No surprise here: The need for personal protective equipment (e.g., surgical masks, surgical and isolation gowns, and scrub suits) may outpace the supply available to healthcare providers during the COVID-19 outbreak. That word came from the FDA in a March 11 letter to providers.
So what are providers to do? First of all, they should RESIST the temptation to toss out all the controls and procedures they already have in place. That said, FDA suggests they loosen the reins just a bit — and strategize about what they use, and when they use it. Here’s some of what the FDA had to say:
In those cases where limited supply levels may change patient care, but may NOT have a significant impact on patient care and healthcare provider safety:
- Between treating patients with the same infectious disease diagnosis or exposure who are maintained in a confined area, allow healthcare providers to wear the same surgical mask, remove only used gloves and gowns, and perform hand hygiene. That said, if the mask, gloves or gown become contaminated, replace them.
- Prioritize the use of gowns and surgical masks by the type of activities required for patients. Prioritize their use for aerosol-generating procedures (such as suctioning, nebulizer treatments, and other respiratory treatments or procedures), care activities where splashes and sprays are anticipated, and high-contact patient care activities (e.g., dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, or wound care).
- For training, use gowns that are beyond the manufacturer-designated shelf life, if available.
When surgical mask or gown usage exceeds supply, employ these crisis or alternate strategies:
- Extend the use of single use gowns by NOT changing the gown between treating patients with the same infectious disease diagnosis or exposure who are maintained in a confined area. Again, though, if the gown becomes contaminated, replace it.
- Use surgical masks and/or gowns that meet CDC recommendations and/or ANSI standards for fluid resistance and bacterial filtration efficiency.
- Prioritize the use of unexpired FDA-cleared surgical masks for procedures where it is important to protect the healthcare provider and/or the patient from risk of exposure to blood and body fluids.
- Use surgical masks beyond the manufacturer-designated shelf life in a setting where there is a lower risk of transmission (e.g., non-surgical). The user should visibly inspect the product prior to use and, if there are concerns (such as degraded materials or visible tears), discard the product.
- Reuse surgical masks during care for multiple patients where they are used to protect the healthcare provider from an activity with low transmission risk (such as dispensing medications). But if the mask becomes contaminated, replace it.
- Be aware that counterfeit masks and gowns may be on the market, especially during this time of reduced supply.
What about N95s?
Not to be confused with surgical masks, N95 respirators, when properly fitted, can filter more airborne particles than face masks, which is important during an outbreak of a respiratory disease like COVID-19. The FDA regulates respirators intended for use in a healthcare setting; however, most respirators are used in construction and other industrial jobs only, and bypass FDA requirements for testing.
That has changed due to COVID-19.
On March 2, the FDA and CDC, working with the National Institute for Occupational Safety and Health (NIOSH), approved respirators NOT currently regulated by the FDA to be used in a healthcare setting by healthcare personnel during the COVID-19 outbreak. Unfortunately, there’s a good chance your local hardware store is out of industrial N95s.