On December 29, 2020, the Centers for Disease Control and Prevention (CDC) provided a summary to help healthcare facilities optimize supplies of disposable N-95 filtering facepiece respirators when there is a limited supply during the COVID-19 pandemic.
The CDC Recommendations include the following:
Conventional Capacity Strategies (should be incorporated into everyday practices):
Engineering Controls:
- Place patients with suspected or confirmed SARS CoV-2 infection in an airborne infection isolation room (AIIR) for aerosol generating procedures, if possible.
- Use physical barriers such as glass or plastic windows at reception areas, curtains between patients, etc.
- Properly maintain ventilation systems to provide air movement from a clean to contaminated flow direction
Administrative Controls:
- Limit healthcare personnel (HCP) not directly involved in patient care (e.g., dietary, housekeeping employees)
- Limit face-to-face HCP encounters with patients (e.g., bundling activities, use of video monitoring)
- Limit visitors to the facility to those essential for patients’ physical or emotional well-being and care
- Cohort patients: Group together patients who are infected with the same organism to confine their care to one area
- Cohort HCP: Assign designated teams of HCP to provide care for all patients with suspected or confirmed SARS CoV-2 infection
- Train HCP on use (proper use, fit, donning, and doffing) and indications for use of N95 respirators
- Implement just-in-time fit testing: Plan for larger scale evaluation, training, and fit testing of employees when necessary during a pandemic
- Limit respirators during training: Determine which HCP do and do not need to be in a respiratory protection program and, when possible, allow limited re-use of respirators by individual HCP for training and then fit testing
Personal Protective Equipment: Respiratory Protection
- Use surgical N95 respirators only for HCP who need protection from both airborne and fluid hazards (e.g., splashes, sprays). If needed but unavailable, use faceshield over standard N95 respirator.
Contingency Capacity Strategies (during expected shortages):
Administrative Controls:
- Temporarily suspend annual fit testing perinterim guidance from OSHA
Personal Protective Equipment and Respiratory Protection:
- Use N95 respirators beyond the manufacturer-designated shelf life for training and fit testing
- Extend the use of N95 respirators by wearing the same N95 for repeated close contact encounters with several different patients without removing the respirator
Crisis Strategies (during known shortages):
When N95 Supplies are Running Low
Personal Protective Equipment: and Respiratory Protection Facemasks:
- Use respirators beyond the manufacturer-designated shelf life that have been identified by CDC as performing adequately for healthcare delivery
- Use respirators approved under standards used in other countries that are similar to NIOSH-approved respirators
- Implement limited re-use of N95 respirators and limit to no more than five uses (i.e., five donnings) per device by the same HCP, unless otherwise specified by the manufacturer. See additional guidance on re-use potential methods for decontamination.
- Prioritize the use of N95 respirators and facemasks by activity type, distance from the patient, and use of source control by the patient
When No Respirators Are Left
Administrative Controls:
- Consider excluding HCP at higher risk for severe illness from SARS CoV-2 infection, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from contact with patients with confirmed or suspected SARS CoV-2 infection
Engineering Controls:
- Use an expedient patient isolation room for risk-reduction
A complete list of CDC recommendations to Optimize N-95 Respirators for healthcare settings can be accessed at: Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages | CDC
OSHA’s Temporary Enforcement guidance for Annual Fit-Testing for N-95 Respirators During the COVID-19 Outbreak can be accessed at: Temporary Enforcement Guidance – Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak | Occupational Safety and Health Administration (osha.gov)
Issue:
Each facility’s Emergency Preparedness Plan should include strategies to implement when N-95 Respirators and other PPE supplies are limited. Facilities must routinely monitor their use of N-95 Respirators and other PPE stock levels and anticipated deliveries in order to determine appropriate capacity strategies.
Discussion:
- Review the facility’s Emergency Preparedness Plan to ensure it addresses the most recent recommendations from the CDC for N-95 Respirators and other PPE capacity strategies. Revise the Emergency Preparedness Plan as appropriate.
- Train all staff on the Emergency Preparedness Plan. Train appropriate staff on capacity strategies prior to implementation of the strategies. Document that the trainings occurred and file the signed training document in each employee’s education file.
- Periodically audit levels of all PPE, including N-95 Respirators, to ensure that supplies are adequate and that there are no anticipated shortages. Determine that the current capacity strategy is being followed by all.
