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Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages
Situational update as of May 2021: The supply and availability of NIOSH-approved respirators have increased significantly over the last several months. Healthcare facilities should not be using crisis capacity strategies at this time and should promptly resume conventional practices. Check the NIOSH Certified Equipment List to identify all NIOSH-approved respirators.
Healthcare facilities should stop purchasing non-NIOSH approved respirators for use as respiratory protection and consider using any that have been stored for source control where respiratory protection is not needed. Respirators that were previously used and decontaminated should not be stored. We do not know the long term stability of non-NIOSH approved respirators and respirators that have been decontaminated, and if these will be recommended for use in the future. Healthcare facilities should return to using only NIOSH-approved respirators where needed.
This summary is intended to help healthcare facilities optimize supplies of disposable N95 filtering facepiece respirators when there is limited supply during the COVID-19 pandemic. The strategies are categorized in a continuum of care and further organized according to the hierarchy of controls, as defined below.
Conventional Capacity Strategies (should be incorporated into everyday practices)
Engineering Controls
Engineering Controls
Place patients with suspected or confirmed SARS-CoV-2 infection in an airborne infection isolation room (AIIR) for aerosol generating procedures, if possible.
Engineering Controls
Use physical barriers such as glass or plastic windows at reception areas, curtains between patients, etc.
Engineering Controls
Properly maintain ventilation systems to provide air movement from a clean to contaminated flow direction
Administrative Controls
Administrative Controls
Limit the number of patients going to hospitals or outpatient settings by screening patients for acute respiratory illness or prolonged close contact with someone with SARS-CoV-2 infection prior to non-urgent care or elective visits
Administrative Controls
Use telemedicine to screen and manage patients using technologies and referral networks to reduce the influx of patients to healthcare facilities
Administrative Controls
Limit HCP not directly involved in patient care (e.g., dietary, housekeeping employees)
Administrative Controls
Limit face-to-face HCP encounters with patients (e.g., bundling activities, use of video monitoring)
Administrative Controls
Limit visitors to the facility to those essential for patients’ physical or emotional well-being and care
Administrative Controls
Implement source control for everyone in the healthcare facility
Administrative Controls
Cohort patients: Group together patients who are infected with the same organism to confine their care to one area
Administrative Controls
Cohort HCP: Assign designated teams of HCP to provide care for all patients with suspected or confirmed SARS-CoV-2 infection
Administrative Controls
Train HCP on use (proper use, fit, donning and doffing) and indications for use of N95 respirators
Administrative Controls
Implement just-in-time fit testing: Plan for larger scale evaluation, training, and fit testing of employees when necessary during a pandemic
Administrative Controls
Limit respirators during training: Determine which HCP do and do not need to be in a respiratory protection program and, when possible, allow limited re-use of respirators by individual HCP for training and then fit testing
Administrative Controls
Implement qualitative fit testing to assess adequacy of a respirator fit to minimize destruction of N95 respirator used in fit testing and allow for limited re-use by HCP
Personal Protective Equipment: Respiratory Protection
Personal Protective Equipment: Respiratory Protection
Use surgical N95 respirators only for HCP who need protection from both airborne and fluid hazards (e.g., splashes, sprays). If needed but unavailable, use faceshield over standard N95 respirator.
Personal Protective Equipment: Respiratory Protection
Use alternatives to N95 respirators where feasible (e.g., other disposable filtering facepiece respirators, elastomeric respirators with appropriate filters or cartridges, powered air purifying respirators)
Contingency Capacity Strategies (during expected shortages)
Administrative Controls
Administrative Controls
Decrease length of hospital stay for medically stable patients with an infectious diagnosis for whom respirator use is recommended during their care
Administrative Controls
Temporarily suspend annual fit testing per interim guidance from OSHAexternal icon
Personal Protective Equipment and Respiratory Protection
Personal Protective Equipment and Respiratory Protection
Prioritize respirators for HCP who are using them as PPE
Personal Protective Equipment and Respiratory Protection
Use N95 respirators beyond the manufacturer-designated shelf life for training and fit testing
Personal Protective Equipment and Respiratory Protection
Extend the use of N95 respirators by wearing the same N95 for repeated close contact encounters with several different patients without removing the respirator
Crisis Strategies (during known shortages)
When N95 Supplies are Running Low
Personal Protective Equipment: Respiratory Protection and Facemasks
Personal Protective Equipment: Respiratory Protection and Facemasks
Use respirators beyond the manufacturer-designated shelf life that have been identified by CDC as performing adequately for healthcare delivery
Personal Protective Equipment: Respiratory Protection and Facemasks
Use respirators approved under standards used in other countries that are similar to NIOSH-approved respirators
Personal Protective Equipment: Respiratory Protection and Facemasks
Implement limited re-use of N95 respirators and limit to no more than five uses (i.e., five donnings) per device by the same HCP, unless otherwise specified by the manufacturer.
Personal Protective Equipment: Respiratory Protection and Facemasks
Use additional respirators beyond the manufacturer-designated shelf life identified by CDC as NOT performing adequately for healthcare delivery
Personal Protective Equipment: Respiratory Protection and Facemasks
Prioritize the use of N95 respirators and well-fitting facemasks by activity type
When No Respirators are Left
Administrative Controls
Administrative Controls
Consider excluding HCP at higher risk for severe illness from SARS-CoV-2 infection such as those of older age, those with chronic medical conditions, or those who may be pregnant from contact with patients with confirmed or suspected SARS-CoV-2 infection
Engineering Controls
Engineering Controls
Use an expedient patient isolation room for risk-reduction
Engineering Controls
Use a ventilated headboard to decrease risk of HCP exposure to a patient-generated aerosol