Recommendations – Patients
 
When using a bi-level ventilatory assistance device (eg. BiPAP, VPAP, Ventilator or CPAP) particles called “aerosols” are produced when you exhale. These aerosols allow the virus to stay in the air for a certain amount of time, increasing the risk of infecting other people.
 
If you are using a ventilatory assistance device and have COVID-19 symptoms or have tested positive for COVID-19, in addition to the standard recommendations (see the MSSS Self-Care Guide), we recommend:
 
Nocturnal use of ventilation only:

• Confine yourself in a well ventilated room to avoid contaminating your family.
• Close the door to your room when you are using your device.
• Always put your mask on BEFORE turning on your device.
• Make sure that your mask is well adjusted and that there are no leaks around it.
• Avoid disconnecting the long tubing from your mask or from the humidifier when your device is turned on.
• Turn off your device before removing your mask.
• When using your device, and for a 4 hour period after having it turned off, ask your family to avoid entering your room.
• If possible, open a window to allow proper aeration while keeping the door closed.
• Wash your hands when getting out of your room.

 
In addition to the recommendations presented above, for caregivers providing for ventilated patients and/or when using ventilation during the day, we also recommend:

• The caregiver should wear a procedure mask and a face shield when standing less than 2 meters from the patient.
• A protective garment may be appropriate when providing care to the patient receiving ventilation. This protective garment must be left in the ventilated room.
• Washing hands which is essential after providing care, interacting with the patient and removing the protective garment.
• The protective garment must be washed in the washing machine if it has been in contact with saliva spatters and secretions and should be cleaned at the end of the day.
• Leaving the necessary material next to the patient receiving ventilation.
• Avoiding manipulating ventilatory assist supplies: do not disconnect the circuit parts when the device is turned on.
• Trying to air out the room.

 
If you are ventilated via a tracheal cannula:

The recommendations mentioned in the previous sections are equally applicable for ventilation via a tracheal cannula, also known as “invasive ventilation”. Moreover:

• Suctioning secretions in your tracheal cannula with a suction device produces aerosols. Your caregiver should wear a procedure mask with a face shield.
• Limit the number of people close to you during the procedure.
• Respirators must do an auto-test when being turned on. Before turning on the respirator, put a clean tissue in front of the tracheal cannula adapter and turn on the device, keeping the circuit as far away from you as possible. Bring the adapter close to the tracheal cannula, remove the tissue and connect the adapter to the tracheal cannula.
• When stopping ventilation, turn off the device before disconnecting the tracheal cannula adapter.

 
Using the Cough Assist:

This treatment also produces aerosols.

If you are doing the treatment by yourself, it is recommended:

• To confine yourself in a room, away from your family.
• To turn on your device.
• To put the mouthpiece in your mouth or the mask on your face.
• To start the treatment by pressing the right button under “Treatment”.
• Before removing the mouthpiece or the mask, press the right button under “Standby”.
• If the filter is dirty or wet, change it.
• If the mask or tubing are dirty (secretions or saliva), clean it following the steps below.

If a caregiver helps you with the treatment, it is recommended that he/she:

• Wear a procedure mask and a face shield. An over-garment is also recommended.
• Turn on the device. 
• Place the mask on your face to avoid leaks around it.
• Start the treatment by pressing the right button under “Treatment”.
• Remove the mask before pressing the right button under “Standby”.
• Distance him/herself if you need to cough.

Cleaning supplies for patients who are COVID-19 positive
 
It is recommended to clean the supplies according to the standard recommendations or more often if dirty.
 
It is also recommended:
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• To have no one next to you.
• To proceed with the cleaning in the bathroom or the kitchen to reduce contamination.
• To clean the surfaces used, before and after the procedure.
• To avoid water spatters.

 
General recommendations: maintenance and cleaning of medical supplies and equipment

• Always wash your hands before starting.
• Prepare the sink: wash it, disinfect it with bleach (1 part bleach, 9 parts water) and then rinse thoroughly with running tap water or use a large bowl reserved only for the cleaning of your medical equipment.
• Fill the sink or the large bowl with warm/hot water.
• Add mild soap (e.g., non-perfumed, non-antibacterial dish soap such as “Sunlight”).
• Disassemble all the equipment and put it in the soapy water.
• Soak all parts for 15 minutes.
• If needed, brush the interior and exterior of the parts that remain soiled with a soft baby bottle brush. Be careful to avoid spatters.
• Rinse all parts with warm/hot water. Hot water may damage certain equipment.
• Delicately shake off as much excess water as possible from items that have been rinsed.
• Allow all parts to dry on a clean towel placing them in such a fashion that will allow water to drain away from them.
• Clean and rinse your sink or the large bowl with dish soap.
• Reassemble all components once thoroughly dry.
• Store the equipment that is not in use in a bag used only for this purpose (e.g., cotton pillowcase) that will protect the equipment from dust and dirt, according to your healthcare team’s recommendations.

 
Cleaning surfaces
                   
It is recommended to apply Quebec’s Self-Care Guide recommendations in Keep your environment clean.
 
Mask:
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• Daily:
  • Clean the inner surface including the inside cushion of the mask using a damp cloth soaked in mild soap and water. All traces of face oil must be removed from the mask so that it continues to fit properly.
  • If the exhalation valve is dirty, clean it with a soft bristle brush according to the guide above.
  • Inspect the mask and straps for signs of wear and tear.
• Each week:
  • Disassemble the mask and the straps according to your healthcare team’s recommendations and soak them using the guidelines above.

Water chamber:

• Daily:
  • Change the water in the water chamber every day. If water remains in the water chamber at the end of the day, discard it. Rinse the water chamber with tap water and refill it using distilled or demineralized water.
  • Do not use tap water or bottled water to refill the water chamber. Only boiled water using the method below may be used.
• Each week:
  • Clean using the general guide above.
  • Some models can be cleaned in the dishwasher; refer to the manufacturer’s recommendations.
  • If deposits remain in the water chamber, the use of a dilute solution of water and vinegar may be necessary. Mix 1 part vinegar with 3 parts water in the water chamber and let sink 30 min. Rinse with running water to eliminate the vinegar smell.

 
Invasive ventilation circuit and non-invasive ventilation circuit with mask:

• Each week and more often if needed (e.g., presence of blood, secretions):
  • Clean the tubing, dead space, adapter and exhalation valve, if present.
• Each week:
  • For the respirators, discard the antibacterial filter.

 
Air Inlet Filter 
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• Each week
  • Clean it according to the standard recommendations.

IMPORTANT

• Discard the filter following a COVID-19 infection.

Tracheostomy Care

Proceed with tracheostomy care as you would usually do. Moreover, it is recommended that:

• The caregiver wear a procedure mask with a face shield and an over-garment during the procedure.
• Disposable supplies should be used (e.g., tracheostomy trays, internal cannula brushes, suction catheter).

Cough Assist:

• Daily:
  • Clean the mask and tubing if dirty.
• Each week:
  • Change the antibacterial filter.
  • Remove dust from the grey air inlet filter.

IMPORTANT
​

• Discard the filters after your COVID-19 infection.

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Boiled Water or “Home Sterile Water”

• Use tap water and let it boil in a big pot for 10 minutes and then let it cool.
• Never use a kettle to boil water because it can leave limestone deposits.
• Fill sterile glass water containers (eg.: Masson jars) with cooled boiled water.
• Close them and write the date.
• Preservation:
  • Sealed container: 5 days in the refrigerator or 2 days at room temperature;
  • Unsealed container: 2 days in the refrigerator or 1 day at room temperature.