The CDC’s recommendation for optimizing the supply of facemasks include “contingency” and “crisis” capacity. These are steps hospitals can take if they are no longer at “conventional” capacity, when standard measures remain in effect. These guidelines, which are subject to change with the coronavirus pandemic, were current as of March 25.1

The CDC defines contingency capacity as practices that may be used temporarily during periods of expected facemask shortages. Crisis capacity may call for stopgap measures “that are not commensurate with U.S. standards of care,” the CDC states. Hospitals with conventional capacity should use facemasks according to product labeling and local, state, and federal requirements.

Contingency Capacity Methods:

  • Selectively cancel elective procedures and nonurgent appointments that typically require facemask use by healthcare personnel (HCP).
  • Remove facemasks for visitors in public areas.
  • Consider removing facemasks in all public areas in healthcare facilities. Facemasks can be provided to symptomatic patients upon check in. Store all facemasks in a secure and monitored site.
  • Extend use of facemasks by wearing the same facemask for repeated close contact encounters with several different patients.

Under extended use conditions:

  • Discard the mask if it becomes soiled, damaged, or difficult to breathe through.
  • Avoid touching facemasks. Perform hand hygiene if contact occurs.
  • Leave patient care areas before removing masks.

Crisis Capacity Methods:

  • Cancel all elective procedures and nonurgent appointments that typically require HCP facemask use.
  • Use masks beyond the manufacturer-designated shelf life during patient care activities.
  • Implement limited re-use of facemasks by using the same facemask for multiple encounters with different patients but removing it after each encounter.
  • Facemasks that fasten with ties may not be able to be undone without tearing and should be considered only for extended use. Facemasks with elastic loops can be considered for re-use.
  • Leave patient areas to remove facemasks. Fold masks so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. Store folded masks in a clean sealable paper bag or breathable container between uses.

Prioritize facemasks for selected activities such as:

  • Essential surgeries and procedures;
  • During care activities that may result in splashes or sprays;
  • During prolonged face-to-face or close contact with a potentially infectious patient;
  • Performing aerosol-generating procedures, if no respirators are available.

If facemasks are not available:

  • Exclude HCP at higher risk for severe illness from COVID-19, such as those of older age, with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected COVID-19 infection.
  • Consider designating HCP who have clinically recovered from COVID-19 to provide care for additional patients with COVID-19. Those who have recovered from COVID-19 may have developed some immunity, but this is unconfirmed.
  • Use a face shield that covers the entire front and sides of the face with no facemask.
  • Consider using patient isolation rooms for risk reduction.
  • Portable fans with high-efficiency particulate air (HEPA) filtration can increase the effective air changes per hour of clean air to the patient room, reducing risk to individuals entering the room without respiratory protection.
  • Consider use of ventilated headboards. These draw exhaled air from a patient in bed into a HEPA filter, decreasing risk of HCP exposure to patient-generated aerosol.
  • HCP may use homemade masks (including scarves or bandanas) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since protective capabilities are unknown. Exercise caution if considering this option. Homemade masks should be used in combination with a face shield that covers the entire front and sides of the face.

REFERENCE

  1. Centers for Disease Control and Prevention. Strategies for optimizing the supply of facemasks. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html