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PPE Fit and Health Care Equity

Learning Objectives
1. Identify challenges with PPE fit that doctors have experienced
2. Describe why health care providers and systems might have difficulty acquiring appropriate PPE
3. Explain the importance of advocating for all health care workers to have well-fitting PPE
0.5 Credit CME

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Audio Transcript

Megan Srivinas, MD: [00:00:06] Welcome to Stories of Care, a podcast from the American Medical Association and the CDC's Project Firstline. On this episode, I spoke with Dr Nicole Yedlinsky, a family medicine and sports medicine physician practicing in Kansas City, Kansas. As a petite and athletic woman, Dr Yedlinsky has struggled to find properly fitting PPE, a problem greatly exacerbated by the COVID 19 pandemic. We're also joined by Dr David Kuhar, an infectious disease physician at the CDC Division of Health Care Quality Promotion. Together, we discuss Dr Yedlinsky's story and the importance of access to properly fitting PPE, both as a matter of safety for practitioners and patients, and as a critical aspect of creating diverse, inclusive health care environments where everyone is supported and treated equitably. Hi Dr Yedlinsky and Dr Kuhar. Thank you so much for being here and joining us today to discuss such an important topic. To start, Dr Yedlinsky, I'd love you to tell us a little bit about your experience in this area and what your background is.

Nicole Yedlinsky, MD: [00:01:15] So specifically, I am a sports medicine and family medicine physician. And so we found that during the pandemic especially, we were running into issues with obtaining personal protective equipment, particularly, otherwise known as PPE, particularly PPE, that was a good fit, especially for individuals who maybe don't fit the quote unquote standard size of physicians.

Srivinas: [00:01:49] Is this something new that popped up during the pandemic or did you have issues even prior to the pandemic?

Yedlinsky: [00:01:55] You know, I think the issues existed well prior to the pandemic. I just think it was something that was highlighted and exacerbated during the pandemic, especially during the early days when it was so important for us to have really good fit for, say, an N95 mask or the respirators or the gowns that we were wearing early on. You know, initially in the, in the pandemic, we just didn't have all the information to know how COVID was transmitted, what were risks, what weren't risks. And so we were trying to be as safe as possible. And the issues that we were running into was having equipment that we felt appropriately protected us in the clinical environment while still being able to provide excellent care. You know, medicine is, has a high demand on physicians. It's an emotional demand. It's a mental demand. It's a psychological demand. And when you don't have gear that fits appropriately, it really takes that extra toll. And especially in clinical spaces where we're being asked to work extra hours, it just took more of a, more of a demand then than prior to the pandemic.

Srivinas [00:03:17] Now that, that makes complete sense. And when you don't have the right gear, how do you, how do you balance your, your need to take care of patients and that oath that you take while still trying to keep your well-being in mind? How did how did you all handle that on the front lines? What did you experience?

Yedlinsky: [00:03:40] So in my situation, right, I, you know, and I think that this was probably more unique to females in the, in the medical space just overall. You know, the there's the truth that females on average are smaller than our male colleagues. And as a result, I had to get fitted several times for a different N95 mask. So I had to go in, get fitted. I had to try several different kinds before I found that one that worked for me. And then about two weeks later, with all of the supply chain issues, that one was not, they couldn't get in-stock. So then I had to go back. I also had another issue with finding eye protection that worked well and didn't fog up, that also fit my face. And that was another issue. You know, we have a lot of focus in the clinical space of making sure that we're as inclusive as possible. And I think part of that inclusivity needs to focus on making sure that all of, all of the individuals that we are saying we want to welcome into that space need to be made to feel welcome. And one of the ways that we need to do that is by making sure that all of the supplies that we need to do our job well are available to us.

Srivinas: [00:05:04] You know, that's a great point. And I would love to bring in Dr Kuhar at this point. If you can start by giving us a little bit about your background and what your experiences then were with exactly what Dr Yedlinsky is talking about.

David Kuhar, MD: [00:05:16] Yeah, absolutely. So I'm David Kuhar. I'm an infectious diseases doctor by training. My usual day job, I work for CDC in the Division of Health Care Quality Promotion, and we put out the infection control recommendations for health care settings, inpatient and outpatient setting. So it, it covers them all. And oh, the pandemic. Wow. What can I say? And especially in the early days. And I should also say I am still clinically active and I do part time practice at a local hospital. So I think I see both the, the public health end as well as some of the clinical end as well. And oh my, I almost don't know where to start. You know, personal protective equipment is key for health care workers. And if you think about protection in health care, it is, we have a lot of a lot of controls in place that keep us all safe. We have things like engineering controls that, you know, air systems that, you know, clear the air. We have administrative controls like things like work processes that help keep us safe, like putting a patient in a separate room, etc. But when it comes down to it and believe it or not, even though we think of it as the least effective method, personal protective equipment, because it's dependent upon being used consistently and correctly, it's super important to morale, feeling like you're safe and being able to do your job. And it is the last line of defense when we have to be, you know, face to face with someone. Companies try to make things so that they are going to fit the widest range of body designs possible. Right. It's better for them if they do because, you know, they're able to accommodate more people, etc. But, it's never perfect. And there are people who are outliers and I think have absolutely a tougher challenge in finding the right manufacturer who is making the right size and it fits them and it makes it harder and it's super unfortunate.

And then I think the pandemic itself made this so much more challenging as we had essentially a crisis in personal protective equipment where we started to run out of all of the critical supplies that we needed. I think there were probably a lot of reasons for this, including lacking, I think, an ability to locally produce a lot of what was needed. We had been importing a lot of this for a long time, which just caused a crunch like I think none of us had ever seen in our careers. So, you know, where am I going with this? I almost don't know what more I can say. This is a super important topic. It's critical that we have appropriate fit and appropriate supplies available. And I could even go on. I don't want to go too far. I mean, the fit is also key to protection. You know, there's a there's an OSHA standard, the Occupational Safety and Health Administration, personal protective equipment standard. All employers have to provide appropriate equipment to their employees. This includes health care and going, you know, a step beyond. We are supposed to be taught what we need, when to use it, how to use it. And that includes being able to remove it without contaminating ourselves. And when your equipment might not fit quite correctly, it can make removing that equipment and keeping your say, yourself safe also more difficult. So I hope I mean, what Dr Yedlinsky, I think, is talking about is probably not, unfortunately not that uncommon a perspective in the pandemic. And I can say I certainly saw dwindling supplies in clinical practice when out there. It was I'd say the first time in my career I felt like I've ever seen anything like this and hopefully the last. Yeah, yeah.

Srivinas: [00:09:18] And with the dwindling supplies, you would often find that certain sizes would run out more quickly. And how did that impact it? I mean, when we're looking at all of this infection control approach, we also have to keep equity in mind as you're talking about different fits and everything of that nature. So the dwindling supplies themselves, how did you see it impact the equity of our health care systems and being able to provide for our employees? Dr Yedlinsky, I'll send that to you first.

Yedlinsky: [00:09:50] Yeah, well, I think, you know, much like what Dr Kuhar said about protection. Right. So if you don't have those supplies available, but you still have a job to do, you still have a mission, still have patients to take care of, then maybe you're sacrificing your own protection, your own safety for the needs of those patients. And for sure, on one day, if something wasn't available, then you sort of had to scramble to make something else work for some individuals who couldn't find a certain mask in the size that they needed.

Then they had to resort to say there's the, the PAPers, which are just like a portable device that's almost like wearing a whole hood on your on your face. And, you know, many of our patients have communication, other communication issues, whether it's speaking a language other than English and having to use interpreters or perhaps our patients who are hard of hearing and that just added an extra layer of difficulty to providing that necessary patient care. You know, I think it also probably led to many physicians maybe cutting corners and putting their own safety at risk because they were just going to take care of the patient and take their chances if they didn't have the supplies that they needed. And, you know, that's an unfortunate situation. And I think it led to a lot of burnout among our physicians who really felt like they were they were, they were at their, at their limits when it came to the patient load and all of those things just having to do with the pandemic in general. But then when their own personal safety was at risk, then it then it just added to that.

Srivinas: [00:11:41] And I can actually really relate to what you're talking about, Dr Yedlinsky. I ended up catching COVID myself in March of 2020 because I was taking care of a patient and didn't have a mask. But my patient needed oxygenation immediately. And luckily for me, I recovered quite easily. I did have a bout of long COVID, but I definitely see the impact personally, and having it be in such a widespread system is concerning. And our conversation has been so, so focused on a lot of the patient care side of things. It makes me also wonder then about the other employees in the health care system, the people who are helping with EVS, the other people who are going in and out of these rooms that are at so much risk. What did you see, Dr Kuhar, from your perspective at looking at many of these guidelines and the supply chain, how are those employees also taken into consideration with the fit tests and the need to have these different varieties of sizes?

Kuhar: [00:12:42] And I can tell you things that we, we heard from a lot of facilities that were struggling. So, you know, first I mean, it was interesting to hear Dr Yedlinsky talk about how she could get fit tested to one N95 respirator, and then the supply runs out and you get another one and you feel like you're starting over. We had, we had heard about facilities that were getting supplies shipped in and they'd get a different respirator every week. And if they didn't have someone on site who could fit test them, they'd have to schedule an appointment to have someone come back and would probably spend four days of the week with everybody wearing respirators that they weren't fit tested to, to get them finally fit tested and then to get another model starting the next week. And sort of this ongoing, ongoing supply changes making this really difficult, if not impossible to do well. A lot of facilities felt like because of, you know, many of the strains, I think that they were in the position that they felt like they had to almost want to say designate the supplies for certain areas and certain kinds of patient care. So they were not going to offer, you know, make respirators and things readily available off of, say, the non COVID-19 care ward and other areas. And I think this absolutely caused feelings of inequity among sometimes different physicians working in other parts of the hospital, feeling like, hey, you know, I still I'm still doing something where a respirator could be indicated. Do I really not going to have one available to me? Is this really where, you know, are these other places more important? And so I think that the effects were even far beyond just COVID care in general. It was widespread in a health care facility. And that that was awful and something else, truly. And I think, you know, to your to your other question about, you know, what about other types of health care workers? You know, I. I felt like. I felt like there was impact across the health care worker spectrum. Everybody felt this to some degree if you were involved in providing patient care. I think our nurses were the ones that probably felt it a lot, the most. If you think about the tasks or the jobs that a nurse, that a nurse does every day, this involves a lot of intense, close contact with the people that they're caring for. And in some ways, you could argue a nurse probably has the most contact in a day with a contagious patient, meaning they're probably, among different health care worker groups, probably among the most consistently at higher risk for exposure should they not have the equipment. And I think we saw a lot of attrition among nurses in general, and nursing shortages became an incredible problem throughout.

Srivinas: [00:15:34] And from your perspective, Dr Yedlinsky, in the direct care setting, did you notice even prior to the pandemic really setting in, were there issues with fit testing being available at the frequency needed? Some of what Dr Kuhar was talking about having during the pandemic. Was that an issue even before?

Yedlinsky: [00:15:54] Not particularly. Mostly because outside of an infectious disease setting, we really didn't need to have that, such a high level of infectious disease control. It really wasn't anything. You know, maybe if you had a patient who was admitted with suspicion of, say, tuberculosis, then all of a sudden it was this, this higher level of care and concern. But before the pandemic, it didn't really highlight anything. Now, I think there were still some issues with fit like, for example, you know, I have, you know, I, I take care of obstetrical patients. I deliver babies. And I noticed before the pandemic that whoever was supplying the gowns that we use, all of a sudden it seemed like these gowns were several sizes, much bigger. And so I was almost swimming in them when I was trying to put them on. I'm only five three. I'm not the tallest person in the world. And it just it, you know, and that was even before the pandemic.

To Dr Kuhar's point. Right. It's somewhat to the advantage of the suppliers to make it a one size fits all. But then that really can impact the, the health care workers' ability to perform the tasks that they need to perform. You know, because I'm, I was swimming in fabric, this not even fabric, it's like that coated plastic paper. But, you know, it just adds an extra level.

Srivinas: [00:17:27] And how about from your perspective Dr Kuhar? Were you seeing patterns of other health care workers or even other health care settings that were having issues with the testing prior to the pandemic?

Kuhar: [00:17:40] Prior to the pandemic? Not so much. I think it's that the settings that generally use respirators and use them with relative frequency fit test their staff and I'm sure it's not perfect everywhere out there, but that's what they're supposed to do and that's what they're, you know, held to by requirements, etc.. But during the pandemic, the other, the other really challenging thing that happened is suddenly nursing homes, outpatient settings and other areas that never used really respirators before suddenly needed to fit test their staff and gain a supply or, you know, basically develop a new supply chain where supplies were dwindling and all the usual supply chains were running out. And so it was that, it placed, I think, extra stress on them. And it placed them in a position where they had to kind of develop all this, develop a respiratory protection program for their you know, for their workers in the middle of all supplies running out. Absolutely. Absolutely. A challenge. And I would say we definitely heard a lot about challenges in that outpatient area as well as nursing homes. Who I think in particular, were getting what I described, a different type of N95 sent to them every week and making it with them. And that typically a place that does not have someone with an occupational health background and who can fit test on site. Making, scheduling and getting this done, you know, consistently for their employees almost impossible, I think almost never imagined that that was what was going to happen, but it absolutely did. And it was pretty widespread.

Yedlinsky: [00:19:21] Yeah. And to add to that, you know, before the pandemic, you had such a small percentage of our patient population who were possibly, you know, highly infectious. That you needed to wear a higher level of PPE to take care of them. Where then during the pandemic, all of a sudden it was so many more people needed to be wearing this higher level of protection. And then it was just a numbers game. So you needed more equipment for more people. And that equipment is, for the most part, one time use, which then all of a sudden now you need more of it to go see the next patient and the next patient and the next patient. Whereas if you have just one patient who needs higher level protection, then you can much better limit the number of interactions with staff. And then it's not that higher volume of supplies.

Srivinas: [00:20:24] And how did you account for this in the beginning? I mean, we've had kind of a very a two years of a variable kind of curve as far as what's been available to us with, you know, the sudden surge of, of need at the beginning and then finally were being able to catch up from a supply chain perspective. So before we're really able to get there, how did you accommodate this, this need for a sudden surge in a way that still was trying to keep equity in mind and an ability to provide for your, for all staff?

Yedlinsky: [00:20:57] So, you know, I work for a very large academic medical center, so thankfully it wasn't up to me to do all of the, the, the ordering. So it wasn't as big of an issue. But we definitely saw, you know, there was more than one surge, at least in our location where I worked. And, and actually we ran into issues at several points in the pandemic. It wasn't just at the beginning. It was also that, you know, we had another surge at the end of 2021 and saw some of those issues coming back because, you know, it was, it was a recurrent issue. And then we had all of those higher supply chain issues that had been more to do with ships that were coming over and getting stuck and not being able to download their, their supplies at the different ports. And, you know, so there were lots of issues at different points and it seemed to be maybe different issues at different times where those factors came into play.

Srivinas: [00:22:06] And so what you're telling me, which is, which also raises concern because it was so recent, was that even in the latest surge, we still didn't have a lot of the supply issues yet stabilized.

Yedlinsky: [00:22:18] Yeah, it seemed to be different issues at different times depending on where in the pandemic we were and what issues we were dealing with. So later on in the pandemic, it was different issues than at the beginning. At the big, at the beginning, it was more making sure everybody was fit tested, making sure people had the. It meant that they needed, you know, and then later on down the road, it became some of the different, different factors that came into play.

Srivinas: [00:22:46] So with the equipment in the testing, not as big of an issue than with the most recent surge, or was it still surrounding those same things?

Yedlinsky: [00:22:54] It was still an issue. It was just kind of kind of different, different factors that went into why it was an issue at different times in the pandemic. You know, towards that, this most recent surge, we had, you know, a better grip, I think, on maybe which patients needed higher level of protection and which ones, you know, you know, towards the end of the pandemic, you know, there was much less of a concern about contact precautions. Right. Because we really honed in on the fact that this was, you know, aerosolized. So we didn't need to do as much of the contact precautions. So then the focus could then be more on the respirators and N95s and those types of equipment and protection. But we still, still ran into issues with that.

Srivinas: [00:23:49] And what are you doing to kind of mitigate potential issues that might arise if there is another surge in the future, as we're anticipating, you know, something to happen in the fall or winter.

Yedlinsky: [00:24:00] That's a really good question, and I'm not sure that I know the answer to that.

Srivinas: [00:24:05] Dr Kuhar, I'm sure that your body is probably trying to figure out this very question has been working on this. This might be something that you may be able to help us on.

Kuhar: [00:24:13] Well, this is a, this is a question that's much bigger than CDC. I mean, this is much bigger. I mean, this is about, you know, for better or worse, we have a free market here for those who develop and make these things. And it's really about a higher level of coordination and sort of making sure that manufacturers are going to have supplies available for us. And, you know, I think that the early surges where we ran out of equipment has also left everyone feeling unsure about what happens with the next surge. Are the supplies going to hold? And when the surge starts, I think a lot of facilities and practices start conserving personal protective equipment. They start using it not in sort of the standard ways that we do, which is, you know, a single shot with each patient, but want to start extending use and doing other things because you feel is there really, is the next shipment really coming? Can I rely on it? You know, I don't want to run out and so on. That feeling of uncertainty, I think, has also led to, you know, some of just conservation, maybe even when it might not be necessary. I know that there have been a lot of efforts to ensure that there will be, that local production can be ramped up. Should that, should say, you know, should there be another surge, or another huge increase in demand and that there are there are pieces in place to do this that were not present earlier. And I think that this has been seen by the White House and I think, honestly, by everybody in health care as a key priority. If we can't keep ourselves safe and feeling safe when caring for people we don't, you feel like you can't, almost can't ensure the safety of your patients, that the system starts to fall apart and that needs to just never happen again.

Srivinas: [00:26:07] And you touched on a couple of things that that really piqued my interest there. And I would love both of your perspectives on this. First, you mentioned conservation practices when things start to pick up. And, you know, we've heard so many different things extending the amount of utilization over a period of time and kind of foregoing some of the typical things that we do. Were some of these practices that you saw, were they, did ever raise concerns for safety and some of the things that were being done?

Yedlinsky: [00:26:36] Yeah. So, you know, at the beginning of the pandemic, we were encouraged to reuse N95s and send it out for cleaning. We kept them in these paper bags that had our name on it. And yeah, absolutely. It was like, okay, is this providing the same level of protection as, you know, given that it was something that was supposed to be a single use item? You know, and there were reassurances that it was, that it was safe, that it was fine. But I think always in the back of our minds, there was that question.

Kuhar: [00:27:07] Mm hmm.

Srivinas: [00:27:08] And then that tags right back to what you were talking about, about burnout among health care workers and feeling like they're not necessarily having their well-being kept in mind.

Yedlinsky: [00:27:18] Yeah, there seems to be this hope, right? That we won't be in this situation again, that this is a one in 100 years pandemic, and maybe we can take some of the lessons that we learned, but hopefully never have to deal with them again. But I think that that is probably not a great strategy for moving forward, that maybe these whole ideas of production and being able to ramp up production, perhaps even having stockpiles of supplies available, you know. And again, if, if our goal in health care is to have more diversity and equity, then we also need to look at making sure that the supplies that we have available serve that purpose as well, and that everyone who wants a place in health care has, feels that, that they are supported and safe and welcome.

Srivinas: [00:28:24] And that's a really important point that you brought up before and bringing up again, the whole aspect of equity with these fits and ensuring that we're really taking into account people's identities and enabling them to feel safe while also monitoring the diversity and ensuring that their identities are being upheld. And I know as physicians, we often get modules and everything that teach us about the importance of fit that we have to take every single year. And so it's drilled into us. And we also have that experience from learning about it from a disease perspective. What about employees that are still involved in patient care but don't necessarily have the health care background or expertize in these materials? Did you find that it was difficult to ensure that everybody was getting access to information to ensure that they were donning and doffing correctly, that they were understanding the importance of utilizing the right mask and the right fit at each time? Was that an issue that that was challenging during the pandemic for you all?

Yedlinsky: [00:29:25] I think at our location it was more making sure that that, and I kudos to where I work that that was actually well distributed information and making sure that everybody was on the same page. We had lots of signage around and making sure that everybody knew what they were supposed to be doing, what locations needed what level of PPE. And so that was that was definitely something that we did well here.

Srivinas: [00:29:53] That's really great to hear. And Dr Kuhar, I noticed you started to look like you were interested in commenting on that as well.

Kuhar: [00:30:01] Yeah. I mean, you know, I think it sort of depends on the health care setting. I think how how hard sort of expanding personal protective equipment use was on staff, etc.. But, you know, if you think about it, you know, we went to universal source control in health care with everybody masking. And so you still are going to have people who sit at desks greeting patients, etc., who aren't typically trained. And so I think a lot of places had to expand that training program almost on no notice, you know, to really get people used to wearing these things correctly. And if you think about it, if you work in health care, we set the example for what everyone sees. And so you want the person at that front desk to be wearing the mask correctly, not having their nose hanging out, you know, not wearing it on their forehead and all the things that we see. Not cutting a hole in the middle so you can breathe better and it sort of eliminates the function of the mask.

Yedlinsky: [00:31:01] Yeah, I saw that more with some of the patients really. So when we were asking our patients to universally mask and many of them were not wearing those masks appropriately. You know, it's sort of like incumbent on me as a health care physician to educate a patient on how to wear a mask appropriately. And that it was sort of an awkward conversation.

Kuhar: [00:31:26] Yeah.

Yedlinsky: [00:31:27] And I even had patients who maybe didn't think that the, that COVID was as much of a risk as it was. And so that was also a challenge as well.

Srivinas: [00:31:38] And I mean, the whole rhetoric around COVID has been very, very difficult in our society as a whole. So I can imagine that that created more challenges, especially in trying to get everyone on board throughout an entire health care system, in every single position like you were discussing, Dr Kuhar. What, what are your visions for the future on how we should best prepare to to be ready for what might come up, both from a PPE perspective, but also specifically keeping equity in mind and trying to encompass everyone in our health care systems.

Yedlinsky: [00:32:17] So I would certainly love to see a greater focus on having a wider variety of PPE in different sizes and shapes to fit all of our health care workers so that they can feel both valued and protected. I'd certainly also like to see there be perhaps a better effort at some of the things that Dr Kuhar mentioned in terms of ensuring supply chains and making sure that the equipment that we need is available when we need it.

Srivinas: [00:32:50] And Doctor Kuhar.

Yedlinsky: [00:32:51] Said.

Srivinas: [00:32:53] I would love your perspective on this too, from perhaps what you are already anticipating from the CDC standpoint or what you would like to see you do?

Kuhar: [00:33:01] Well, no, I'm you know, like I said, some of this is a lot bigger. A lot of these issues are bigger than CDC. And to some degree, you know, manufacturers do what is going to be profitable for them. However, I think what needs to, I can echo with Dr Yeslinksy said enough about the importance of having a good variety for appropriate fit. And there's nothing better to have happen than a crisis that brings this to light. It gets people interested, it draws investments. And I think, I think there has been a great realization that if we don't protect health care workers and they don't feel protected, that health care starts to collapse. And that is a complete disaster for the entire country and something that no one wants to see happen. So I'm hopeful that manufacturers are going to kind of expand those designs, etc.. I know that the federal government has been working on sort of a more multiagency, kind of united front on ensuring that those supplies are available. And I think the other key thing is, is that I think it's important for health care workers to know what do you do if your equipment's not fitting and to remember you have options. OSHA requires that your employer provide you appropriate functioning equipment. You can talk to your employer about this and say, help me, this isn't fitting. I'm not sure what to do. It can go to a consultation with an occupational health provider to help you. And if you feel like your employer is not responding, OSHA on their website has an area that you can file a complaint. And they are responsive and will investigate to kind of make sure that someone addresses your safety needs. And so I think it's really important that people remember that there are options. It's not perfect. It's not always a one size fits all. But there are there are options in place to address this.

Srivinas: [00:34:59] No pun intended, with one size fits all. Well, what were you going to say, Doctor Yedlinsky?

Yedlinsky: [00:35:05] No, that was a great point. Yeah. Just knowing that there are options out there.

Srivinas: [00:35:10] Well, that's a very uplifting note to kind of think about for the future. Thank you both so much for being here today. Are there any last, final thoughts you would want to share with our audience? Dr Yedlinksy let you go first?

Yedlinsky: [00:35:25] Yeah, I just again, I want always to have that lens of the of the equity and inclusion when it comes to anything involving provision of health care. And that includes taking care of our health care providers and clinicians.

Srivinas: [00:35:43] Thank you. Dr Kuhar?

Kuhar: [00:35:45] And I'd add, you know, while it is an employer's responsibility to provide that equipment and to ensure that there's appropriate equity, etc., advocate for yourself and don't be afraid to do so. You know, that equipment needs to fit correctly. You need to be, you are. You should be trained to remove it without contaminating yourself. And if it's not happening and you need to ask questions, ask for help and ask for training. It's one of the most important things for helping to make things better.

Srivinas: [00:36:14] Well, those are great points to leave off. So everybody keep in mind equity for all of your employees. And if it's not happening, advocate yours, for yourself or for the people around you. Well, thank you so much for being with us. This has been such an enlightening conversation and I look forward to hopefully having so much of the feedback that you guys have given be adapted in the future. Stories of Care is a publication of the AMA and CDC'S Project Firstline. Project Firstline is a national infection control training collaborative, working to provide all health care professionals with the foundational infection control knowledge they need and deserve to protect themselves, their patients, their coworkers, and their communities. For more information, trainings and other infection control resources, visit cdc.gov/projectfirstline and amafirstline.org.

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If applicable, all relevant financial relationships have been mitigated.

Credit Renewal Date: August 22, 2023

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Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 0.50  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 0.50 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 0.50 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 0.50 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 0.50 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 0.50 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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