COVID-19: Personal Protective Equipment (PPE)

Personal protective equipment, commonly referred to as "PPE," is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. The guidance below is to protect health care workers and other patients at facilities that provide care to patients with COVID-19.

General Public. The CDC recommends following everyday preventive actions, such as washing your hands, covering your cough, and staying home when you are sick.

Patients. Patients with confirmed or possible SARS-CoV-2 infection should wear a face mask when being evaluated medically.

 
 

 Health Care Personnel

Health care personnel should adhere to Standard and Transmission-based Precautions when caring for patients with SARS-CoV-2 infection. Recommended PPE is described in the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Health Care Settings.

 Extended Use and Limited Reuse of N95 Respirators in Health Care Settings

DHS has published interim guidance regarding the use and decontamination of respirators

Health care facilities should review CDC’s guidance on PPE optimization and NIOSH’s guidance on extended use and limited reuse of N95 respirators for full information.

Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients, without removing the respirator between patient encounters. Extended use is well suited to situations wherein multiple patients with the same infectious disease diagnosis, whose care requires use of a respirator, are cohorted (e.g., housed on the same hospital unit).

Reuse refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (‘doffing’) after each encounter. Extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission.

If extended use or reuse of N95 respirators is permitted, health care facilities should consider additional training and reminders (for example, posters) for staff to reinforce the need to minimize unnecessary contact with the respirator surface, strict adherence to hand hygiene practices, and proper donning and doffing technique.

For extended use or reuse of N95 respirators, health care facilities should advise staff to take the following steps to reduce contact transmission:

  • Ensure respirators are only used by a single wearer.
  • Ensure the respirator maintains its fit and function.
  • Discard respirators following use during aerosol generating procedures.
  • Discard respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
  • Discard respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.
  • Discard any respirator that is obviously damaged or becomes hard to breathe through.
  • Consider use of a cleanable face shield (preferred) over the respirator and/or other steps (for example, masking patients, use of engineering controls) to reduce surface contamination.
  • Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

Additionally, for reuse of N95 respirators, health care facilities should advise staff to take the following steps:

  • Follow the employer’s maximum number of donnings (or up to five if the manufacturer does not provide a recommendation).
  • Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses. To minimize potential cross-contamination, store respirators so that they do not touch each other. Storage containers should be disposed of or cleaned regularly. Pack or store respirators between uses so that they do not become damaged or deformed.
  • Label containers used for storing respirators and/or label the respirator itself (for example, on the straps) between uses with the user’s name to reduce accidental usage of another person’s respirator.
  • Avoid touching the inside of the respirator. If inadvertent contact is made with the inside of the respirator, perform hand hygiene.
  • Use proper respirator donning techniques including inspection of the device for physical damage (for example, Are the straps stretched out so much that they no longer provide enough tension for the respirator to seal to the face? Is the nosepiece or other fit enhancements broken?)
  • Use a pair of clean (non-sterile) gloves when donning a used respirator and performing a user seal check. Discard gloves after the respirator is donned and any adjustments are made to ensure the respirator is sitting comfortably on your face with a good seal.
    More information can be found at: CDC COVID-19 for instructions in how to perform a seal check.
Decontamination of Filtering Facepiece Respirators (FFRs)

Among other strategies, decontamination of FFRs has been suggested as a crisis capacity strategy. Decontamination procedures are not considered standard use by any of the FFR manufacturers or CDC’s National Institute for Occupational Safety and Health (NIOSH); however, in light of the existing shortages, CDC published guidance on their website.
 
In addition, the Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUA) for several FFR decontaminated processes. These EUAs included a guidance document for the decontamination method manufacturer along with specific instructions for the health care facility and health care workers, including the number of decontamination cycles that can be utilized for each process.

Due to the inaugural nature and risks associated with these decontamination procedures, these procedures are meant to be implemented as in-house policies that require specialized equipment, a written program, and adequately trained staff. The respirator manufacturer(s) must be consulted to determine if the chosen method is compatible with the FFRs in use at each institution.

An alternative suggested strategy to decontamination of FFRs is to issue five respirators to each health care worker who may care for patients with suspected or confirmed COVID-19. The health care worker will wear one respirator each day and at the end of each shift store it in its own breathable paper bag. (Each bag should be placed in a second paper bag that is disposed after each use). The order of FFR use should be repeated, so that a minimum of five days passes between each FFR use. This will result in each worker requiring a minimum of five FFRs, providing that they put on, take off, care for them, and store them properly each day.

For additional information, and updated resources, please refer to current CDC website.

 Guidance on PPE from the Strategic National Stockpile

DHS expects that personal protective equipment (PPE) from the Strategic National Stockpile (SNS) will not fully meet the needs of the provider community operating at surge capacity. Because DHS expects continued PPE shortages, facilities should follow strategies to optimize the supply of PPE in accordance with guidance from the Centers for Disease Control and Prevention (CDC).

Optimizing Your PPE

  • To optimize PPE, facilities should ensure that they have also implemented all possible engineering and administrative controls to reduce infectious disease transmission. Engineering controls may include isolation in airborne infection isolation rooms, use of physical barriers, properly maintaining ventilation systems, and other measures. Administrative controls may include limiting the number of patients going to hospital or outpatient settings, excluding all health care personnel (HCP) from patient care areas who are not directly involved in patient care, limiting face-to-face encounters of HCP with patients, restricting visitors, source control, cohorting patients and HCP, maximizing use of telemedicine, and other measures.
  • Per the CDC guidance, facilities should understand their current PPE inventory, supply chain, utilization rate, and community PPE supply to know whether they are operating under conventional capacity, contingency capacity, or crisis capacity.

Conventional Capacity Measures

Under conventional capacity, facilities use measures for providing patient care without any change in daily contemporary practices. These measures, consisting of engineering, administrative, and PPE controls, should already be implemented in general infection prevention and control plans in health care settings.

Contingency Capacity Measures

Under contingency capacity, facilities use temporary measures during periods of expected PPE shortages that may change daily contemporary practices but may not have any significant impact on the care delivered to the patient or the safety of the HCP. Depending on the type of PPE, measures may include:

  • Use of PPE beyond the manufacturer-designated shelf life for training and fit testing.
  • Extended use of PPE, which refers to the practice of using the same PPE for repeated close contact encounters with several different patients, without removing the PPE between patient encounters.
  • Limited re-use of PPE, which refers to the practice of using the same PPE by one HCP for multiple encounters with different patients but removing it after each encounter.
  • Other measures.

Crisis Capacity Measures

Under crisis capacity, facilities use alternate strategies, or a combination of alternate strategies, during periods of expected or known PPE shortages that are not commensurate with contemporary U.S. standards of care. Depending on the type of PPE, measures may include:

  • Extended use or limited re-use of PPE.
  • Prioritization of PPE.
  • Use of PPE beyond the manufacturer-designated shelf life for health care delivery. The FDA recommends that because expired PPE, such as gowns and surgical masks, still provide some protections, these PPE can be utilized by HCP as long as there are no visible damages, such as degraded materials or visible tears, and the PPE is not being used in surgical settings.
  • Use of PPE approved under standards used in other countries that are similar to U.S. standards.
  • Use of alternatives to PPE, such as supplies that have not been evaluated as effective.
  • Other measures.

During severe resource limitations, facilities should consider excluding HCP who may be at higher risk for severe illness from COVID-19, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected COVID-19 infection.

Resources

  • CDC guidance on strategies to optimize the supply of PPE for details on appropriate optimization measures by specific type of PPE
  • CDC checklist for optimizing the supply of N95 respirators

 PPE Reserve

What is it?

  • The State Emergency Operations Center set aside a limited reserve of PPE from the strategic national stockpile.
  • This reserve is for long-term care providers who are caring for COVID-19 positive individuals.

Can I request PPE from this reserve?

To be eligible to request PPE from this reserve, you must answer YES to BOTH of the following questions:

  • Are you a long-term care provider?
    • Any entity licensed by DQA as a residential facility.
    • All licensed or certified adult family homes.
    • Home health, personal care, and supportive home care providers.
    • Participant-hired providers (applies to all Medicaid long-term care programs).
    • Adult protective services providers.
  • Are you caring for someone who tested positive for COVID-19?

I answered YES to both questions. How do I make a request?

  • Step 1: Explore all options for PPE. This includes sourcing from local vendors or from other facilities in your area.
  • Step 2: Download and complete the PPE Reserve Request form.
  • Step 3: Email the completed form to your county emergency manager

I'm not eligible for the PPE Reserve, now what?

  • Step 1: Explore all options for PPE. This includes sourcing from local vendors or from other facilities in your area.
  • Step 2: If you have exhausted your options for sourcing PPE, reach out to your county emergency manager.
  • Step 3: Your county emergency manager will consider your request and may use local resources to provide PPE. Counties receive a limited amount of PPE from the State Emergency Operations Center. They will not be able to fill every request they receive.

 PPE Fact Sheets

Law Enforcement Personnel Use and Conservation: Personal Protective Equipment

Law enforcement personnel use and conservation: PPE, P-02645
English

Extended wear: eye protection, mask and gown PPE P-02644

Extended wear: eye protection, mask, and gown, P-02644
English | Hmong | Spanish

Conserve: N95 Respirators, face shield, and goggles for medical professionals P-02644A

Conserve: N95 respirator, face shield, and goggles, P-02644A
English | Hmong | Spanish

 

N95 respirator limited reuse, storage, and retrieval PPE for medical professionals P-02644B

N95 Respirator limited reuse: removal, storage, and retrieval, P-02644B
English | Hmong | Spanish

Delivery Drivers: Use and conservation of PPE P02665

Home and Community Based Service Providers Use and Conservation of PPE, P-02665
English

Home and Community Based Service Providers: Use and conservation of PPE P-02665a

Home and Community Based Service Providers: Use and Conservation of PPE, P-02665A
English

 

Recipients of Home and Community Based Services: Use and Conservation of PPE P02665B

Recipients of Home and Community Based Services Use and Conservation of PPE, P-02665B
English

n-Home Visits for Social Workers: Use and Conservation of PPE P02665C

In-Home Visits for Social Workers Use and Conservation of PPE, P-02665C
English

Providers of Transportation Services: Use and Conservation of PPE P02665D

Providers of Transportation Services Use and Conservation of PPE, P-02665D
English

 

 Resources

Last Revised: July 31, 2020

 RESPONSE RESOURCES FOR WISCONSINITES — www.dhs.wisconsin.gov/covid-19/help.htm