk about severity we ask ourselves questions like are we in a high risk category? Are we over the age of 60? I am. Do I have a underlying health condition? Am I facing asthma, diabetes, respiratory issues, cancer treatments, heart conditions? Do I have a compromised immune system? Have I been on some drugs that would greatly lower my immune system?

The second component that we’re going to talk about, and that you would grade in this assessment, would be the probability. What’s the probability that you’ve been around someone or been in contact with a surface that might have a coronavirus on it? Have you been around people? Have you been practicing safe social distancing, staying six feet away from people that might be able to transmit to you?

Have you had to go to public places? Did you go to the grocery store, the pharmacy? Were you forced to take your vehicle in to get it repaired? Have you been in contact with someone that’s displaying signs of illness or coughing or other risky behaviorórisky nowadays?

What’s the probability that you or the collections you’re caring for have been in contact with someone who might have a virus? Has your collection been isolated for six to nine days? If it has and no one has been in, you don’t have anything to worry about. Has anyone been in your storage areas or in direct contact with your collection?

So by answering those questions, you can determine whether your probability is about 50/50, very slight, or you have something to worry about.

The third component of the SPE model, risk assessment model, is exposure. If you’ve been sequestered away at home and haven’t seen anybody, haven’t let anybody in the house, and it’s been like that for 14 days, you’re pretty safe. Your exposure is low.

If, instead, you’re on the front lines, working with known sick patients, like some of my family members might be, then, you are in a high exposure situation. Are you working in a facility that is still open to the public? Were you, or was your site, in contact with someone known or suspected to have COVID-19?

So, again, you can go to our website and this will take you to your Apple store or Google Play store and you can download the risk assessment tool. Based on

your risk assessment, you’re going to be responsible, and you and you alone are responsible, for determining how much risk you’re really willing to tolerate.

So what are our protection options based on the risk assessment that we have chosen? If the risk assessment is very low you may resolve yourself to use gloves or a procedural or examination mask. This is not an N95 mask, but this is what you might use in a low risk situation. These masks would include a paper surgical mask or even a homemade mask, and I have a couple of masks here. This is a homemade mask. Yes, if you’re a Dr. Who fan, those are Daleks on them.

NCPTT Risk Assessment App

Covid-19 Basics: PPE

Let’s talk about gloves. These gloves, these are blue nitrile gloves. They come in a variety of sizes. They’re examination gloves. These are the recommended gloves for use to protect your hands. Now you see a lot of news saying don’t wear gloves, just wash your hands frequently, and that is an excellent idea. But for me, if I’ve got gloves on I am much less likely to touch my face, so I keep that in mind.

This is the only mask that’s recommended by the CDC and the American Institute for Conservation. This is an N95 full respirator mask. This is a respirator, not a mask. You can see on it, it says N95, although it says that backwards. This is able to block out the COVID-19 virus to about 95%. It fits tightly on your face. It has two straps.

In addition, you may use goggles. I happen to have these at home. My laboratory goggles are in the lab, where I can’t go right now. Normally you want goggles that fit over your glasses if you’re like me. I’ll be blind for a little while today and wear a safety goggle. These still don’t adhere tightly to your face. And they do make goggles that do adhere tightly to your face, and that helps prevent the virus from getting into your eyes.

Here is another type of N95 mask. This was kindly given to me by my Research Associate, Vrinda. This comes from India. But, again, you see a different design of these masks.

In addition, you might want to have personal protective clothing, or outer clothing. This is my lab coat that I wear in a laboratory environment. If I’m going to go out and I’m going to be in a public place where I feel is a risky place, I’m going to have some protective clothing over me, something that I can take off and turn inside out and launder.

So based on your risk assessment and your comfort with risk, you may choose to only use gloves and a procedural mask in a low risk situation. You may want to add goggles and a protective clothing in a high risk situation, or a medium risk… Excuse me, a medium risk situation.

In high risk scenarios you are going to want to have a gown or outer protective clothing, or even a Tyvek suit, an N95 respirator, gloves, goggles, and a hair cap. Now note, this should probably be reserved for first responders or really high risk individuals.

The CDC has advised using personal protective equipment based on three different categories. The first is conventional use, and that is where hospitals have… or healthcare providers have plenty of access to gloves, respirators, personal protective equipment.

The second realm, which is one that we’re really currently facing, is contingency use. This means that there’s a shortage of N95 masks, so instead of this being a one wear mask, many healthcare providers are wearing these masks until they’re visibly soiled, and then they have to dispose of them. So they’re reusing these masks. They make sure that they keep their hands off the mask and that they handle them a lot by the straps and they put them safely in a sterile situation.

Removing PPE

Removing PPE

The third situation is one that we might be facing in the future, and that is when we are in crisis situations, there’s no longer masks, there’s no longer the appropriate materials. And I think that that is when we have to start thinking about other sources for protecting ourselves.

I need to note here that the American Institute for Conservation’s Health and Safety Committee advises against using anything but an N95 mask during this pandemic. Their logic is that you would be fooling yourself if you used anything less.

Now, I want to talk a little bit about how to put on your PPE. Both how you put on the PPE, and how you take off the PPE, is really critical to protecting yourself. You always work by putting on your garment first, so I would put this on first. Then I would put on my goggles, I would put on my mask… Let me get the mask on. They recommend putting it on from the bottom up. Can you hear me? And then after that you would put on your gloves. Okay.

So once you have your protective equipment on… Here is the slide for this and the order you put it in. Put on your gown or outer protective clothing, put on your goggles, put on your mask, and then put on your gloves.

Before you do any of this there are two things you need to remember. First, make sure you’re not running a fever or feeling sick. Second, make sure you wash your hands, do proper hand sanitation for 20 seconds, as recommended by the Center for Disease Control, or CDC. You may want to go on and have a hair cap that you’ll cover your hair with as well. And you’ll find notes on the PPE sequence in our comments that will take you to the appropriate page.

Now after you have been in a situation where you might be exposed to a virus on a surface or somebody who might be sick, removing your PPE is a critical part of the process. The gloves are removed first, because they’re the most contaminated. I’m going to put these gloves on. Give me a second. I really should use larges, but I have mediums with me.

So I have my gloves on, let’s say I have my respirator on, but I’m not going to put it on so that you can hear me. I have my gloves on. I’ve come in contact with surfaces that may or may not have the virus. What do I do next? First I’m going to take and wipe down the gloves with an alcohol based disinfectant or a bleach based disinfectant if that’s what you’ve got.

So I’ve washed the gloves. Now I made sure that I didn’t get the water onto my hands, but I’ve rinsed off and I’ve washed the gloves. We’re going to wait like 10 seconds to make sure they’re clean. Now we’re going to take this finger and put it inside this glove and pull it inside out, because what we’re doing is trapping any of the contamination inside the glove. I’m going to reach over to the other hand, grab that exterior and turn that glove inside out and shove this glove into that glove. Now these gloves are ready to be disposed of, and they should be disposed of in a place that’s not going to come into contact with other people.

Okay, so we’ve talked about removing the gloves first. Once we remove the gloves we wash our hands again with soap and water, so we’ve disinfected our hands. Now we’re going to put another pair of gloves on, because the first were really, we know, the most contaminated, and now these are the least contaminated, the new gloves we put on.

Removing PPE

Removing PPE

We’ll take the gown off. If it’s tied in the back we’ll have somebody unhook it for us. Then we take our eye protection off. When you take off your mask you do it from the back of your head, and use the straps at the back of your head to take your mask off. After that your hairnet should be taken off. Okay, the last personal protective equipment that you remove is that which you’ve worn, those last set of gloves. Then you do your hand hygiene again.

Okay, so here’s to recap the order in which we do this. You move from the most contaminated to the least contaminated area. You clean the gloved hands with an alcohol based sanitizer. Then you remove those gloves and dispose of them. You wash your hands with soap and water. You put on a new pair of gloves, and then you go from the most contaminated to the least contaminated.

Again, you remove your goggles or face shield from the back of the head, you remove your mask or respirator using the straps from the back of your head, you remove your cap or your hairnet, and then you remove those gloves again last.

We’ve taken our items off. We’ve turned them inside out. What is our next step? We have the contaminated outer clothing. We might have worn… If all

else failed, we might have worn our personally made mask, and we’ll talk about these a little more in a minute. If we had our N95, we’re going to store that.

So, after each use you dispose of the gloves. If we reach the crisis level we may have to reuse gloves. If that’s the case, the Journal of Hospital Infections states that the life of the coronavirus on a surgical glove is about eight hours and on silicone gloves it’s about five days. So they need to be set aside and isolated until the virus is no longer active.

While wearing gloves, you want to carefully wipe the inside and the outside of your face shield or goggles with a clean cloth saturated with a neutral detergent or a cleaner wipe. Always, you want to remove these items and put them in an appropriate place. I would separate my personal protective equipment, my outer protective equipment, from my regular laundry and I would launder that normally with soap and water, and I would do that on the hottest temperature that the fabric can stand, which you really want it to be 90 degrees centigrade.

Again, to summarize what we do for disinfecting our PPE… Let me see if I can see from over here. We dispose of gloves, turning them inside out. We clean our goggles and face shields with a clean cloth and soap and water or a disinfectant. We remove and store the N95 mask until it’s visibly soiled before we get rid of it. We wash cotton masks in hot water and detergent, and we turn protective clothing inside out, and again wash in hot water and detergent.

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About the Team

Jason Church has spent that last 17 years as a conservator focusing on masonry and metals. He is an active member of the National Heritage Responders, having taught several disaster response workshops as well as being deployed to disaster recovery in the field. Church has a MFA in Historic Preservation and is a Professional Associate of the American Institute for Conservation    

Sean Clifford is an IT Specialist with the National Park Service where he develops web and mobile projects. Before joining NPS, he developed software for DirecTV and Dish Network service providers, worked as a licensed investigator in New Orleans, and managed download software stores at SoftDisk. He is a graduate of the Louisiana Scholars’ College and holds an M.Ed. and Ed.S. in Educational Technology from Northwestern State University of Louisiana. 

Catherine Cooper, Ph.D. is a research scientist at NCPTT, where she focuses on analysis and characterization of materials.  As an analytical chemist, she completed postdoctoral research at the Rhode Island School of Design (RISD) Museum and the Arizona State Museum prior to joining NCPTT.  She holds a Ph.D. in Archaeological Chemistry/Anthropology from the University of British Columbia, Vancouver. 

Vrinda Jariwala is working as a research associate at the National Center for Preservation Technology and Training. She is working on research on removing crude oil from cultural resources using surface washing agents. She studied A.P.D. Technical Building Conservation–a Historic Environment Scotland run programme in the field of material conservation at Engine Shed, Scotland. Jariwala did her Masters in Architectural Conservation from the School of Planning and Architecture, New Delhi.   

Isabella Jones is a recent graduate of Northwestern State University of Louisiana with a double major in; Biology with a concentration in natural sciences as well as a bachelor’s degree in Art with a concentration in graphic communications. Jones has joined the NCPTT team producing videos and doing graphic design.     

Mary F. Striegel, Ph.D., FAIC, has 25 years of experience working as a conservation scientist with the National Park Service. She focuses on  decay of cultural materials and treatments to protect them. Previously she served as a conservation scientist with the Getty Conservation Institute. She is a Fellow of the American Institute for Conservation and holds a Ph.D. in Inorganic Chemistry from Washington University in St. Louis. 

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