Directive 5 and changes to the interim PPE recommendations based on increasing prevalence of Omicron variant

Sent on behalf of Marc Simard, Director, Occupational Health and Safety, Shelley Schmidt, Director, IPAC.

Quick details:

  • Directives 5 and 1 were revised December 17th and as an interim precaution, the requirements changed for all healthcare workers providing direct care to or interacting with suspect, high risk exposed, or confirmed cases of COVID-19, and/or any Droplet/Contact Precautions;
    • Staff in these situations should don N95 respirators (fit tested, seal checked) or approved equivalent, gloves, eye protection (face shields or goggles), and isolation gowns.
  • Fit tested and seal checked N95 respirators must be used by all healthcare workers in the room where Aerosol Generating Medical Procedures (AGMPs) are being performed, are frequent or probable.
  • A point of care risk assessment (PCRA) must be performed by every regulated health professional before every patient or resident interaction.
  • N95 respirators will be made available on all units and for all staff – please speak with your manager.

On December 15, 2021 Public Health Ontario released the Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19.

In light of the interim recommendation and the application of the precautionary principle, the Chief Medical Officer of Health has updated the PPE requirements outlined in Directive 5 (revised December 17th).

Directive 5 states:

As an interim precaution, in light of the uncertainty around the mechanisms of transmission of the COVID-19 Omicron variant of concern, the required precautions for all healthcare workers providing direct care to or interacting with suspect, high risk exposed, or confirmed cases of COVID-19 or any Droplet/Contact Precaution patients are N95 respirators (fit tested, seal checked) or approved equivalent, gloves, eye protection (face shields or goggles), and isolation gowns

  • A point of care risk assessment (PCRA) must be performed by every regulated health professional before every patient interaction.
  • All healthcare workers providing direct care to or interacting with suspected, probable or confirmed COVD-19 patients will have access to appropriate PPE. Fit tested, seal checked N95 respirators are available on all units for all staff. Please speak with your manager if you have questions.

Staff continue to require a medical mask and eye protection at minimum when interacting with patients at screening, in ambulatory care areas, or inpatient areas. 

There continues to be no change to patient placement:

  • COVID-19 positive patients are placed in Droplet Contact Precautions in a private room, or cohorted with another positive patient in consultation with IPAC.
  • A COVID-19 patient undergoing an AGMP should be placed in a negative pressure room if available, or in a private room with the door closed (including a portable HEPA unit, if available).

Low risk COVID-19 patients, such as those who are undergoing asymptomatic surveillance or those with atypical symptoms and an alternative diagnosis may continue to be placed in Droplet/Contact Precautions within the bedspace, in consultation with IPAC. The PPE outlined above is also required for these patients if staff are unsure why they are in Droplet/Contact Precautions.  

We have a good supply of N95s at this time, but to ensure stewardship and conservation of PPE: 

As a reminder, transfer swabs for COVID-19 are required on admission from or to another health care facility at this time. For transfers to a LTC facility or Retirement home, obtain a COVID-19 swab prior to transfer, transfer the patient and inform the facility that the results will be available within 24 -48 hours.

The situation with Omicron in Ontario is rapidly evolving, and we will continue to review Provincial guidance and policies as they become available to us.

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