Preserving PPE Supply – How Some Facilities are Conserving Their Stockpiles

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In response to developing national and international shortages of Personal Protective Equipment (PPE), many facilities are implementing enhanced clinical practice guidelines to preserve their supply of items such as gowns and masks.  Including the potential safe use of expired supplies as indicated recently by NIOSH, some potential ways to do this are shown below:

Some example guidelines from NETEC facilities regarding the monitored use of N95 respirators are:

• Limiting N95 use to patients who meet criteria for airborne isolation, consistent with existing policies.

  • Assessing airborne isolation requests with infection prevention and hospital epidemiology in advance of use.
  • The Infection Prevention coordinator (IP) on call should be contacted immediately for review and approval of all airborne isolation orders.
  • Expediting TB evaluations with respiratory therapy and lab so that airborne isolation can be discontinued as soon as safe and feasible.
  • Providing education on safe N95 reuse during a single shift per CDC recommendations (more details below).
  • Continuing to evaluate alternate options for respiratory protection supported by additional information and staff/provider training as needed.

• Implementing processes to control access to N95 Masks in inpatient and ambulatory areas

  • Airborne isolation is appropriate for patients with chickenpox, disseminated shingles, measles, suspected or confirmed pulmonary TB and novel coronavirus infection.
  • Once an airborne isolation order is approved, have materials management limit the release to one box of regular N95 masks and one box of small N95 masks to the unit.
  • Any healthcare worker who needs to enter the patient room will sign a log to receive a mask for the shift.
  • Masks should be reused per the guidelines below and replaced if they become contaminated or damaged.
  • Materials management will release additional single boxes of N95 masks as needed following review of the use log.

• Limiting Airborne Isolation Room Entry

  • Only essential medical personnel should enter the room to limit N95 mask use. Teaching service teams should try to limit room entry on rounds to the attending physician. Remember, N95 masks are intended for use by trained healthcare workers and not patient visitors. If you have questions or concerns about patient visitation and PPE requirements, contact your IP on call.

• N95 Reuse Guidelines

  CDC guidelines (CDC, https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Frespirator-supply-strategies.html, Accessed 3/6/2020) outline the safe reuse of N95 masks on an individual, single-person basis. To facilitate this process, we are asking all staff and providers caring for patients on airborne isolation to observe the following practices:

  • A single N95 mask can be reused during a shift but should be discarded at the end of the day.
  • You should put on the N95 mask while wearing clean gloves and perform hand hygiene immediately after removing it.
  • The N95 mask should be stored in an open plastic bag or paper bag between uses. These will be provided for you on your unit.
  • N95 masks should never be shared with another person. Make sure to put your name on either your storage bag or the mask straps (don’t write on the mask itself).