Personal Protective Equipment (PPE)

The American College of Surgeons (ACS), the American Medical Association, The Joint Commission, and other concerned stakeholder organizations issued a public statement outlining our concerns about the existing shortages of masks, face shields, other personal protective equipment (PPE), ventilators, swab kits, and testing capacity that frontline caregivers and patients critically need. The statement calls for federal, state, and local policymakers to immediately remove any impediments in the supply chain.

PPE is needed immediately to protect the caregivers who are risking their own health to care for patients in the most need. Shortages of ventilators and intensive care facilities threaten the lives of the sickest patients.

The statement strongly supports emergency efforts at the federal level to dramatically increase the production and distribution of PPE and other necessary medical equipment and supplies. It also supports the availability of telehealth services during this time to use less PPE while preventing the spread of infection.

We must all work immediately to remove any impediments anywhere in the supply chain and come together at the federal, state, and local levels to develop an approach for a fair, equitable, and swift distribution across the nation that is based upon evidence of the most need. Read the full statement.

The COVID-19 pandemic has caused widespread shortages of personal protective equipment (PPE), including facemasks, respirators, and protective eyewear in hospitals across the U.S. and around the world. As a result, some facilities have found it necessary to extend the use of, or reuse, PPE.

The University of Nebraska Medical Center (UNMC), Omaha, has provided guidance on extended use and limited reuse of PPE, adapted from the Centers for Disease Control and Prevention (CDC) and the University of Maryland, Baltimore, sources. The document offers useful definitions and directions.

Extended use refers to the practice of wearing PPE for encounters with several patients. Reuse refers to using the same PPE for multiple encounters with patients but removing it between encounters.

The document lays out some guiding principles, including the following:

• Extended use is preferred over reuse
• Facemasks, powered air purifying respirators (PAPRs), N95s, and eye protection can be reused carefully and in a limited manner during this shortage
• PPE should be used by a single individual
• Disposable N95 respirators for COVID-19 patients can be reused or have extended use if they are sealed, were not used in aerosol-generating procedures, or have been otherwise soiled
• N95s are prioritized for personnel at high risk of infection or complication
• Traffic to patient treatment areas should be limited

General guidelines state that N95s should be locked or secured in designated areas, labelled with individual staff names and usage times, and that full-face shields also are dedicated to individual staff.

The document provides guidance for extended use of surgery/procedure facemasks; detailed directions for donning and doffing N95 respirators that considers storage and maintaining sterility when either a procedure mask barrier or a full face shield is used; instructions for limited reuse of full face shields; and instructions for reuse of PAPR hoods, including disinfection, storage, of disposal of PAPR components.

Additional COVID-19 resources from UNMC can be accessed here.

The University of Kansas Health System also has issued personal protective equipment (PPE) recommendations. The guidance outlines PPE recommendations for the following: patient care for patients not suspected for COVID-19, patient care for patients suspected or testing positive for COVID-19, and aerosol generating procedures on patients suspected or positive for COVID-19 and airway procedures on all patients. For patients with no COVID symptoms, health care professionals can safely wear a surgical ear loop mask in ambulatory clinics, the emergency department (ED), acute care units (ACUs), intensive care units (ICUs), and other procedural areas. If a patient has COVID symptoms or has a COVID test pending or test positive and receives care in ambulatory clinics, the ED, ACUs, ICUs, health care personnel should wear eye protection/face shield, a surgical/ear loop mask, gown, and gloves. When any aerosol generating procedure is performed in ambulatory clinics, the ED, ACUs, ICUs, and other procedural areas, health care personnel must wear a powered air-purifying respirator (PAPR) or N95 respirator, a face shield/eye protection, gown, and gloves.

The CDC has posted additional COVID-19 resources, including a PPE burn rate calculator. This spreadsheet-based model provides information for healthcare facilities to plan and optimize the use of PPE for response to COVID-19. Access the CDC resources.

The shortage of PPE for people who are in direct contact with potentially infected COVID-19 patients is a significant problem. A simple, elegant, practical solution is to supply the caregiver was seven N-95 masks and seven individual paper bags. Each bag will be labeled Monday, Tuesday, Wednesday etc. At the end of each day if the mask is not soiled it will be placed in the specifically labeled paper bag and kept by the individual provider. On the next day the process will be repeated. The rationale is that it is unlikely the virus will survive on the mask for seven days. It is feasible that it would be safe to use the mask again in a week. There will be an initial outlay of seven masks for each provider but this process could extend the use of the masks. If a mask is soiled or in some way unusable it would be discarded and replaced. This process will also provide comfort to the provider since they will have their own supply of PPE.