Please respond to these below

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In response to the evolving situation of COVID-19 as the basis for policy changes, JPS Health Network has made modifications to its building access, screening, and PPE requirement policies. “The policy process consisted of a series of actions, critical to resolving a problem analysis and formulating solutions. The process can involve many organizations and individuals and requires multiple steps” (Mason, Dickson, McLemore, & Perez, 2021).
WHO declared COVID-19 a pandemic in March 2020, with over two million confirmed COVID-19 cases in the USA in 4 months since COVID-19 inception, with total deaths reaching over 500 thousand. Owing to this, JPS Health Network has been following guidance from the federal, state, and local agencies. That guidelines recommend screening, identification, and isolation procedures to get patients the care they need and to keep JPS team members and our community safe.
CDC recommends that people wear cloth face coverings in public settings and when around people outside of their household, especially when other social distancing measures are challenging to maintain (CDC, 2020).
From the Federal Emergency Management Agency. Delimit the need for PPE by maximizing the use of barrier controls whenever possible (e.g., masking patients, Plexiglas barriers, car windows, and improved ventilation systems). Use teleconsultation, internet-based interviews, or remote camera-based observations, as available. Limit visitor access and offer technology-enabled alternatives (e.g., video chat) (FEMA, 2020).
Occupational Safety and Health Administration released a memorandum. "This memo provides temporary enforcement guidance to Compliance Safety and Health Officers for enforcing the Respiratory Protection standard, supply shortages of N95 filtering facepiece respirators due to the COVID-19 outbreak. The Respiratory Protection standard has specific requirements, including a written program, medical evaluation, fit-testing, and training, that employers must follow to ensure workers are provided and are properly using appropriate respiratory protection when necessary to protect their health. On March 11, 2020, the President directed the Department of [Health and Human Services to "take all appropriate and necessary steps concerning general use respirators to facilitate their emergency use by healthcare personnel in healthcare facilities and elsewhere," and he directed the Department of Labor to "consider all appropriate and necessary steps to increase the availability of respirators." Appropriate respiratory protection is required for all healthcare personnel providing direct care of these patients" (OSHA, 2020).
These changes have been on JPS internet public website and announced to all employees via email. JPS patients and visitors are given a mask when they arrive. JPS employees are required to wear a mask and face shield while working except in the breakroom where they are expected to practice social distancing. Several hand sanitizers were placed on several locations throughout the JPS facility. JPS visitors are limited to one per patient. Visitors under the age of 18 will not be allowed into JPS Facilities. No visitors will be permitted in the ED except in the case of minor patients. Team members' screening is in effect, and anyone with illness or fever will be asked to return home. JPS is asking all patients and employees a series of questions designed to identify people who may have been exposed to COVID-19. Infection Prevention team will be immediately notified if any symptomatic patient answers "yes" to the recommended screening questions. That patient will be isolated while Infection Prevention activates the level of isolation and protection needed, coordinating with the Tarrant County Public Health Department. Tarrant County Public Health. The following changes have helped slow down the spread of COVID-19 among team members and the community.

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As of consequence of COVID-19, our hospital has undergone many changes at a rapidly rate. One of the key concerns from the beginning of this pandemic was the proper use of personal protective equipment (PPE), especially N95 masks. Questions arose regarding how to properly use and discard our mask between each patient and after each 13-hour shift.
The Centers for Disease Control and Prevention (CDC, 2020) currently recommend the extended use of a single N95 for repeated encounters with several patients who are infected without having to remove between each encounter. Our unit being the COVID assigned unit, implemented this recommendation and we wear our masks throughout the entire shift. Education via pamphlets, HealthStream videos and return demonstrations was provided by our infection control department. Throughout the shift, everyone in the unit minimizes the need to remove the mask and at the end of the shift we place it in a paper bag to be taken for autoclaving. Now this is where we have a problem because according to recent research, findings report that autoclaving decontamination actually degrades the Filtering Facepiece Respirators (FFRs) of an N95. In their study Meisenhelder, C., et al., (2020) tested two methods of decontamination, dry heat at 95 Celsius and autoclaving cycles. Their findings suggest that not only does autoclaving damage the FFRs by failing the filtering test, but the fit of the mask after one single autoclave cycle fails too. So, what does this mean for current CDC recommendations? Do we continue wearing autoclaved N95 respirators?
For the past three months I have been using autoclaved masks that have undergone three or four cycles already. The scarcity of supplies is very real in our hospital and I understand the need to use what we have resourcefully, but how do we ensure the safety of everyone taking care of COVID patients if FFRs fail fit and filtering tests? Our policy for extended use and reusing N95 still remains and we are expected to continue using N95 that have undergone autoclaving cycles. My fear lies with numbers of positive patients increasing in our area and the increasing nurse shortage but if we continue to use degradable PPE, we will become the ill.

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