Dear PAGNY Provider,
Many of you have reached out in recent days with questions about the availability of COVID-19 testing for PAGNY providers and safety issues around personal protective equipment (PPE) including New York City Health + Hospitals’ supply levels and guidance around distribution and usage. PAGNY has been actively seeking out information and advocating for you in our ongoing discussions with H+H and will continue to do so.
H+H issued new guidance on “Occupational Health Services (OHS) and Employee COVID-19 Testing” (linked). Beginning on April 1st, testing of providers will be coordinated by OHS through a centralized hotline and will be by appointment only. The system will prioritize symptomatic employees, followed by asymptomatic employees caring for COVID-19 patients, then asymptomatic employees with symptomatic family members at home, then asymptomatic employees who wish to be tested.
PPE Supply Levels
Supply levels are not only a national but global issue and we are working with H+H to provide you updated information regarding efforts to obtain and maintain supplies necessary to protect clinical providers. PAGNY is closely monitoring the situation to make sure that PAGNY providers have access to PPE needed to safely care for COVID patients.
Last week, H+H announced distribution of approximately 200,000 N95 masks, 2 million surgical masks, and 70,000 face shields. The Mayor also reported that an additional 430,000 surgical masks, 170,000 N95 masks, 175,000 pairs of gloves, 98,000 face shields and 72,000 surgical gowns are coming to NYC health care facilities from the State and Federal governments. H+H also confirmed that about 100 new ventilators from the federal stockpile will be dedicated to H+H, with another 300 going to other hospitals around New York City. H+H is continuing to procure more PPE and ventilators and PAGNY is working to ensure your continued access to necessary PPE.
PPE Usage and Re-usage
H+H has adopted the CDC’s PPE crisis guidelines in its recently issued “Use and Reuse of PPE for COVID-19” (linked). We encourage you all to read the guidelines. We want to highlight one aspect of the guidance that empowers you to make the determination regarding re-use of certain PPE: “While [H+H] encourage[s] the re-use of N95 respirators as appropriate… The User must be the one responsible for making the decision of whether the criteria for re-use are met, and whether reuse is appropriate in the clinical setting.” The policy also provides several patient care scenarios where re-use is or is not recommended.
First, this means that there is no “mandate” on how often an N95 should be re-used, nor any mandate on how many days an N95 respirator is expected to last. The statement highlighted above affirms that it is the sole decision of the user/provider as to how often and how long they will use their N95. Whenever a user decides he or she needs a new N95 respirator, H+H has stated that they will receive one when they ask.
Second, an N95 respirator can be re-used for up to 5 days UNLESS the N95 respirator is:
– Not intact
– Cannot achieve adequate fit
– Cannot achieve the seal check.
For example, an intensivist may have used the N95 respirator one time, and during that one time the respirator has become contaminated. The H+H guidance says that N95 respirator must NOT be re-used.
The H+H guidance also says a N95 respirator can be re-used at the user’s discretion multiple times within the 5-day window. However, it also makes clear that the N95 respirator cannot be re-used beyond 5 days. At this point, it most likely no longer functioning to the manufacturer’s specifications. After 5 days, it must be discarded.
The H+H guidance also outlines the expected use and re-use scenarios and timelines for other PPE including surgical masks, face shields, and gowns. Please consult these guidelines along with your own clinical judgment to inform your use of PPE.
Difficulty Obtaining Appropriate PPE
If you have difficulty obtaining appropriate PPE for the work you are performing or encounter issues with re-usage, you should seek assistance from your Supervisor, the Chief/Chair of your department, and if your request is not resolved to your satisfaction, speak with your facility’s Chief Medical Officer.
PAGNY is committed to your safety. If you are unable to resolve these or any issue impacting your safety, you can always speak with your PAGNY representatives at the facility’s PAGNY office. We recognize that there is valid concern, confusion, and anxiety about PPE supplies and we want to assure you that PAGNY will continue to advocate for changes that are necessary to protect you.
Jorge I. Montalvo
Chief Operating Officer
Physician Affiliate Group of New York, P.C.