Personal Protection Equipment or PPE supplies have had shortages over the past few months, with demand exceeding supply due. With COVID-19 cases continuing to increase in the United States at record levels with an average of 50,000 new cases per day over the past week, PPE supplies will be difficult to come by.

The lack of PPE in the U.S. is especially frustrating to healthcare workers because this is the primary defense against catching the virus themselves.

 Dr. Megan Ranney, an emergency room doctor and researcher at Brown University in Rhode Island who co-founded the volunteer-run organization #GetUsPPE, said as cases in Texas surged requests for PPE from health facilities in the state shot up.  Requests have gone up from 2,000 pieces of equipment last week to more than 220,000 this week.

Kevin Mealy, a spokesperson for the Oregon Nurses Association, told Katu News that nurses are still being asked to reuse PPE. In some cases, nurses are using PPE for multiple patients, which he says is against safety guidelines.

He says, "It's not safe, it's not sustainable. And it will be a problem if we continue to see COVID-19 cases continue to rise as the OHA and others are projecting."

As the urgency of high-profile COVID-19 outbreaks in the north-east of the country and cities such as New York faded in late spring, so did attention to the acute PPE shortage for frontline health workers. But fragile supply chains and wary hospital administrators continue to push some workers to wear N95 masks and gowns for up to a week, even though they are designed to be changed between patients. Frontline health workers have long warned that reusing such equipment leaves them at a higher risk of becoming infected.

"Many people thought once the alarm was sounded back in March surely the federal government would fix this, but that hasn't happened," said Deborah Burger, a California nurse and president of National Nurses United, a union representing registered nurses.

Cases are particularly surging in Texas, Florida, and Arizona, which pushed to reopen their economies early and had looser restrictions.

Demand for protective equipment has soared, but unlike in March, when efforts focused on getting PPE for major hospitals — especially in New York, Detroit, and Chicago — supplies now are desperately needed by primary care offices, nursing homes, prisons, and psychiatric and disability facilities. As many states continue to reopen their economies, demand has also surged from the construction industry, the restaurant industry, and other sectors.

While some workplaces will have PPE that is required daily or worn at all times, other personal protective equipment should be safely stored. The storage of personal protective equipment is almost as necessary has having it on hand, and an obligation set forth by OSHA, specifically requiring that PPE is "maintained in a sanitary and reliable condition."  A facility should have a specific area, away from harsh conditions, designated solely for storing PPE. While PPE needs to be stored in a specific drawer or cabinet, it must also be easily accessible in case of emergencies. Facilities should consider having extra PPE on hand. In the case of lost, damaged, or compromised equipment, injuries can be avoided by having extra equipment stored on site.

Steps in putting on PPE Gear:

1. Identify and gather the proper PPE to put on. Ensure the choice of gown size is correct (based on training).
2. Perform hand hygiene using hand sanitizer.
3. Put on isolation gown. Tie all of the ties on the gown. Assistance may be needed by other healthcare personnel.
4. Put on NIOSH-approved N95 filtering facepiece respirator or higher (use a face mask if a respirator is not available). If the respirator has a nose piece, it should be fitted to the nose with both hands, not bent or tented. Do not pinch the nose piece with one hand. Respirator/face mask should be extended under the chin. Both your mouth and nose should be protected. Do not wear respirator/face mask under your chin or store in scrub's pocket between patients.*
5. Respirator: Respirator straps should be placed on the crown of the head (top strap) and base of the neck (bottom strap). Perform a user seal check each time you put on the respirator.
6. Face mask: Mask ties should be secured on the crown of the head (top tie) and base of the neck (bottom tie). If the mask has loops, hook them appropriately around your ears.
7. Put on face shield or goggles. When wearing an N95 respirator or half face piece elastomeric respirator, select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full-face coverage. Goggles also provide excellent protection for eyes, but fog is common.
8. Put on gloves. Gloves should cover the cuff (wrist) of the gown.
9. Healthcare personnel may now enter the patient room.

Steps in taking off PPE Gear:

1. Remove gloves. Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or birds beak).
2. Remove the gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in a gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose of the trash receptacle.
3. Healthcare personnel may now exit the patient room.
4. Perform hand hygiene.
5. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from the head. Do not touch the front of the face shield or goggles.
6. Remove and discard respirator (or face mask if used instead of respirator). Do not touch the front of the respirator or face mask.*
7. Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.
8. Face mask: Carefully untie (or unhook from the ears) and pull away from face without touching the front.
9. Perform hand hygiene after removing the respirator/face mask and before putting it on again if your workplace is practicing reuse.*

During the COVID-19 pandemic, you should clean your hands after you have been in a public place and touched an item or surface that is frequently touched by other people. This includes door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens, etc. You should also clean your hands before touching your eyes, nose, or mouth because that's how germs enter your body.

Use Hand Sanitizer When You Can't Use Soap and Water. Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label.

Sources:

https://www.theguardian.com/us

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

https://katu.com/news/local/some-fear-rise-in-coronavirus-cases-could-lead-to-ppe-personal-protective-equipment-supply-issues-again

https://www.washingtonpost.com/health/2020/07/08/ppe-shortage-masks-gloves-gowns/

https://www.backtoworksafely.org/