Title: Conserving PPE
Course: COVID CURRICULUM (Export) > Section: Module1: Infection Prevention & Control

Given COVID-19 related PPE shortages, you may be asked to extend the use of or reuse your PPE according to organizational policy.

You may also be provided with a supply of masks to use in the clinical areas. Please ensure that you DO NOT share these with friends or family members, they are intended for your clinical use only.

Ontario Health (2020) has provided guidance on conserving PPE including extended use and reuse of PPE as outlined below. Since there may be variation between organizations, please ensure that you follow local policies and procedures.

Image source: Mika Baumeister on Unsplash

Extending Use of PPE

Strategy | Description
Extended use

Applicable to the following types of PPE:

• N95 respirators (disposable)

• Surgical/procedure masks (disposable)

• Isolation gowns (disposable and cloth)

• Eye protection (disposable and reusable)
PPE may be used over an extended period of time and over the course of many patients, in settings where it is feasible (e.g., while caring for a cohort of patients with suspected or confirmed COVID19 in an inpatient setting).  *Always follow your organizational policy.

- Extended use of PPE, including N95 respirators, is not recommended after performing an AGMP
  - After performing an AGMP for a patient with suspected or confirmed COVID-19, PPE items should be safely removed (“doffed”). Disposable items that cannot be reprocessed should be discarded (e.g., gloves), reusable items cleaned/disinfected (e.g., cloth gowns), and N95 respirators placed in the appropriate receptacles for reprocessing.

Consider the following key principles:

- Extend the use of PPE for as long as possible, but once wet, damaged, soiled, or removed (e.g., to eat or drink), or after exiting the patient care area, PPE should be changed
- Take extra care when removing the PPE as this is when self-contamination may occur. Disposable items that cannot be reprocessed should be discarded (e.g., gloves), reusable items cleaned/disinfected (e.g., cloth gowns), and N95 respirators placed in the appropriate receptacles for reprocessing
- Gloves should be changed between every patient encounter
- Adhere stringently to hand hygiene before and after handling PPE and between patient encounters. It is safe to wear your PPE for multiple patient encounters. In fact, you may reduce your risk of self-contamination by reducing the number of PPE changes
- While wearing a mask take extra care not to touch it. If you do, immediately perform hand hygiene
Layering PPE
Layering involves wearing more than one piece of PPE at the same time, such as complementary items that provide protection to the same area (e.g., an N95 respirator with a face shield over top) or more than one of the same item (e.g., double gloves)

- The evidence to support the practice of layering is inconclusive. However, some guidance suggests that face shields could protect a mask or respirator from surface contamination from larger splashes or sprays. Face shields are being used on top of masks to protect other parts of the face and extend the use of the mask worn underneath

Adapted from Ontario Health (2020a, p.12)

Limited Reuse of PPE

Strategy | Description
Limited reuse

Applicable to the following types of PPE:

• N95 respirators (disposable)

• Surgical/procedure masks (disposable)

• Cloth isolation gowns

• Eye protection (disposable and reusable)
Limited reuse refers to the practice of using the same PPE item for multiple encounters with patients, but carefully removing it (“doffing”) after each encounter, storing it safely, then putting it back on (“donning”) without disinfecting.  *Always follow your organizational policy.

Limited reuse of PPE carries a higher risk of self-contamination than with extended use. The feasibility of limited reuse may depend on the health care setting.

Limited reuse of PPE, including N95 respirators, is not recommended for when performing an AGMP

Consider the following key principles:

- The PPE is safely stored between patient encounters and put back on again (“donned”) before the next encounter with a patient
- Take great care when removing or redonning the PPE as this is when self-contamination may occur. Also, take care to avoid contaminating the inside of the mask
- Even when reuse is practiced or recommended, restrictions are in place that limits the number of times the same item is reused (therefore referred to as “limited reuse”)
- Once the PPE is wet, damaged, or soiled, it should be placed in the appropriate receptacle. Disposable items that cannot be reprocessed should be discarded (e.g., gloves), reusable items cleaned/disinfected (e.g., cloth gowns), and N95 respirators placed in the appropriate receptacles for reprocessing
- Gloves should be changed between every patient encounter
- Adhere stringently to hand hygiene before and after handling PPE and between patient encounters
- While wearing a mask take extra care not to touch it, and if you do, immediately perform hand hygiene

Adapted from Ontario Health (2020a, p.16)