Optimizing Personal Protective Equipment Use During the COVID-19 Crisis

Since the dawn of disposable, single-use products in health care, we have been taught to never reuse a product. If we had to care for someone on transmission-based precautions, be it contact or droplet, we would don the proper equipment before entering the room and doff it before leaving, tossing it in the waste receptacle placed near the door for convenience.

Today, in light of the drastic shortage of personal protective equipment (PPE), we are being taught to unlearn all that we knew as best practice and begin our journey of “optimizing” what we have. How do we, in our hearts, reconcile what we have been taught and learn to embrace this new “best” practice?

Coming to Terms with the New Normal

The most important first step in accepting our new norm is to understand why it is here. PPE shortages pose a tremendous challenge to the U.S. healthcare system due to the COVID-19 pandemic. Facilities that have never had an issue with ordering supplies found out about a month ago that supplies were being placed on allocation. This means that while they can get a limited amount, it wouldn’t necessarily be what they ordered.

Availability of PPE is critically low, and what is available needs to be prioritized for the areas that are most at need.

Contingency Strategies to Optimize PPE Supplies

The CDC recommends strategies to optimize the use of PPE when supplies are stressed, running low, or absent. Contingency strategies can help stretch PPE supplies when shortages are anticipated.

Three general strata have been used to describe surge capacity and can be also used to prioritize measures to conserve PPE along the continuum of care:

• Conventional capacity—These measures consist of providing patient care without any change in daily contemporary practices. This set of measures, consisting of engineering, administrative, and personal protective equipment (PPE) controls, should already be implemented in general infection prevention and control plans.
• Contingency capacity—These measures may change daily standard practices but may not have significant impact on the care delivered to the patient or the safety of healthcare personnel. These practices may be used temporarily during periods of expected shortages.
• Crisis capacity—These strategies are not commensurate with typical U.S. standards of care. These measures, or a combination of these measures, may need to be considered during periods of PPE shortages.

We are currently in a crisis capacity. At no other time in our lives would we consider, or want to consider, reusing PPE. Understanding that crisis situations call for unprecedented measures helps to alleviate the anxiety from practicing against the norm.

Guidelines for Facemask Reuse in Crisis Capacity

The most important piece of PPE required in our battle against COVID-19 is the facemask. It not only protects the patients we treat, it also protects us from harmful microorganisms.

Remembering that we are in at this time in crisis capacity, these are the general strategies to use when optimizing the use of facemasks:

• Use facemasks beyond the manufacturer-designated shelf life during patient care activities.
• Implement limited re-use of facemasks:
  • This is the practice of using the same facemask by one healthcare personnel (HCP) for multiple encounters with different patients but removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for COVID-19, care should be taken to ensure that HCP do not touch the outer surfaces of the mask during care and that mask removal and replacement be done in a careful and deliberate manner.
• Extending the use of a facemask:
  • Unlike re-use of a facemask, which has HCP removing the mask between patients, this simply means that HCP put the facemask on at the start of the shift and remove it when the shift ends. This eliminates the potential for contamination that occurs during the donning/doffing process. This strategy is being utilized by many large health care facilities at this time.
  • This method is preferred by the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Nurses Association (ANA).

Whichever method is being used in your facility, there are things to always keep in mind:

• The facemask should be removed and discarded if it is soiled, damaged, or hard to breathe through.
• HCP should leave the patient care area if they need to remove the facemask.
• When not in use, masks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage.
• The folded mask can be stored between uses in a clean sealable paper bag or breathable container.

What About Homemade Masks?

Homemade masks have become a hot topic on social media. The general public, eager for ways to contribute, are finding creative ways to help the medical field. But should medical professionals accept and use these masks?

The answer is a resounding “maybe.” Remember, we are in a time of crisis. We are facing a shortage of equipment that provides safety for our patients and ourselves.

So how can a homemade mask be used safely?

• Keep in mind at all times that no matter how well made, even if the homemade mask comes with a “filter,” these masks are not medical grade PPE.
• When considering source control—this is, protecting those we come in contact with from us as a potential source—there is adequate support to allow the use of a homemade mask.
• If you are lucky enough to work in a community that does not currently have an outbreak of COVID-19, having the staff wear a cloth mask during the course of their shift can be helpful.
• Always keep in mind that if you need to go into the room of a patient that is on droplet or contact precautions, the mask should be removed and placed in a paper bag, and medical grade PPE should be applied before you enter the room. Upon leaving the room, remove the contaminated PPE, wash your hands, and reapply the cloth mask.
• Ideally, a homemade cloth mask should be used in combination with a face shield that covers the entire front (extending to the chin or below) and sides of the face.

This is an unprecedented time in our history. What once was normal is not now. What once was unacceptable is now necessary. However, there is comfort in history. During the Spanish influenza pandemic of 1918, a man named Joe Capps, a chief of service at a Washington hospital, demonstrated to his team an innovation he was experimenting with—a gauze mask. He found that when patients with respiratory disease were given a gauze mask to wear, it was an important contribution in preventing the spray of infection to others.

We have come a long way since Joe Capps’ gauze mask. However, the point of this piece of history is to simply recognize that as devastating as the Spanish influenza pandemic was, the country survived. Not only survived, but eventually thrived. We will do so again.

For now, take deep breaths, relax, and trust in your knowledge.

Want more information to help you navigate the COVID-19 crisis? Be sure to check out MedBridge’s COVID-19 Resource Center as well as the free course, “Preventing the Spread of COVID-19 for Healthcare Staff.”