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By: Kevin Asp, CRT, RPSGT on March 25th, 2020

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COVID-19 (Coronavirus) and Sleep Centers: Risks, Precautions, and Recommendations


COVID 19The coronavirus disease 2019 (COVID-19) outbreak is affecting individuals in the U.S. and across the globe. Anxiety and fear surrounding it can cause strong emotions and can be overwhelming. Because they're at the forefront where they can be exposed to the virus, healthcare workers, including sleep clinicians, are among those who are experiencing stress and uncertainty caused by COVID-19.

COVID-19 and Sleep Centers

The Public Safety Committee of the American Academy of Sleep Medicine (AASM) is providing a response to frequently asked questions (FAQs) on a dedicated webpage in order to help accredited sleep facilities and sleep technologists address the spread of the asymptomatic virus. AASM will update this FAQ page as needed as new relevant information surfaces and questions arise.

The AASM will address questions as much as possible of specific relevance to COVID-19's impact on sleep medicine practice. But, members and readers need to know that developments pertaining to COVID-19 that healthcare workers require for guiding clinical decision-making is still emerging.  Along with reviewing the CDC's Infection Control information and other CDC COVID-19 information, sleep clinicians, accredited sleep facilities staff, and healthcare workers should also obtain guidance from their local and state health departments.

Risk Management in the Sleep Center: Infection Control 

This FREE module contains extensive discussion of infection control guidelines ranging from hand washing to flu vaccines. General requirements include universal precautions and use of protective gear.

Risks in Sleep Centers using CPAP/BiPAP 

There are certain risks of using CPAP, BiPAP and other types of equipment needed for administering Positive Airway Pressure (PAP) to patients with suspected or known cases of COVID-19.  

For instance, during the SARS-CoV outbreak in Toronto, half of all cases of SARS-CoV were in healthcare providers and despite current safety protocols, three of them died. The biggest risk of being exposed and becoming infected was in those individuals involved in airway manipulation or in individuals who experienced aerosolized pathogen exposure due to positive airway pressure therapy, nebulizers or high-flow nasal oxygen treatment.

 There's limited published data, and what's available suggests the use of PAP therapy could potentially increase particle dispersion. Because of this potential for increased risk of infecting other people, you should base the administration of PAP therapy through a mask on a comprehensive risk-benefit analysis for COVID-19 infected patients.

The Risks of Continued PAP Therapy

  • There could be an increased risk of COVID-19 transmission to other people in the environment of continued PAP therapy. Take those living in the patient's proximity into consideration, particularly if they're at risk for serious infection. Theoretically, there's a greater risk of dispersing the virus with PAP therapy than without it, but it's not yet known how much the risk to other people changes because of PAP treatment specifically.

  • Depending on the surface type, viral particles could persist.

  • Individuals who are at risk of infection because of PAP therapy include all those living in the same residence.

  • It's not known yet if patients can become reinfected from reusing filters, tubing or masks.

General Precautions of Healthcare Workers and COVID-19 

Here are some precautions healthcare workers should take when it comes to COVID-19:

1. Healthcare workers should consult with their state or local departments of health to figure out if their patients meet Persons Under Investigation (PUI) criteria. Healthcare workers should notify their facility's infection control personnel immediately if they suspect a patient has COVID-19.

2.  Healthcare workers should follow the guidelines placed by the CDC for infection prevention and control (IPC), if they care for patients that have received a diagnosis of, been exposed to or are at great risk for contracting the virus.

3. Practice measures to avoid spreading the virus. There is still a lot to learn about COVID-19 and this includes how it spreads and how easily. Based on what's presently known about this virus and about other types of coronaviruses, spreading is believed to occur mostly between people in close contact with others through respiratory droplets.  

You can come in close contact with a patient you're caring for if you:

  • Are within approximately six feet (two meters) of patients with the virus for an extended period of time.

  • Have direct contact with a COVID-19 patient's infectious secretions, such as serum, sputum, respiratory droplets and blood.

If you do come in close contact with a COVID-19 patient while you're not wearing all recommended PPE, you could be at risk of becoming infected yourself.

4. Healthcare workers who care for patients with possible or confirmed COVID-19 should follow recommendations by CDC for IPC or infection prevention and control, which include:

  • Evaluate and triage patients who are experiencing acute respiratory symptoms or who have COVID-19 risk factors to reduce chances of exposure, which include placing them in an exam room and closing the door and having them wear a facemask.

  • Use Standard and Transmission-Based Precautions, when caring for patients with possible or confirmed COVID-19, Practice alcohol-based hand rub hand hygiene when coming in contact with possible infectious material, before and after you come in contact with patients and before you put on and remove PPE, which includes gloves. If your hands are visibly soiled, use soap and water.

5. Practice environmental cleansing and disinfecting. Perform regular cleaning and disinfection procedures in  healthcare settings, particularly in areas where you perform aerosol-generating procedures. Perform management of laundry and medical waste in accordance with routine procedures using standard precautions. 

Recommendations for Sleep Clinics and Sleep Labs

Once community COVID-19 transmission subsides, you can then re-assess all sleep care services. Guidelines are put in place to not only keep your patients safe, but also your healthcare workers and sleep technologists. It's important that everyone does their part to minimize and halt the spread of COVID-19.

Sleep clinicians and sleep facilities should also refer to AASM COVID-19 Mitigation Strategies for Sleep Clinics and Labs.  

About Kevin Asp, CRT, RPSGT

Because of the implementation of his best practices of Implementing Inbound Marketing in its Medical Practice, he turned the once stagnant online presence of Alaska Sleep Clinic to that of "The Most Trafficked Sleep Center Website in the World" in just 18 months time. He is the President and CEO of inboundMed and enjoys helping sleep centers across the globe grow their business through his unique vision and experience of over 27 years in sleep medicine.

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