Mary Striegel: 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 behavior�risky
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.
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.
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.
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.
Now we want to talk about the issue of homemade
masks. A lot of people are making them. They
may be very important to us at some point.
A protective mask may reduce the likelihood
of infection, but it doesn't eliminate it.
There's a certain amount or effectiveness
that each mask has.
A mask like these homemade masks do not perform
the same way as a respirator does, and that's
why the CDC recommends that the homemade mask
is the choice of last resort for frontline
health professionals. But homemade masks may
be useful, depending on our risk assessment,
how the mask was made, and the materials that
the mask is made from.
This mask as is, is 95% effective. This mask,
which is a cotton mask that's two layers with
no filter in it, although it has a filter
pocket... Look, I've made a filter pocket
here, but it has no filter in it. This mask
is 50 to 58% effective, so that means you
know, you got a 50/50 chance with this.
What materials if we're going to make a homemade
mask, if we've... Excuse me, I've got a question
coming in. Yes, 90 degrees [Celsius]. Yes.
If we are using materials to make these masks...
Or what materials should we choose? So, in
2013 a research article was published by Cambridge
researchers that looked at materials for homemade
masks. The title of the article was
�Testing the Efficacy of Homemade Masks,
Would They Protect in an Influenza Pandemic.�
So, their recommendations are the following
materials. Cotton tee shirts, cotton pillow
cases, cotton tea towels and cotton cloth.
Why do they recommend this? Because they say
these materials provide some breathability
for the wearer. If you stop all the air from
moving in and out, people aren't going to
keep them on their face. They're going to
take them off.
We will post in the comments later, the efficacy
of some of the materials that they've tested.
Again, these run in range of 58% to about
82% effective. I believe that's right. So,
these are the materials that researchers have
looked at for homemade masks in a pandemic.
If we're going to make some masks, I actually
made prototypes of two masks. I wanted to
see how difficult they were to make, I wanted
to see how comfortable they were to wear,
and I wanted to see how easily someone who
has a fabric stash might be able to address
this.
The first mask I looked at was a two-layer
mask with a filter pocket and adjustable wire.
The tutorial comes on the YouTube Easy to
Sew channel. The website is here, and Vrinda
will place the website in our comments as
well.
We see that the mask I was showing earlier
is made from this pattern. I found that this
mask was the easier of the two to make, although
it was a little bit difficult to get the elastic
into the loops on the sides. I used 10 inches
of a pipe cleaner doubled in half to make
the ridge line. See, this is the upper ridge,
so that it could be flexible and could conform
to one's face. So this goes on my nose, my
ears, I pull it down, I pinch the nose, I
come across the bridge, and that's this one.
I would say that when wearing this for a while
I felt more strain on my nose than I did with
the other mask that I'm going to show you.
Now if I were able to get filter material,
like an N95 filter material, I could put that
in this mask right there. I could insert it.
Other materials that could be inserted include,
if you happen to have a vacuum cleaner with
HEPA filter bags, you could cut a piece of
the HEPA filter bag and put it in here. It
gives about 92% effectiveness for blocking
the virus. The problem is it makes it sort
of hard to breathe and some people find it
too uncomfortable to wear for a long length
of time.
The second homemade mask I'm going to tell
you about is from Canada, and this mask has
a center seam down it. It uses elastic cord
rather than quarter inch elastic for the ears,
and it is again a two-layered mask with a
pocket so that you could insert something
else into the pocket. This mask, again, was
found on
a YouTube channel, the Sewing Therapy channel,
and I'll show you the mask that I made from
it.
Again, it has a way to put a metal ridge into
it. I used, again, 10 inches of pipe cleaner
that were folded in half, so I had two layers
of pipe cleaner up there. You see it has sort
of a more U-shape. It has a center seam. The
back pocket is made different. You can pull
it up and down. I think you could put an N95
mask inside this if you wanted to protect
your N95 mask from dirt and bacteria.
This mask, again, goes on over the nose, behind
the ears, you pull it down, you put it snug.
I can tell you this was a harder mask to make,
but it's more comfortable to me personally.
I'll probably get tired of that, but again
it's more comfortable to me, and it was a
little bit harder to make. So more comfortable
but harder, easier but a little less comfortable.
Both of these are two layers of 100% cotton
and they both have pockets for the possible
insert of a filter.
We've been talking about homemade masks. In
hospital situations, the University of Florida's
Department of Anesthesiology has come up with
another, or an alternative, to an N95 mask,
which they're making from a material... What
is the name? It's call halyard H600 two-ply
polyspun polypropylene... Or two-ply spun
polypropylene.
That material is often found in surgical trays
and it's discarded, so people who work in
hospitals can get ahold of this halyard H600
two-ply spun polypropylene. The key with this,
is masks made from this have about 92% efficacy
in blocking the virus from your face.
Now I've shown you that I have a lab coat.
Not everybody has a lab coat. Not everybody
has an isolation gown. So I wanted to mention
that just starting today there is a website
where you can download a pattern to make an
isolation gown. These come in adult sizes
from small to extra-large. You would make
them out of 100% cotton. They could easily
be taken off, turned inside out, and laundered
in hot water.
We have a question from Sukrit Sen that says
how do we sanitize our masks so that we can
reuse them? An N95 mask cannot really be sanitized,
so you're going to use them, and you're going
to use precautions to try to keep them clean
for as long as possible, and mine already
is not looking so hot. With your cloth mask,
you would take the filter out and discard
it. You would wash these in hot water.
If you are fortunate enough to have a respirator
with cartridges, the way they've taught you
to sanitize the respirator with cartridges
is there are alcohol wipes that you can use.
You start from the inside... No, you start
from the outside. You wipe down the outside.
You wipe down the most contaminated surface
first. Get rid of that wipe, take another
alcohol wipe and wipe down the inside of your
surface. Once you feel that your cartridges
are expended you want to
discard them and put a new set of cartridges
on a respirator. I hope that answers your
question Sukrit.
Our final question today is what are we going
to do with... Or how can we help our community?
If your museum, site, or firm has the good
fortune of having any of these following materials,
please contact your hospital or your first
responders and consider donating these items.
This N95 disposable respirator is the most
sought after item for healthcare professionals
right now. If you donate one you could be
saving a life. Nitrile gloves� Nitrile gloves
of all sizes are really needed, because I've
already talked to you about using two or three
of them every time you're having to take off
protective equipment, put protective equipment
back on. These are really important.
If you have the good fortune to have face
shields the hospitals are needing them. Safety
goggles might be useful. Disposable gowns,
Tyvek suits and hair caps are all needed right
now. If the hospital is following CDC guidelines,
it is unlikely that they will take homemade
masks except as a last resort, and we don't
know if we're going to get to the last resort.
Before you try to donate anything to your
hospital, to your first responders, contact
them and see what they need. Because hospitals
go through a lot of gloves they may have their
gloves, but contact them first to ask.
I think that just about concludes our presentation
today. Remember your personal protective equipment
is to protect you. It doesn't always help
the other person. Keep in mind that you can
donate your personal protective equipment
to places that are in crisis right now.
I want to thank my colleagues who, as always,
help me with these productions. You have Jason
Church, who's Chief of Technical Services,
Sean Clifford, who is the Information Technology
Specialist, Catherine Cooper, who's a Conservation
Scientist at NCPTT, Vrinda Jariwala, who is
my Research Associate and has been so instrumental
in fact checking everything that we put out,
and Isabella Jones, who is our Visual Information
Specialist and helps me turn these into videos.
We're hoping to have more information to you
soon and the next broadcast will be announced
on our website or our Facebook page as soon
as it's available. Thank you for tuning in
and I hope that this information will be helpful
to you. Thanks, and goodbye.
