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PPE Memo and GuidelinesCity Manager’s Office 215 E. McKinney St., Denton, TX 76201  (940) 349-8307 1 OUR CORE VALUES Integrity  Fiscal Responsibility  Transparency  Outstanding Customer Service DATE: April 20, 2020 TO: All City Employees FROM: Todd Hileman, City Manager SUBJECT: Personal Protective Equipment Guidelines During the COVID-19 Pandemic   On behalf of the City, I again want to thank you for all you are doing to serve our community. Duiring the COVID-19 pandemic, the safety of the community and our employees has been our most pressing and fundamental priority. While the City initially addressed employee safety through the closure of facilities, teleconferencing, and strict social distancing requirements, we must plan for how we may continue protecting our employees when facilities begin to open and the organization shifts toward normal operations. At the beginning of April, an cross-departmental team was formed with the goal of coordinating the use and supply of personal protective equipment (PPE) throught the organization. One of my first requests of this group was to create a set of guidelines that addresses the use of PPE within the organization. As stated in the guidelines, its intent is to keep our employees healthy by supplying them with the appropriate personal protective equipment (PPE) to accomplish their job responsibilities and to make PPE last as long as possible due to national shortages as a result of the COVID 19 pandemic. I ask every employee to carefully review the Personal Protective Equipment Guidelines During the COVID-19 Pandemic (attached). They will illustrate the appropriate use of PPE when an employee cannot maintain proper social distancing. Also attached is a template that department directors and supervisors can use to determine which PPE each employee should use.As COVID-19 safety standards change, we will update our guidelines accordingly and distribute them to the organization. Thank you for your continued efforts to improve of the safety our community and each other. COVID 19 Personal Protective Equipment (PPE) Standard Operating Procedure _________ Department Policy: In accordance with the Personal Protective Equipment (PPE) Guidelines, each employee will wear their normally required PPE and any additional PPE identified based on OSHA 3990 recommendations. Each job has been evaluated and additional PPE has been identified in the Risk and PPE Chart below. Any PPE needs not addressed, or special requirements based on job responsibilities, and pertaining to the COVID 19, need to be addressed in the Special Request Chart below. RISK AND PPE CHART Department Job Title Exposure Risk (OSHA 3990-Very High, High, Medium, Low) Additional PPE Required (Goggles, Gowns, Gloves, Masks/Respirators) Ex. Fire Fire Fighter/Paramedic Very High Risk Goggles, Gown, Gloves, N95 Respirators Special Request Chart This chart should include any special requests. Examples: FR masks, or N95 respirators based off a medical providers recommendation. Department Job Title Exposure Risk Special PPE Requirement Reasoning Ex. DME Lineman Medium FR Masks Due to arcing, we need a completely FR uniform and mask to be safe.           Personal Protective Equipment (PPE) Guidelines During the COVID 19 Pandemic Purpose The intent of these guidelines is to keep our employees healthy by supplying them with the appropriate personal protective equipment (PPE) to accomplish their job responsibilities and to make PPE last as long as possible due to national shortages as a result of the COVID 19 pandemic. During this pandemic, the City of Denton will continue to evaluate the changing recommendations by the Center for Disease Control (CDC), the Federal Drug Administration (FDA), the Occupational Safety and Health Association (OSHA), and other federal and state resources about how to appropriately protect our employees. Guidelines Employees will continue to meet current PPE standards outlined in their respective Department procedures, based on job responsibilities. Due to increased risk during this pandemic, any time City of Denton employees are around the public or coworkers, they will need to wear a surgical or cloth mask which covers the mouth and nose. This will be considered the minimum acceptable PPE when performing work responsibilities or activities where the recommended social distancing standards cannot be met, including but not limited to in-person meetings, small group gatherings, and sharing a vehicle. Furthermore, the City of Denton will utilize the OSHA classification system to determine the risk level of exposure (very high, high, medium, or low) for each employee. Department Directors, in consult with Human Resources, will evaluate job duties in accordance with factors set out in the OSHA guidance to determine if additional PPE is required to combat the COVID 19 pandemic. Departments will identify employee classifications (i.e. OSHA 3990- Guidance on Preparing Workplaces for COVID 19) within a written procedure for cost recovery purposes. Types of PPE The main components of PPE are goggles, gloves, respirators, masks, and gowns. There are various types of each. Here are some guidelines for determining the appropriate PPE to wear and considerations on how to wear it:  Goggles- Make sure they seal the eyes completely. Glasses or goggles with vents are not considered full protection. However, if nothing else is available, safety glasses are better than nothing. o Who should wear them? For non-healthcare providers, safety glasses and social distancing should be sufficient for daily wear.  Gloves- There are different types of gloves. Some are approved for handling food and some are medical grade. o Who should wear them? If an employee is handling money, food, or coming into close contact with people (<6ft.) then they should wear medical grade gloves. The boxes will usually say “for medical use” on them. Otherwise, any kind of glove is better than no glove.  Gowns- Mainly used by healthcare providers who are in close proximity to known, or suspected, infectious patients. o Who should wear them? With the current shortage, there should be no reason for someone outside of the healthcare field to be wearing a disposable gown. However, staff can bring a change of clothes.  Masks/Respirators- Surgical masks and cloth masks are considered the acceptable minimum for City employees within these guidelines. Masks should always be tight fitting and cover the nose and mouth at all times. Facial hair should be shaved in a fashion that it does not impede a mask from functioning as intended. o N95 respirators, or equivalent- These respirators shall be used by healthcare providers (Fire/EMS) and Law Enforcement Officers when performing any job functions that requires medical treatment of a patient. o Surgical Masks- These masks are disposable and should be discarded if they become soiled or dirty. They should only be used for one 24-hour period. o Cloth Masks- Any cloth mask is acceptable, donated or purchased, so long as it covers the mouth and nose completely. 100 percent cotton has proven to be of good quality for this purpose. Cloth masks should be made to be machine washable and washed daily. More information about cloth masks can be found here: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting- sick/diy-cloth-face-coverings.html Donated/Issued/or Supplied PPE PPE will be provided by the City at the City’s cost, and distributed to departments based on the specifications set forth in the respective departmental procedures. Employees have the option of bringing their own PPE, provided it meets departmental specifications. Employees issued/assigned PPE are required to dispose of used PPE appropriately (for disposable/“one-time use” equipment) or daily clean (wash and sanitize) their utilized equipment. Classifying Worker Exposure Risks The City of Denton will utilize the OSHA classification system (below) to determine the risk level of exposure for each employee. PPE shall be distributed and required based on the risk level of each employee. Department Directors will start evaluating their employees and classifying their jobs under the guidance given by the OSHA classifications. Each Department will need to identify each employee classification within a written policy for cost recovery purposes. OSHA 3990- Guidance on Preparing Workplaces for COVID 19 Classifying Worker Exposure to SARS-CoV-2 Worker risk of occupational exposure to SARS-CoV-2, the virus that causes COVID-19, during an outbreak may vary from very high to high, medium, or lower (caution) risk. The level of risk depends in part on the industry type, need for contact within 6 feet of people known to be, or suspected of being, infected with SARS-CoV-2, or requirement for repeated or extended contact with persons known to be, or suspected of being, infected with SARS-CoV-2. To help employers determine appropriate precautions, OSHA has divided job tasks into four risk exposure levels: very high, high, medium, and lower risk. Most American workers will likely fall in the lower exposure risk (caution) or medium exposure risk levels. Very High Exposure Risk Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures. Workers in this category include: ■ Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known or suspected COVID-19 patients. ■ Healthcare or laboratory personnel collecting or handling specimens from known or suspected COVID-19 patients (e.g., manipulating cultures from known or suspected COVID-19 patients). ■ Morgue workers performing autopsies, which generally involve aerosol-generating procedures, on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. High Exposure Risk High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19. Workers in this category include: ■ Healthcare delivery and support staff (e.g., doctors, nurses, and other hospital staff who must enter patients’ rooms) exposed to known or suspected COVID-19 patients. (Note: when such workers perform aerosol-generating procedures, their exposure risk level becomes very high.) ■ Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected COVID-19 patients in enclosed vehicles. ■ Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. Medium Exposure Risk Medium exposure risk jobs include those that require frequent and/or close contact with (i.e., within 6 feet of) people who may be infected with SARS- CoV-2, but who are not known or suspected COVID-19 patients. In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers who may return from international locations with widespread COVID-19 transmission. In areas where there is ongoing community transmission, workers in this category may have contact with the general public (e.g., schools, high-population-density work environments, some high-volume retail settings). Lower Exposure Risk (Caution) Lower exposure risk (caution) jobs are those that do not require contact with people known to be, or suspected of being, infected with SARS-CoV-2 nor frequent close contact with (i.e., within 6 feet of) the general public. Workers in this category have minimal occupational contact with the public and other coworkers. PPE Guidance As It Pertains To Risk Exposure After determining each position’s risk exposure, Department Directors should use the following OSHA recommendations when determining the level of PPE required for each risk exposure category. Very High/High Risk- Gloves, Gowns, Face Protection, and Masks or Respirators depending on the employee’s risk of encountering persons known, or suspected, to be COVID 19 positive. Medium Risk- Workers with medium exposure risk may need to wear some combination of gloves, a gown, a face mask, and/or a face shield or goggles. PPE ensembles for workers in the medium exposure risk category will vary by work task, the results of the employer’s hazard assessment, and the types of exposures workers have on the job. Low Risk- Requiring employees to wear surgical or cloth masks when they are around people is recommended for workers in the lower exposure risk group. This requirement is above and beyond the recommendations by the CDC for people who are high risk of severe illness from COVID 19 due to pre-existing conditions. Workers should also continue to use the PPE, if any, that they would ordinarily use for other job tasks. Conclusion The City of Denton is committed to keeping employees healthy and safe during this pandemic. Currently, there is a nationwide shortage of Personal Protective Equipment (PPE). The preceding guidelines are intended to keep employees from being exposed to infectious diseases, like COVID- 19, and to prolong PPE inventory. There may be a time when PPE is no longer available. Therefore, the City must find ways to extend the usefulness of its current inventory in the safest way possible.