Facing a Shortage of N95 Masks During COVID-19?

“Disposable filtering facepiece respirators (FFRs) are not approved for routine decontamination and reuse as standard of care. However, FFR decontamination and reuse may need to be considered as a crisis capacity strategy to ensure continued availability. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate FFRs.” -  Centers for Disease Control and Prevention (CDC)

What used to be routine and disposable, is now of concern to those that depend on single use N95 respirators (masks) to protect themselves from airborne infections, such as COVID-19. Wearing an N95 respirator for hours at a time (extended wear) or reusing a respirator several times (removing between uses) are practices used to ease shortages.

The National Institute for Occupational Safety and Health (NIOSH), along with the CDC, recognizes the possibility of N95 respirator depletion during a pandemic and developed recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators. The CDC favors extended use over reuse as it involves less touching of the respirator and less risk of contact transmission.  To make sure employees are following proper protocol, cities should have clearly written procedures in their respirator programs.

Current CDC guidelines on extending respirator supply:

• Minimize the number of staff who need to use respiratory protection through engineering and administrative controls.
• Use alternative respirators where feasible.
• Implement practices allowing the extended use and reuse of N95 masks when acceptable.
• Prioritize the use of N95 respirators for staff at the highest risk of contracting infection.

Reuse recommendations:

• Hang used respirators in a designated storage area where they cannot come into contact with each other or in a clean, breathable container like a paper bag.
• Avoid touching the inside of the respirator and if you do touch it, wash your hands.
• Use a pair of clean gloves when putting on a used respirator and performing user seal checks, then discard the gloves.
• Follow manufacturer guidelines on how many times a respirator can be worn, if no guideline exists use no more than five times.
• Follow the manufacturer’s user instructions for the respirators.Label containers used for respirators or the respirator itself (on the strap) with the user’s name.

As a last resort, the recommendation would be to decontaminate N95 filtering facepieces. This would make the mask safer, but not necessarily safe. There are three approved methods to decontaminating a mask:

• UV-C light
• Hydrogen peroxide vapor
• Moist heat

There are many consumer, and medical products out there that claim to decontaminate masks that are ineffective, so it’s important to follow the CDC guidelines on proper cleaning. Cleaning with alcohol, dunking the mask in hydrogen peroxide or other chlorine types of solutions will damage the masks and should not be used.

The following precautionary measures are to be used prior to using a decontaminated FFR:

• Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the FFR.
• Avoid touching the inside of the FFR.
• Use a pair of clean (non-sterile) gloves putting on a mask and perform a user seal check.
• Visually inspect the FFR to determine if its integrity has been compromised.
• Check that components such as the straps, nose bridge, and nose foam material did not degrade, which can affect the quality of the fit, and seal.
• If the integrity of any part of the FFR is compromised, or if a successful user seal check cannot be performed, discard the FFR and try another FFR.
• Users should perform a user seal check immediately after they put on each FFR and should not use an FFR on which they cannot perform a successful user seal check.

Note: CDC and NIOSH do not recommend that FFRs be decontaminated and then reused as standard care. This practice would be inconsistent with their approved use, but we understand in times of crisis that option may need to be considered when FFR shortages exist.

Additional Resources from OSHA:

Video: How to Perform a Seal Check with an N-95 Respirator

Video: Respiratory Fit Testing

Expanded Temporary Enforcement Guidance on Respiratory ProtectionFit-Testing for N95 Filtering Facepieces in All Industries During theCoronavirus Disease 2019 (COVID-19) Pandemic

Submitted by: Julie Jelen, Loss Control Consultant

Disinfecting Shared City Vehicles During COVID-19

We are all aware that washing hands and disinfecting high-touch surfaces are the two best ways to defend against the spread of the coronavirus. What if you’re sharing city vehicles? How do you know you’re properly destroying the virus to protect yourself and your co-workers?

The key is to not damage those surfaces while disinfecting. According to the CDC, alcohol solutions that contain at least 70 percent alcohol are effective against the coronavirus. Most every surface in a vehicle can safely be cleaned with isopropyl alcohol and a microfiber cloth. Most EPA-registered household cleaners, such as Lysol Disinfecting Wipes, are also effective.

While wearing your personal protective equipment, clean these frequently touched surfaces:

• steering wheel                                            
  
• door handles
• arm rests
• shift lever
• buttons or touch screens
• seat adjusters
• wiper and turn signals stalks
• air vents
• seat belt buckles
• grab handles
• door arm rests
• cup holders

Good ol’e soap and water are safe for cleaning the fabric and leather interior. For those vehicles that transport passengers, CaviCide1 is an approved spray that kills the virus within one minute. The St. Paul Police Department has a short YouTube video using this product.

What not to use:

Do NOT use bleach or hydrogen peroxide inside the car surfaces. They will kill coronaviruses but will likely damage the car’s upholstery, vinyl, and plastics.

Do NOT use ammonia-based cleaners (blue glass cleaners). They can damage the car touch screen anti-glare and anti-fingerprint coatings. It also breaks down the vinyl on the dash and makes it sticky over time.

NOTE: Bleach, hydrogen peroxide, ammonia, and many household cleaners are adept at killing germs, which is the goal. Just be aware it may potentially fade or damage a vehicle’s interior. Always follow the label instructions on the bottle and safety data sheets on proper PPE when applying these chemicals.

Additional short video on disinfecting your vehicle:

COVID-19 Car Tips: How to Disinfect Your Car, Safely Get Gas, and Use the Drive-Thru (Auto Trader Canada)

Submitted by: Julie Jelen, Loss Control Consultant

Protecting Your Liquor Store Employees from COVID-19

In these times of quarantine and only traveling for essentials, it is important for liquor stores to act similarly to grocery stores in taking necessary precautions to disinfect the store and protect employees. With everyone trapped inside, alcohol consumption and sales have gone up quickly, and the liquor store is one of the few places the public can still go.

Some things that cities need to consider are  providing employees with disposable latex/nitrile gloves and providing hand sanitizer at the counter. It is also a best practice to spray down the counter, register, and surrounding areas with a disinfectant such as Clorox wipes or disinfectant spray periodically during the day. 

At first, it was not all that uncommon to see cashiers also wearing facial masks if available along with enforcing social distancing. Most recently, that has been replaced with use of barrier shields, which have been installed separating the cashier from the customer with the only opening at the counter level to allow for currency transactions. These barrier shields, also now being referred to as sneeze guards, are typically 36" to 48” in height and the length would vary depending on the area being protected. These can be commercially purchased or easily made by something as simple as cutting a groove into a 2x4 making a frame, using angle iron for framing, and placing a sheet of plexiglass or clear plastic as the barrier.

While these barrier shields or sneeze guards do provide excellent protection for the register area, social distancing is still a key control regardless of where you or your employees are at. Some have used signage that forces spacing at the register lines. It is more common to see taping placed on the floor leading to the registers with sectioned waiting areas of 6-foot intervals. But social distancing also applies when an employee is stocking shelves or assisting customers. This can all be done while still maintaining social distancing.

The CDC guidelines for disinfecting your store include:

• Clean the area or item with soap and water or another detergent if it is dirty. Then, use disinfectant.
• Recommend use of EPA-registered household disinfectant. Follow the instructions on the label to ensure safe and effective use of the product. Many products recommend:
• Keeping surface wet for a period of time (see product label)
• Precautions such as wearing gloves and making sure you have good ventilation during use of the product. 
• Diluted household bleach solutions may also be used if appropriate for the surface. 
• Check to ensure the product is not past its expiration date. 
• Unexpired household bleach will be effective against coronaviruses when properly diluted. Follow manufacturer’s instructions for application and proper ventilation. Never mix household bleach with ammonia or any other cleanser. Leave solution on the surface for at least 1 minute.
  To make a bleach solution, mix:
• 5 tablespoons (1/3rd cup) bleach per gallon of water OR
• 4 teaspoons bleach per quart of water.
• Alcohol solutions with at least 70% alcohol.

When doing the store cleaning and disinfecting the employee completing the task should follow extra steps to protect themselves even for something as simple as taking out the trash. The CDC recommends the employee be completely covered with gloves, a gown, and a mask if possible. Educating workers and providing training on the proper way to disinfect and proper way to use/wear PPE could also go a long way in limiting their individual exposure especially when performing the cleaning tasks.

Tying into this precaution is thinking about the exchanging of money or payment method from the customers. Considering a short-term policy where the store won’t accept cash payments could be necessary, and if you can let the customer use the keypad for their card themselves without touching it that would be effective in limiting exposure. If you are still accepting cash payments, like touched on before, the employees should have gloves on, and you could even set out hand sanitizer for customers to use. Make sure to disinfect any shopping carts or baskets, or just put them away for the time being.

Another possible precaution to take is limiting the amount of people in the store at one time, or doing a curbside pickup routine, which would be similar to what a restaurant’s carry out service is doing. This would eliminate the need for many people to come inside. Since barrier shields are not an option in a curbside scenario, it is suggested that those employees should be wearing disposable gloves and mask as they will be in closer contact.  Even a homemade mask or cloth can serve this purpose. 

The key controls at a liquor store or any activity continue to be maintaining and enforcing social distancing and good personal hygiene practices. By doing this and incorporating some of the steps indicated above you can provide a safe environment for these employees and limit overall exposure to COVID-19 for everyone involved.

Additional information:

How Liquor Stores Adapted to the COVID-19 Crisis

Plexiglass to Protect From theSpread of Coronavirus 

CDC Information on Cloth FaceCoverings to Help Slow the Spread of COVID-19

Submitted by: Michael Neff, Loss Control Consultant

Cleaning and disinfecting for COVID-19 virus

From the Editor: Updated with Reopening Guidance 5/18/20

The global pandemic occurring right now is causing us all to be more cautious when it comes to the cleaning and disinfecting of our home and workspaces. Especially those who are still coming into work and potentially encountering the public and those who may be sick. The CDC has recommendations when it comes to cleaning and disinfecting. 

According to the CDC, cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in community settings. One thing to be aware of is the difference between

cleaning and disinfecting. Cleaning is mostly dealing with visible things (dust, dirt, grime, etc.). Disinfecting removes the contaminants from below the surfaces.  Cities should pay attention to the close contact points, the surfaces that are touched regularly. This could include but not limited to:

• Doorknobs, handles, locks, window latches
• Light switch plates, alarms
• Cupboard handles and drawer handles
• Handrails and elevator buttons
• Bathrooms
• Tablets, smart phones, radios
• Computers- keyboard, monitor, control pad, and mouse
• Desks and chairs, especially important if these are shared stations
• Printers
• Remote controls
• Sinks, refrigerators, microwaves
• Countertops
• Buttons, switches and controls
• Vacuums, mops, mop buckets, and other cleaning equipment

The CDC recommends the following on how to clean and disinfect:

• For hard surfaces that are dirty, they should be first cleaned with detergent or soap prior to disinfecting. When disinfecting hard surfaces, most common EPA-registered household disinfectants should be effective. 
• For soft surfaces (carpet, rugs, drapes, etc.) remove visible contamination first and clean with recommended cleaners for the surface. Once cleaned, if items can be washed, wash per manufacturer’s instructions, using the warmest appropriate water setting. Also, dry items completely. 
• For electronics remove visible contamination if present and follow manufacturer’s instructions for cleaning and disinfecting products. If no guidance from manufacturer, consider using alcohol-based wipes/sprays containing at least 70% alcohol to disinfect screens.
• For linens, clothing and other items that go into the laundry, do not shake dirty laundry (this will help prevent possibility of virus dispersing in air). Hampers/carts that are used for laundry transport should also be cleaned and disinfected.
• If a person was known to be sick in the area, open outside doors and windows to increase air circulation in the area. Wait 24 hours before you clean or disinfect. If 24 hours is not feasible, wait as long as possible.

Another item to consider is the use of personal protective equipment (PPE) when cleaning and disinfecting. The CDC recommends cleaning staff should be wearing disposable gloves and gowns for all tasks in the cleaning process. If gowns are not available, clothing should be laundered after cleaning and disinfecting. Cities should look at the Safety Data Sheets (SDS) before using the chemicals, as certain chemicals pose different risks and hazards. The SDS will also show if additional PPE or measures need to be taken when handling the chemical. The employees who are cleaning should be cleaning their hands often, especially after removing gloves at the end of their shift.

Employees who are cleaning should be provided PPE training which should include when to use PPE, what PPE is necessary, how to properly put PPE on and off, and how to properly dispose of PPE. Employees also must be trained on hazards of cleaning chemicals and bloodborne pathogens standard. 

For more information regarding cleaning and disinfecting, please refer to Cleaning and Disinfection for Community Facilities from the CDC.

Additional CDC Reopening Guidelines:
Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes

Reopening America Cleaning Disinfection Decision Tool

Submitted by: Kate Connell, Loss Control Consultant

COVID-19 and Property Risk

Many facilities are closing around the United States to reduce the spread of COVID-19. Although COVID-19 is one of the most extraordinary risks right now, Cities should remember that there are still other ongoing risks that are considered serious, such as property risk. With spring also just around the corner, flooding and even existing high-water tables creating water infiltration into a building can become issues.  Property risk can include fires, vandalism and theft, and roof damage. Facilities left idle or understaffed can cause these properties to be vulnerable.  There are things you can do.

FM Global released an article with recommendations to help protect City facilities during COVID-19, which include the following:

• Essential personnel: Consider contacting authorities and having them be aware that the security and maintenance personnel on your site are essential.
• Active security: Consider daily inspections at idle facilities to look for things such as criminal activity, smoke, fire or other property damage. Consider installing cameras and sensors to detect activity.
• Fire protection: Maintenance should be checking sprinkler valves daily to ensure they are locked open. Any ignitable liquid and debris should be removed. Special emphasis should be placed on any welding and hot work being done.
• Flood protection: Spring is upon us, consider elevating equipment and having flood barriers present.
• Maintenance: Consider continuing daily maintenance activities, as well as any overdue maintenance such as fixing a small roof leak. Leaving maintenance untreated could cause bigger issues, not to mention the cost associated with those issues.

As a reminder, the League Loss Control staff has property resources, which include checklists for Cities to use.  Many of these resources address the concerns mentioned above.  Even if the building is not officially closed, routine inspections can help prevent losses. If you do not have these resources and are interesting in having them, please contact your Loss Control Representative.

Submitted by: Kate Connell, Loss Control Consultant

Sanitizing Your Playground Equipment During COVID-19

On March 27th 2020, Minnesota Governor Tim Walz announced the “Stay-at-Home Emergency Executive Order” during the COVID-19 pandemic, which acknowledges the decision to close playgrounds is for each local jurisdiction. This event made many cities wonder what to do if they decide to keep them open and how to sanitize playground equipment.

Studies from the National Institute of Health (NIH) have shown the Coronavirus can live up to 2-3 days on plastics and metal. While cleaning, frequent washing of hands, and not touching faces may help keep most people safe, children play on equipment with their whole bodies, including their faces. The risk of the spread of the virus is increased. Completely closing playgrounds is a difficult task. Some cities are choosing to post signs with messaging that the equipment is not sanitized, or playground is closed, and some are fencing the area.

If cities do allow playgrounds to remain open, it is recommended that they follow the CDC’s guidance on the cleaning of facilities and surfaces, as the best practice. For playground equipment, the CDC suggests:

• If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
• For disinfection, most common EPA-registered household disinfectants should be effective.
• A list of products that are EPA-approved for use against the virus that causes COVID-19 is available here. Follow the manufacturer’s instructions for all cleaning and disinfection products for concentration, application method and contact time, etc.
• Additionally, diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can be used if appropriate for the surface. Follow manufacturer’s instructions for application, ensuring a contact time of at least 1 minute, and allowing proper ventilation during and after application. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
• Prepare a bleach solution by mixing:
• 5 tablespoons (1/3 cup) bleach per gallon of water or
• 4 teaspoons bleach per quart of water

City employees also need to ensure their own safety and comply with OSHA’s standard of Bloodborne Pathogens by wearing the appropriate Personal Protective Equipment (PPE) while cleaning, including the handling of trash.

 Submitted by: Julie Jelen, Loss Control Consultant

Simple ergonomic tips for working from home

Working from home can be a pain in the neck, but it doesn’t have to be. Preventing musculoskeletal disorders (MSDs) exposure at home is just as important as working in the office. MSDs are soft-tissue injuries caused by sudden or sustained exposure to repetitive motion, force, vibration, and awkward positions. These disorders can affect the muscles, nerves, tendons, joints, and cartilage in your upper and lower limbs, neck and lower back.

Reality is, working from home may be temporary and you don’t have an allocated office space in your home. Even if working from a kitchen table and chair or couch there are cheap and creative ways that you can use to set up your workstation to stay comfortable and prevent injury. For example:

• Use a good chair if possible. If you don’t have a good chair, add pillows or rolled towels for back/leg support.
• Raise your chair as most kitchen tables and desks are too high. Use a pillow or seat cushion if needed.
• Raise your monitor by using boxes, books, bricks, cans of soup, etc.
• Support your feet on books, a shoe box, etc., if they don’t firmly touch the ground while sitting.
• Use an external keyboard, mouse, and monitor if possible. This helps prevent bending your neck and looking down. The top of the monitor should be at or just below eye level, shoulders relaxed, elbows and knees at a 90-degree angle.
• Take breaks. Set a timer every 60 minutes to get up and walk around.

Here are tips from an ergonomics expert on how to set up your desk. The Mayo Clinic also has a how-to guide to help ensure your home office area is set up correctly.

Here is a webinar from the Vermont League of Cities & Towns on Remote Working Best Practices.

If you are a FirstNet Safety Training user, there’s online ergonomic training to select for your employees. LMCIT also has an alliance with CoastalFlix, a new, no-cost way to bring safety training videos for our members. There are many short ergonomic streaming videos to select from.

Submitted by: Julie Jelen, Loss Control Consultant