[May 13, 2020] Guidance on Aerosolizing Respiratory Treatments in LTCFs

On May 12, 2020, the Indiana State Department of Health (ISDH) issued a document providing guidance on mitigating the use of aerosolizing respiratory treatments in long-term care facilities to minimize the risk of COVID-19 transmission, including the administration of inhaled medications via nebulizer therapy and noninvasive airway support via C-PAP and Bi-PAP.

The current recommended best practice is to shift to the use of Metered-Dose Inhalers, as opposed to nebulized treatments, for all long-term care residents, as applicable, in consultation with the resident’s medical provider.

In circumstances that require nebulizer therapy, if a resident is confirmed or suspected to be COVID-positive, the guidance offers the following strategies:

• Have the resident, if able, self-administer via mask to prevent unnecessary health care personnel exposure; otherwise, full PPE including an N95 respirator & eye protection is recommended for health care personnel.
• If applicable, remove roommate prior to treatment and have them remain out of the room for at least one (1) hour post-treatment.
• If possible, open the window a couple of inches and use a fan to direct airflow out of room during treatment and for at least ten (10) minutes post-treatment.
• Keep privacy curtain drawn around resident for the duration of procedure.
• Have resident wear a surgical mask over nebulizer mask to filter viral particles.
• Keep door closed throughout the treatment and for one (1) hour post-treatment.
• After treatment, disinfect all surfaces around the resident with an EPA approved cleaner.

To assist health care personnel who perform or assist with aerosolizing producing procedures, IHCA/INCAL also recommends reviewing Item #11 in the CDC’s Guidance for Infection Control in Health Care Facilities, which further specifies the PPE that should be used for aerosol-generating procedures.  If you have any questions, please contact Lori Davenport at ldavenport@ihca.org.