• 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.