HealthApril 04, 2020

Combating PPE shortages on the frontline

As healthcare professionals, we all know the importance of personal protective equipment (PPE) in preventing the spread of infection, and protecting those caring for patients on the frontline of the coronavirus disease 2019 (covid-19) pandemic. As the number of covid-19 cases rises, so does the shortage of PPE.

The Association for Professionals in Infection Control and Epidemiology (APIC) surveyed its 11,922 U.S.-based infection preventionist members from March 23 through March 25, 2020, using a seven-question online questionnaire about the availability of PPE in their organizations. The results of the survey were based on responses from 1,141 infection preventionists throughout the United States. Nearly 70% of them responded on behalf of a healthcare system, not an individual facility. Survey highlights included:

  • Nearly half revealed that they were either nearly out of, or out of respirators (48%) and face shields (49%)
  • 31% were either nearly out of, or out of, procedure masks
  • 28% reported being nearly out of, or out of, hand sanitizer
  • Only 12.25% reported receiving supplies from the Strategic National Stockpile (APIC, 2020).

Calculating burn rate

So how do healthcare organizations combat these shortages? First, they can use the personal protective equipment (PPE) burn rate calculator provided by the Centers for Disease Control and Prevention to calculate the average consumption rate or “burn rate” for each type of PPE. To use the calculator, the healthcare organization enters the number of full boxes of every type of PPE (respirators, face shields, procedure masks, gowns, and gloves) into the spreadsheet at the beginning of each day. The tool then calculates the average consumption rate, which can assist the organization with planning and optimizing PPE supplies (CDC, 2020a).

Optimizing PPE when supplies run low

When burn rate calculations show that supplies are running low, healthcare organizations may need to consider crisis capacity strategies:

  • Use intact PPE that, according to the CDC, performs adequately for healthcare delivery beyond the manufacturer’s shelf life.
  • Prioritize PPE use for selected care activities that increase exposure risk. For example:
    • Reserve respirators for aerosol-generating procedures and care of patient with airborne transmitted diseases such as tuberculosis, measles, and varicella
    • Reserve sterile gloves and gowns for urgent surgical procedures
  • Use respirators that are similar to NIOSH-approved respirators, but approved under standards used in other countries.
  • Permit reuse of respirators by one staff member for multiple encounters with different patients.
  • Use respirators that, according to the CDC, may not perform adequately for healthcare delivery beyond the manufacturer’s shelf life (CDC, 2020b).

Reprocessing respirators

Reprocessing respirators helps conserve respirator supplies. This week, Advanced Sterilization Products announced that they received emergency Food and Drug Administration (FDA) approval for their protocol to use sterilizers to reprocess select N-95 (and similar) respirators for reuse during the pandemic. This protocol enables healthcare organizations to prolong the lifespan of the respirators by using sterilizers that are already in many healthcare facilities (ASP, 2020).

Running out of respirators

When respirator supplies run out, exclude higher risk healthcare workers (those with chronic medical conditions, those who may be pregnant, and those of older age) from caring for patients with known or suspected covid-19. Instead, assign healthcare workers who have recovered from covid-19 and therefore, might have some protective immunity to the care of those patients with known or suspected covid-19. As a last resort, use masks not evaluated or approved by NIOSH or improvised masks (CDC, 2020b).


Association for Professionals in Infection Control and Epidemiology. (2020). Protecting Healthcare Workers during the covid-19 pandemic: A survey of infection preventionists.

Centers for Disease Control and Prevention. (2020). Personal Protective Equipment (PPE) Burn Rate Calculator.

Advanced Sterilization Products (ASP). (2020). Instructions for Use for Reprocessing N95 Masks in STERRAD® Sterilization Systems During the covid-19 Public Health Emergency.

Centers for Disease Control and Prevention. (2020). Summary List for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators During the covid-19 Response.

About the author

Collette Bishop Hendler, RN, MS, MA, CIC, Editor-in-Chief, Lippincott Solutions, Point-of-Care, is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an Infection Preventionist.

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