Reports of dwindling supplies of personal protective equipment (PPE) for frontline healthcare providers are daily headline news. The most basic piece of PPE, the facemask, is reported in extremely short supply at all levels of the healthcare system.According to the Centers for Disease Control and Prevention (CDC) surge capacity is the "ability to manage a sudden, unexpected increase patient volume that would otherwise severely challenge or exceed the present capacity of a facility." The CDC explains 3 levels of surge capacity that can be used to prioritize facemask conservation efforts along the continuum of care. Conventional, contingency, and crisis capacity strategies are explained in the slides below.
CONVENTIONAL CAPACITY. Measures consist of providing patient care without any change in daily contemporary practices. This set of measures, consisting of engineering, administrative, and PPE controls should already be implemented in general infection prevention and control plans in healthcare settings.
Use facemasks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Facemasks that are not regulated by FDA, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.
CONTINGENCY CAPACITY STRATEGIES. “Measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare HCP. These practices may be used temporarily during periods of expected facemask shortages.”
Selectively cancel elective and non-urgent procedures and appointments for which a facemask is typically used by HCP.
Remove facemasks for visitors in public areas. All facemasks should be placed in a secure and monitored site. This is especially important in high-traffic areas like emergency departments.
Implement extended use of facemasks. Extended use of facemasks is the practice of wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters.
How to implement extended use of facemasks. The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. HCP must take care not to touch their facemask. If they touch or adjust their facemask they must immediately perform hand hygiene. HCP should leave the patient care area if they need to remove the facemask.
Restrict facemasks to use by HCP, rather than patients for source control. Have patients with symptoms of respiratory infection use tissues or other barriers to cover their mouth and nose
CRISIS CAPACITY STRATEGIES. “Strategies that are not commensurate with US standards of care. These measures, or a combination of them, may need to be considered during periods of known facemask shortages.”
Cancel all elective and non-urgent procedures and appointments for which a facemask is typically used by HCP.
Use facemasks beyond the manufacturer-designated shelf life during patient care activities. If there is no date available on the facemask label or packaging, facilities should contact the manufacturer. The user should visually inspect the product prior to use and, if there are concerns (such as degraded materials or visible tears), discard
Implement limited use of facemasks. Limited re-use of facemasks is the practice of using the same facemask by one HCP for multiple encounters with different patients but removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, care should be taken to ensure that HCP do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner.
The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. Not all facemasks can be reused: Facemasks that fasten to the provider via ties may not be able to be undone without tearing and should be considered only for extended use, rather than re-use. Facemasks with elastic ear hooks may be more suitable for re-use.
HCP should leave patient care area if they need to remove the facemask. Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.
Prioritize facemasks for selected activities such as: Provision of essential surgeries and procedures ** During care activities where splashes and sprays are anticipated ** During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable ** For performing aerosol generating procedures, if respirators are no longer available.
