Summary of Recommendations for PPE Conservation and Management
Import
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Purchase from international suppliers: China proposed as a primary market given manufacturing capacity, experience with and decline in COVID-19 incidence
Reclaim
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Dentists, farmers, construction, high schools, universities, veterinarians, salons, manufacturing, aerospace, industrial “clean labs”
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Individual HCW procurement in towns and communities
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Charitable movements
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Public or private buybacks
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Public or private bounties
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Reuse
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Rotate through 72-h cycles given current understanding of surface viability
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Reusable elastomeric respirators (have exchangeable filter cartridges)
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Disinfectants
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Heat (eg, autoclave), UV, ozone, ethylene oxide, hydrogen peroxide, bleach, isopropyl alcohol, gamma or e-beam radiation, microwave, copper sulfate, methylene blue with light, sodium chlorine, iodine, zinc oxide impregnation (gowns), hypochlorous acid, commercial laundering (for cloth)
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Repurpose
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Prefabricated masks: snorkel and scuba, 3D printed, welder’s, civilian military grade gas masks, ski buffs
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Eye and face shields: sports eye protectors, motorcycle helmets with visors, balaclavas
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Gowns: plastic ponchos or poly bags, bedbug sheet material
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Adhesive bandage as nasal PPE
Create supply
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Sewn fabric masks and gowns, coffee filter masks, home HVAC filter masks
Extend supply
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Plastic face shields (water bottle cutouts, thermoplastic sheets, A4 acetate sheets, Ziploc bags) to preserve face masks and eyewear
Reduce nonessential services
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Cancel elective and ambulatory procedures; reduce questionable contact and isolation precautions (eg, MRSA/VRE, influenza, cellulitis)
Reduce patient contact
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Utilize mobile and out-of-room monitoring and device controls, e-consults, extended dwell IVs, batching medications or self-administration, barrier visits
Alter staffing
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Reduce student and trainee patient contacts
Use nonhuman services
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Nonhuman services (drones and robots) for delivery of test kits for self-testing, robots for equipment movement within hospitals, decontamination protocols
Stratify use by patient risk
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Cohort patients and reduce PPE use for those at low risk (ideally requires testing to accurately stratify low and high risk)
Employ immune workers
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HCWs recovered from clinical illness or with demonstrated immunity care preferentially for COVID-19 patients without PPE
Use government solutions
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Regionalize care and supply, import international supply, ration supply, loosen import regulations, commandeer business to accelerate supply
Manage supply
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Reduce bulk packaging, Pyxis-like controlled distribution, nongovernment regional coordination of PPE distribution
Miscellaneous
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Convert RV trailers to negative pressure spaces; phase change material to improve comfort and reduce reuse of gowns
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