- 1) The Centers for Disease Control and Prevention (CDC) recommends enhanced droplet precautions. Cover mucosal surfaces (eyes, nose, and mouth) and provide skin contact precautions.
- 2) N95 masks DO NOT work properly with facial hair; shaving is strongly recommended for anyone participating in direct patient care.
- 3) Personal Protective Equipment (PPE) should be donned/doffed per CDC instructions and following proper techniques to minimize the risk of self-inoculation.
- 4) If possible, have a trained observer watch donning and doffing to guard against accidental exposure of medical personnel.
- 5) The following procedures carry a significantly higher risk of virus aerosol formation:
  - Tracheal Intubation
  - Extubation (accidental or planned)
  - Bag-Valve Mask Ventilation
  - Any disconnection of the ventilator circuit
  - Tracheal suctioning without in-line suction device
  - Tracheostomy (and Cricothyroidotomy)
  - Cardiopulmonary Resuscitation

Levels of PPE

Levels are based upon risk of disease and risk of procedure. NOTE: the patient should wear a basic facemask (cloth or otherwise) whenever feasible to provide an additional barrier.

Minimum: Face covering, eye protection glasses, gloves, and makeshift gown. NOTE: For patients with low probability of disease and where direct contact with the patient is low, gowns may not be required (mirroring conventional droplet precautions).

Better: Surgical mask or N95 mask, face shield (either standalone or with mask) and eye protection, gloves, gown (surgical or contact), head covering.

Best: N95 mask (with or without surgical mask covering) with face shield and disposable head covering or hooded face shield (e.g., Chemical, Biological, Radiological, Nuclear, and high yield Explosives (CBRNE) pro-mask) along with gown and gloves.

Conservation of PPE

- 1) COVID-19 can survive on various surfaces for up to 72 hours or longer.
- 2) Use cloth face covering when risk is low to conserve supply of surgical face masks and N95 masks needed for high risk procedures (e.g., endotracheal intubation).
- 3) Doff PPE in a manner that allows for it to be easily donned again without contacting contaminated surfaces (if possible).
- 4) For re-use of surgical face masks or N95 masks: while wearing gloves, store the mask in a paper bag in a dry, shaded/indoor area for 72 hours prior to using again. DO NOT use bleach or UV radiation (i.e. sunlight) to ‘sterilize’ the N95 – this will degrade mask effectiveness.
- 5) Eye protection glasses and face shields should be cleaned with a diluted bleach solution between uses.

Mask Recommendations

U.S. National Institute for Occupational Safety and Health recommends the following for extended use and re-use of N95 respirators:

- 1) N95 masks maintain their effectiveness for at least 8 hours of continuous or intermittent use.
- 2) N95 masks should be discarded following aerosol generating procedures (e.g., endotracheal intubation) or when visibly contaminated with bodily fluids.
- 3) Consider using a large face shield that sits in front of the mask, wear a surgical mask over-top of the N95, or masking the patient to minimize contamination.
- 4) Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the mask.