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Personal Protective Equipment (PPE) Resources

Organizations that Need Resources
Virginia Resources: This document provides details on how providers can log their PPE shortages: http://www.vdh.virginia.gov/content/uploads/sites/13/2020/03/PPE-Recommendations_Shortage-Situations.pdf. Regional health coalitions are tracking PPE shortages to inform VDH guidance and may be able to provide contact information for vendors or leverage supplies. Contact information can be found at https://vhass.org/regional-info/. Report type of PPE or supply item(s) in shortage, the vendor, and the reason for the reported shortage (allocation, back-order, etc.).

If you are a local, Virginia health care provider, EMS or first responder organization, or other medical professional who is experiencing shortages of personal protective equipment (PPE), you can contact your local office of the Virginia Healthcare Emergency Management Program. Click here to find out which regional healthcare coalition covers your area. The Virginia Healthcare Emergency Management Program works with Virginia hospitals and healthcare systems to enhance the Commonwealth’s capabilities to prepare, respond, and recover from all-hazards. 

Additionally, you can contact your local health department through the Virginia Department of Health through this website. The VDH has access to limited resources from the National Stockpile and is able to distribute to local health care providers when supplies allow. 

National Resources: If you or a health care provider has questions or is experiencing shortages of personal protective equipment or other supplies, you should call FDA’s toll-free line at 1-888-463-6332 (1-888-INFO-FDA), then choose option (*). The line is available 24 hours a day to help address difficulties obtaining supplies. Please note, however, that FDA does not control the production volume or distribution of medical devices.  Here is a FAQ on 3D printing of PPE from the FDA: https://www.fda.gov/medical-devices/3d-printing-medical-devices/faqs-3d-printing-medical-devices-accessories-components-and-parts-during-covid-19-pandemic


Organizations that Have Resources

Virginia Resources: If you are a Virginia production organization who is producing PPE or other medical equipment and would like to help responding to shortages of PPE, you can contact your local office of the Virginia Healthcare Emergency Management Program. Click here to find out which regional healthcare coalition covers your area. The Virginia Healthcare Emergency Management Program works with Virginia hospitals and healthcare systems to enhance the Commonwealth’s capabilities to prepare, respond, and recover from all-hazards. 

Potential vendor offers: Given the high volume of potential vendors, the Administration has established a more streamlined vendor evaluation process. Please direct all businesses with offers to covid19offers@dgs.virginia.gov

PPE Donations: VDEM has issued the following survey to gather information from the private sector on offers of assistance to Virginia (donation, in-kind contribution, discounted): https://bit.ly/VaDonations. This applies to donation offers for tests, PPE, or other necessary equipment.


FEMA released information for how to help via donations, volunteering and for the private sector. Their specific guidance includes:

  • Businesses that have medical supplies or equipment to donate are asked to go to www.fema.gov and provide of the offer through our online medical supplies and equipment form. The direct web link is www.fema.gov/coronavirus/covid-19-donations. 
  • Businesses that want to sell medical supplies or equipment to the federal government, please email specifics to covidsupplies@fema.dhs.gov. 
  • Licensed medical volunteers can offer their services by registering with the Emergency System for Advance Registration of Volunteer Health Professionals. You can access a direct link to do so through fema.gov
  • Donate Blood:  One thing people can do to help is to donate blood. Many blood drives have been cancelled, impacting the supply. Blood donation centers have the highest standards of safety and infection control. To find where you can donate blood, visit redcross.org.

To sell medical supplies or equipment to the federal government, please submit a price quote under the COVID-19 PPE and Medical Supplies Request for Quotation. Full details can be found in the solicitation (Updated Notice ID 70FA2020R00000011). This solicitation requires registration with the System for Award Management (SAM) in order to be considered for award, pursuant to applicable regulations and guidelines. Registration information can be found at www.sam.gov. Registration must be “ACTIVE” at the time of award.  

If you have medical supplies or equipment to donate, please provide us details on what you are offering through our online medical supplies and equipment form athttps://www.fema.gov/covid19offers.

If you are interested in doing business with FEMA and supporting the response to COVID-19 with your company’s non-medical goods and/or services, please submit your inquiry to the Department of Homeland Security’s Procurement Action Innovative Response (PAIR) team at  DHSIndustryLiaison@hq.dhs.gov.

In addition to these avenues to help, licensed healthcare professionals that want to volunteer can get information on eligibility, view credential levels by clinical competency and register with the Emergency System for Advance Registration of Volunteer Health Professionals in their state.

If you are a hospital or healthcare provider in need of medical supplies, please contact your state, local, tribal or territory department of public health and/or emergency management agency. Any needs that cannot be met by the state or tribe are then sent to the respective FEMA regional office who are coordinating requirements through the FEMA National Response Coordination Center. FEMA is working with the Department of Health and Human Services and other federal agencies to fulfill requests and ship supplies as quickly as possible.

Potential vendor offers

Given the high volume of potential vendors, the Administration has established a more streamlined vendor evaluation process. Please direct all businesses with offers to covid19offers@dgs.virginia.gov

PPE Donations

VDEM has issued the following survey to gather information from the private sector on offers of assistance to Virginia (donation, in-kind contribution, discounted): https://bit.ly/VaDonations. This applies to donation offers for tests, PPE, or other necessary equipment.


Guidance for healthcare partners

Information for Laboratories 

VDH Website 

DCLS Guidance

  • COVID-19 Laboratory Guidance Document

You may find FDA’s COVID-19 FAQ  useful in addressing questions related to vaccines, biologics, human tissue products, drugs, medical devices and tests, and food products. FDA also has specific COVID-19 FAQs for Emergency Use Authorizations, Diagnostic Testing, Food Safety for Industry, Healthcare Professionals, and other specific audiences. These are updated as information becomes available.


Homemade Personal Protective Equipment (PPE)

Healthcare Personnel (HCP) use of homemade masks Centers for Disease Control (CDC): In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

Guidance for homemade hand sanitizer: Dr. James Palmieri, the Associate Professor for Microbiology and Immunology at the Edward Via College of Osteopathic Medicine (VT Campus) gave the following guidance about creating homemade hand sanitizer with common household items that are also obtainable in pharmacies or supermarket chains.

WHAT YOU NEED:

  1. Go to the sunburn product area at your local pharmacy and purchase aloe vera gel ($3-$6)
  2. Buy a bottle of 70% isopropyl alcohol ($1-$2)
  3. Buy tea tree oil — a popular antibacterial essential oil ($4-$6)

PROCEDURE:

  1. In a container that has a lid: Create a 50/50 mix of isopropyl alcohol and aloe vera gel
  2. Put in 2-3 drops of tea tree oil
  3. Shake for 1 minute
  4. Ready for use

Dr. Palmieri still recommends washing your hands 20 times a day and use the isopropyl alcohol to wipe down your keyboard and cell phones. He also suggests buying baby wipes to clean surfaces.


Frequently Asked Questions Regarding PPE

Gloves

  • What type of glove is recommended to care for suspected or confirmed COVID-19 patients in healthcare settings?
    • Nonsterile disposable patient examination gloves, which are used for routine patient care in healthcare settings, are appropriate for the care of patients with suspected or confirmed COVID-19.
  • What standards should be considered when choosing gloves?
    • The American Society for Testing and Materials (ASTM)external icon has developed standards for patient examination gloves.
    • Standard specifications for nitrile gloves, natural rubber gloves, and polychloroprene gloves indicate higher minimum tensile strength and elongation requirements compared to vinyl gloves.1,2,3,4
    • The ASTM has developed standards for patient examination gloves. Length requirements for patient exam gloves must be a minimum of 220mm-230mm depending on glove size and material type.1,2,3,4
  • Is double gloving necessary when caring for suspected or confirmed CoVID-19 patients in healthcare settings?
    • CDC Guidance does not recommend double gloves when providing care to suspected or confirmed 2019-COVID patients.
  • Are extended length gloves necessary when caring for suspected or confirmed COVID-19 patients in healthcare settings?
    • According to CDC Guidance, extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. Extended length gloves can be used, but CDC is not specifically recommending them at this time.
  • How I do put on (don) and take off (doff) my gloves?
    • Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
    • If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPEpdf icon.
    • It is important for HCP to perform hand hygiene after removing PPE. Hand hygiene should be performed by using an alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds.  If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Gowns

  • What testing and standards should I consider when looking for CDC-recommended protective clothing?
    • CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids outlines the scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare.
    • Many organizations have published guidelines for the use of personal protective equipment (PPE) in medical settings. The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI): ANSI/AAMI PB70:2012pdf iconexternal icon describes the liquid barrier performance and a classification of surgical and isolation gowns for use in health care facilities.
    • As with any type of PPE, the key to proper selection and use of protective clothing is to understand the hazards and the risk of exposure. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks to be performed by the user of the PPE. (Technical Information Report (TIR) 11 pdf iconexternal icon[AAMI 2005]).
    • For gowns, it is important to have sufficient overlap of the fabric so that it wraps around the body to cover the back (ensuring that if the wearer squats or sits down, the gown still protects the back area of the body).
  • What type of gown is recommended for patients with suspected or confirmed COVID-19?
    • Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by patients with suspected or confirmed COVID-19.
  • What types of gowns are available for healthcare personnel to protect from COVID-19?
    • While the transmissibility of COVID-19 is not fully understood, gowns are available that protect against microorganisms. The choice of gown should be made based on the level of risk of contamination. Certain areas of surgical and isolation gowns are defined as “critical zones” where direct contact with blood, body fluids, and/or other potentially infectious materials is most likely to occur. (ANSI/AAMI PB70pdf iconexternal icon).
    • If there is a medium to high risk of contamination and need for a large critical zone, isolation gowns that claim moderate to high barrier protection (ANSI/AAMI PB70 Level 3 or 4pdf iconexternal icon) can be used.
    • For healthcare activities with low, medium, or high risk of contamination, surgical gowns (ANSI/AAMI PB70 Levels 1-4pdf iconexternal icon), can be used. These gowns are intended to be worn by healthcare personnel during surgical procedures.
    • If the risk of bodily fluid exposure is low or minimal, gowns that claim minimal or low levels of barrier protection (ANSI/AAMI PB70 Level 1 or 2pdf iconexternal icon) can be used. These gowns should not be worn during surgical or invasive procedures, or for medium to high risk contamination patient care activities.
  • What is the difference between gowns and coveralls?
    • CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids provides additional comparisons between gowns and coveralls.
    • Gowns are easier to put on and, in particular, to take off. They are generally more familiar to healthcare workers and hence more likely to be used and removed correctly. These factors also facilitate training in their correct use.
    • Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. Surgical/isolation gowns do not provide continuous whole-body protection (e.g., they have possible openings in the back, and typically provide coverage to the mid-calf only).
    • The level of heat stress generated due to the added layer of clothing is also expected to be less for gowns when compared to coveralls due to several factors, such as the openings in the design of gowns and total area covered by the fabric.
  • How do I put on (don) and take off (doff) my gown?
    • Check to see if your facility has guidance on how to don and doff PPE.  The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
    • If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.pdf icon
    • It is important for Health Care Providers (HCP) to perform hand hygiene before and after removing PPE. Hand hygiene should be performed by using alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.
  • Is it acceptable for emergency medical services to wear coveralls as an alternative to gowns when COVID-19 is suspected in a patient needing emergency transport?
    • Unlike patient care in the controlled environment of a healthcare facility, care and transport by EMS present unique challenges because of the nature of the setting. Coveralls are an acceptable alternative to gowns when caring for and transporting suspect COVID-19 patients.  While no clinical studies have been done to compare gowns and coveralls, both have been used effectively by healthcare workers in clinical settings during patient care. CDC’s Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids guidance provides a comparison between gowns and coveralls, including test methods and performance requirements. Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well.  This added coverage may be necessary for some work tasks involved in medical transport. However, coveralls may lead to increased heat stress compared to gowns due to the total area covered by the fabric. Training on how to properly remove (doff) a coverall is important to prevent self-contamination. Comparatively, gowns are easier to put on and, in particular, to take off.

Respirators

  • Should I wear a respirator in public?
    • CDC does not recommend the routine use of respirators outside of workplace settings (in the community). Most often, spread of respiratory viruses from person-to-person happens among close contacts (within 6 feet). CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching your eyes or nose, and covering your cough or sneeze with a tissue. People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.
  • What is a respirator?
    • A respirator is a personal protective device that is worn on the face or head and covers at least the nose and mouth. A respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases or vapors. Respirators, including those intended for use in healthcare settings, are certified by the CDC/NIOSH.
  • What is an N95 filtering facepiece respirator (FFR)?
    • An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.
  • What makes N95 respirators different from facemasks (sometimes called a surgical mask)?
    • Infographic: Understanding the difference between surgical masks and N95 respiratorspdf icon
    • N95 respirators reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets. N95 respirators are tight-fitting respirators that filter out at least 95% of particles in the air, including large and small particles.
    • Not everyone is able to wear a respirator due to medical conditions that may be made worse when breathing through a respirator. Before using a respirator or getting fit-tested, workers must have a medical evaluation to make sure that they are able to wear a respirator safely.
    • Achieving an adequate seal to the face is essential. United States regulations require that workers undergo an annual fit test and conduct a user seal check each time the respirator is used. Workers must pass a fit test to confirm a proper seal before using a respirator in the workplace.
    • When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.
    • Unlike NIOSH-approved N95s, facemasks are loose-fitting and provide only barrier protection against droplets, including large respiratory particles. No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent leakage around the edge of the mask when the user inhales.
    • The role of facemasks is for patient source control, to prevent contamination of the surrounding area when a person coughs or sneezes. Patients with confirmed or suspected COVID-19 should wear a facemask until they are isolated in a hospital or at home. The patient does not need to wear a facemask while isolated.
  • What is a Surgical N95 respirator and who needs to wear it? 
    • A surgical N95 (also referred as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings. In times of shortage, only HCP who are working in a sterile field or who may be exposed to high velocity splashes, sprays, or splatters of blood or body fluids should wear these respirators, such as in operative or procedural settings. Most HCP caring for confirmed or suspected COVID-19 patients should not need to use surgical N95 respirators and can use standard N95 respirators.
    • If a surgical N95 is not available for use in operative or procedural settings, then an unvalved N95 respirator may be used with a faceshield to help block high velocity streams of blood and body fluids.
  • My employees complain that Surgical N95 respirators are hot and uncomfortable – what can I do?
    • The requirements for surgical N95 respirators that make them resistant to high velocity streams of body fluids and help protect the sterile field can result in a design that has a higher breathing resistance (makes it more difficult to breath) than a typical N95 respirator. Also, surgical N95 respirators are designed without exhalation valves which are sometimes perceived as warmer inside the mask than typical N95 respirators. If you are receiving complaints, you may consider having employees who are not doing surgery, not working in a sterile field, or not potentially exposed to high velocity streams of body fluids wear a standard N95 with an exhalation valve.
  • My N95 respirator has an exhalation valve, is that okay?
    • An N95 respirator with an exhalation valve does provide the same level of protection to the wearer as one that does not have a valve. The presence of an exhalation valve reduces exhalation resistance, which makes it easier to breathe (exhale). Some users feel that a respirator with an exhalation valve keeps the face cooler and reduces moisture build up inside the facepiece. However, respirators with exhalation valves should not be used in situations where a sterile field must be maintained (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.
  • How can I tell if a respirator is NIOSH-approved?
  • How do I know if a respirator is falsely advertising NIOSH-approval?
  • How do I know if my respirator is expired?
    • NIOSH does not require approved N95 filtering facepiece respirators (FFRs) be marked with an expiration date. If an FFR does not have an assigned expiration date, you should refer to the user instructions or seek guidance from the specific manufacturer on whether time and storage conditions (such as temperature or humidity) are expected to have an effect on the respirator’s performance and if the respirators are nearing the end of their shelf life.
  • What do I do with an expired respirator? 
    • In times of increased demand and decreased supply, consideration can be made to use N95 respirators past their intended shelf life. However, the potential exists that the respirator will not perform to the requirements for which it was certified. Over time, components such as the strap and nose bridge may degrade, which can affect the quality of the fit and seal. Prior to use of N95 respirators, the HCP should inspect the respirator and perform a seal check. Additionally, expired respirators may potentially no longer meet the certification requirements set by NIOSH. For further guidance, visit Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response.
  • What methods should healthcare facilities consider in order to avoid unintentional loss of PPE during COVID-19?
  • Monitoring PPE supply inventory and maintaining control over PPE supplies may help prevent unintentional product losses that may occur due to theft, damage, or accidental loss. Inventory systems should be employed to track daily usage and identify areas of higher than expected use.  This information can be used to implement additional conservation strategies tailored to specific patient care areas such as hospital units or outpatient facilities.  Inventory tracking within a health system may also assist in confirming PPE deliveries and optimizing distribution of PPE supplies to specific facilities.