. 2020 Jul 7;50(9):1191–1204. doi: 10.1007/s00247-020-04713-1

Table 4.

Strategies to optimize the supply of personal protective equipment (PPE) and other equipment in different surge capacity settings

Level of surge capacity	Strategy
Contingency	• Use equipment beyond the manufacturer-designated shelf life for fit testing and training (e.g., N95 respirator, gown) • Extended use of equipment • Use of alternate equipment (e.g., cloth gowns, coveralls, equipment meeting international standards) • Selectively cancel elective and non-urgent procedures and appointments for which eye protection is typically required • Shift eye protection supplies from disposable to reusable devices such as goggles and face shields • Remove facemasks in public areas. Restrict facemasks to use by providers only
Crisis	• Use of facemask and eye protection equipment beyond the manufacturer-designated shelf life for health care delivery • Use of equipment approved under standards used in other similar countries • Extended use and reuse of equipment • Selectively cancel elective and non-urgent procedures and appointments for which facemask, gown or eye protection is typically used by the provider • Prioritize use of facemask, gown and eye protection equipment by activity type (use during aerosol-generating procedures or other high-contact patient care activities) • Consider using safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes • Reprocess eye protection with effective cleaning methods
When no equipment is available	• Exclude provider at higher risk for severe illness from COVID-19 (e.g., immunocompromised) from contact with known or suspected COVID-19 patients • Designate convalescent provider for provision of care to known or suspected COVID-19 patients • Consider using gown alternatives that have not been evaluated as effective (preferably with long sleeves and closures such as snaps, buttons) • If facemask not available, consider: use of face shield that covers the entire front (extends to the chin or below) and sides of the face with no facemask; use of expedient patient isolation rooms for risk reduction; use of ventilated headboards, and provider use of homemade masks (e.g., bandana, scarf)

Level of surge capacity

Strategy

Contingency

• Use equipment beyond the manufacturer-designated shelf life for fit testing and training (e.g., N95 respirator, gown)

• Extended use of equipment

• Use of alternate equipment (e.g., cloth gowns, coveralls, equipment meeting international standards)

• Selectively cancel elective and non-urgent procedures and appointments for which eye protection is typically required

• Shift eye protection supplies from disposable to reusable devices such as goggles and face shields

• Remove facemasks in public areas. Restrict facemasks to use by providers only

Crisis

• Use of facemask and eye protection equipment beyond the manufacturer-designated shelf life for health care delivery

• Use of equipment approved under standards used in other similar countries

• Extended use and reuse of equipment

• Selectively cancel elective and non-urgent procedures and appointments for which facemask, gown or eye protection is typically used by the provider

• Prioritize use of facemask, gown and eye protection equipment by activity type (use during aerosol-generating procedures or other high-contact patient care activities)

• Consider using safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes

• Reprocess eye protection with effective cleaning methods

When no equipment is available

• Exclude provider at higher risk for severe illness from COVID-19 (e.g., immunocompromised) from contact with known or suspected COVID-19 patients

• Designate convalescent provider for provision of care to known or suspected COVID-19 patients

• Consider using gown alternatives that have not been evaluated as effective (preferably with long sleeves and closures such as snaps, buttons)

• If facemask not available, consider: use of face shield that covers the entire front (extends to the chin or below) and sides of the face with no facemask; use of expedient patient isolation rooms for risk reduction; use of ventilated headboards, and provider use of homemade masks (e.g., bandana, scarf)