MINISTRY OF HEALTH GUIDANCE ON THE RATIONAL USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR COVID-19 IN HEALTH CARE SETTINGS UPDATED 28™ MAY 2020 PERSONAL PROTECTIVE EQUIPMENT IN THE HEALTH CARE SETTINGS Personal Protective equipment (PPE) should be used based on the risk of expesure (eg, type of activity) and the transmission dynamics ofthe pathogen (eg, contact, droplet or aerosol). The following observations should be ensured fr rational use of PPE: Minimize the need for PPE, Consider using telemedicine 10 evaluate suspected cases of COVID-19, thus minimizing the need for these persons to goto health care felts for evaluation Use physical baie to reduce exposure to the COVID-19 virus, such as glass or plastic windows. This approach canbe implemented in areas ofthe vealth care setting ‘where patents will first present, such as triage areas, the repistation desk at the ‘emergency department, rat the pharmacy window where medicatin is collected, Restrict healthcare workers ffom entering the rooms of COVID- 9 patents if they are not involved in ditet are ‘Consider bundling activities to minimize the number of times a rocm is entered (e.g. check vital signs during medication administration or have food delivered by heath care workers while they ae performing other care) and plan which activities will be performed atthe bedside Visitors will not be allowed but if this i not possible, restriet the number of visitors to areas where COVID-19 patents are being isolate; restrict the amount of time are allowed to spend inthe area; and provide clear instrtion about how to‘put on and remove PPE and perform hind hygiene to ensure that visitors avid self= contamination, Such Visitors should wear face mask. ‘The following aspects are new considerations inthis guidance Posipone eletive, non-urgent procedure, and hospitalizations, reduce frequency of | visits for chronie patients, epply telemedicine ad telephone solutions where possible 0 that health care workers, ward, and PPE can be redistributed to services in which (COVID-19 patients receive care, Cohort confirmed COVID-19 patients without coinfection with oher transmissible ‘microorganisms ia the same room in onder to streamline the workflow and facilitate extended use of PPE (see below). Designate dedicated health care workersteams only for COVID-19 patient care 0 that they can use PPE for longer petiods of time (extended use of PPE), if necessary (Gee considerations section below for detail). Restrict the number of health eare workers from entering the rooms of COVID-19 patents if they are not involved in providing direct cae. Streamline the workow and reduce toa safe evel care that requires face-to-fce interaction between health worker and patient, To do so, consider bundling setvitis to minimize the umber of times a room is entered (eg check vital signs during medication administration or have food delivered by health eare workers while they are performing other eate) and plan ‘whic activities willbe performed atthe bedside, Consider using specific PPE only if in direct close contact with the patient or when touching the environment (e.g, wearing @ medical mask and face shield, not using loves or gown over the scrub suit, if entering the patient's rom only to ask 8 or make visual checks)Ensure PPE use is rational and appropriate PPE should be used based on the risk of exposure (e.g. type of activity or procedure) and the son dynamies ofthe pathogen (e.g. contact, droplet or aerosol). The overuse of PPE will have a further impact on supply shortages. Observing the following recommendations will ‘ensure rational use of PPE, ‘+ The type of PPE used when eating for COVID-19 patents will vary acording to the setting, type of personnel, and activity (Table 1) ‘+ Health care workers involved in the direst care of patents should use PPE according 19 indications ‘+ Specifically, for aerosol-generating procedures and support treatments (tracheal intubation, noninvasive ventilation, tracheotomy, eaiopulmonary resuscitation, manual and bronchoscopy) health care workers should use respirators, eve protection, loves and owns; aprons should also be used if gowns are not uid resistant ventilation before intubati ‘+ Among the general public, persons with symptoms suggestive of COVID-19 or those cating for COVID-19 patients at home should receive medical masks and instructions on their use For seditonal ‘information, see Home care for patients with COVID-19 presenting wih mild symptoms snd management oftheir contats. TRISK ASSESSMENT FOR PPE SELECTION YES Performa T, A Tati of exposure to Blood or body [2-3 | auc isk fuids? assesment [2 Temy cea ik? Face Preston by asking TA my bands a a? Gloves yourseithe | a, Are my clothes anak? — Gownlapron following 5. The patent know or suspected to have | Addiiona:presations uestons infectious disease ‘2g. Covel, N9S respirator‘TABLE 1: RECOMMENDED TYPE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) TO BE USED IN THE CONTEXT OF COVID-19 DISEASE, ACCORDING TO ‘THE TYPE OF ACTIVITY POINTS OF ENTRY (POEs) arg Tage prone | atv Type ar PPE oF -Aainintative meas | AM stath aay > Sargeat ast Screening ea OE Staff and} Fist vrcenn = — Maintain spadia e healthcare | (temperature Mstance of at least workers feasurement) not 13m Involving direct contact | + Surgical mask t ‘Second sereening (ie, | * NOS respirator inervevingpaengers” | 2 Disposable gown | withfeerferelineal || 3 Gloves Bees 3 eeopentace D9 ti travel history). Sereening Area ‘Cleaners {Spatial dktancin Sereening Af where passengers are | 2 Surgical Maske being sreent 2 Waterproof Gowny be ia dy gloves oe, TeRapORRTY GUAT |-PLO“E Stat wd} Enteving the quarantine + — Maina ap as healtheare "| atea,butnotproviding | "distance of at least ‘workers direct assistance iam + Shrgleat mask Sener, TEE Sena are acitye at0F Freprotestion iirleal masks Disposable Edin and Apron Heavy duty gloves | 5 Hye protection uinboots ‘Cleaners “Cleaning Temporary quarantine areaPatients ar eal aK Spatial distance "ARIDUERCE OF itanster | hile ~) Heatieare Transport workers ‘tapected COVID-19 patients fo the (unrantine faites. = NSS FapiraTOrIC sharing same Compartment stherwise use Direct Inpermesble Gown 2 Gloves 2 Preprotection “Transporting ‘confirmed COVID-19 ents tothe lolation ° ieee seamerament + Soe Driver Tayolee ona arin Suspesfedeoafirmed | COV disease and | hearer omnpartment is Separated from the eBVib«I9 patient Eve protect > Maintain spatial distance ofa least 13m + Surgical mask Asintng with Toading | ¢ NS repiator ‘Grunloading patient Disposable rire impermeable Suspested/contirmed Gown COVIDASaieme | + Cloves + Eyeproteetion [Naive sonaer wit + NGS FespiRCOr patient with Disposable: Ruspetednatirmed | impermeable Gown “D9, but wo ‘loves separation between + Eye protection Gtver'sand patient's compartments. Patient with | Transport to the ‘argieal mask if sunpecteiconni | eeeraiheaincare | ‘tolerated elt. Covina ‘iscase |‘Cleaners of | Cheamragater aad gia mask Somevaness | fefneenseansport of | nnpermeable patients it 2 Gown Apres Risecteconiemed | + Hens dy gloves CORD Geeta the | Esehrotestion feferral healtheare i ‘TABLE 2; SPECIAL CONSIDERATIONS FOR RAPID RESPONSE TEAM: TASES WTA POBDIC HEALTN INV ESHEATEONS AP THE COMMUNITY ‘Seti > Target personnel or — [Activity “Type TPP ar 7 patent procedre Fie Rapid response | Remote Interview | No medical PPE ne inpected oF Rice Marea onfirmed COVID- | National Regulation SBiyadentsor heir comacts | Remote interview the preferred Vee mentee tmetae z response fam | Ta-persom interview | + NOS Fepiratar mag Investigators one Maint spatat Stspected or distance oft confirmed COVID- | least {9>patients without direct contact interview sou De conducted ouside {he house or outdoors, Sd confirmed or Sspected COVED patents soul wear ilersted. Fidd “Rap response eam an Taree |= Spatial dss investigators. symptomatic ‘Spates. i + NOS'Mask‘The Interview should] be performed outside Atehouse or outdoors Itinerary «ater the household ‘avironment, use ermal imaging distance of at east LS ttand donot oath anything inthe iousehotd cavironment. (Fie Rapid response team | Sample colletion 7 NS ‘rom contacts of respirator COVID-19 patients | + Coveralls + Gloves + Bye protection ‘TABLE 3: OUTPATIENT FACILITIES “Type oF PPE oF procedure eran ene distance of at Teast 1.8 Surseal mask Fasemak Facemaske Spatial distance Workers traging 95 respirator Eye protection Feidrmenbe Gloves alma NIST] sting physical Tmpermeabte Garalapron‘Cleaners “ATTer and betwaan [+ — Surgical mask ‘consultations with | * Disposable amas Sera wn and to cereal serena a Be EN oTeS. Ae — eR RT = spanrasaee ene E see pera Teiae® par ee foe ceo | sri are 2 ie ERI = Ra ‘respiratory & + Face mask: E eee “eases — ates} kaaucnine ~~ pT a Sua, | ma ‘Setting. “Target personnel ~~] Type of PPE or emia pecs amare Ee a IESG rake | rovdiegateat + Worm a | ae oar Covibay |S tin aun. iis + Ea. i itag Sees ae five Becien |? ecm ee eee, ee es — — ” Boots© Heeshield, : EEE ae —EE ee ren —) Bice as, direst contact | 3 Gloves bl a a mask ” war fre peste x eee + Spatial distance "| ae |; Rete * ah aes ‘stance of at east 15 m. | respiratory | Bu 27 Maloun gpatatCaregiver [Eater te patent's] Sirgteal mask. | om, bit ot Syatal distancing roving iret care CaRaEIVEr Gaver trom | > Sareea) Mask. COU paten |S Aponte ot being cared! tor at sh) ome. se nratection Trealthcare workers Providing direct 3S respirator sanceto | + Gown | 2 Gloves + _Eyeprotection Tubleaes eq, | Tnairawals without Tema, ‘alls, basa tain | Te*Pirstory ole ations, parliament). | SYmptoms In addition to sing the appropriate PPE, ffequent hand hygiene and respiratory hygiene should always be performed. PPE shouldbe diseared in an appropriate waste container after use, and ‘hand hygiene should be performed before putting on and after taking off PPE. The number of visitors should be restricted. I visitors must enter a COVID-19 patents room, they’should be provided with clear instructions about how to put on and remove PPE and abou: performing hand hygiene before putting on and after removing PPE; this should be supervised by aealiheare worker. Issued by Dr. Simon Kibias, OGW ‘Ag, Director, Dircetorate of Health Standards Quality Assurance and Regulations 0