Expectations for PPE Usage

COVID-19; Programs and Resources

The CDC outlines expectations for personal protective equipment (PPE) use in their interim infection prevention and control recommendations to prevent COVID-19 spread in nursing homes. Given that PPE is now largely available for purchase, facilities are expected to be using PPE with these conventional strategies.  

Per CDC guidance, this includes: 

  • Communities with minimal to no community transmission: adhere to Standard and Transmission-Based Precautions based on anticipated exposures and suspected or confirmed diagnoses. This might include use of eye protection, an N95 or equivalent or higher-level respirator, as well as other PPE. In addition, universal use of a well-fitting facemask for source control is recommended for health care personnel (HCP) if not otherwise wearing a respirator. 

  • ​Communities with moderate to substantial community transmission: 
    • ​Follow Standard Precautions (and Transmission-Based Precautions if required) based on the suspected diagnosis which includes using an N95 respirator or equivalent and face protection for applicable situations with increased risk of pathogen transmission.
    • With respect to COVID-19 transmission prevention precautions, HCP should use PPE as described below: 
      • ​N95 respirators or equivalent or higher-level respirators should be used for 
        • All aerosol generating procedures (refer to Which procedures are considered aerosol generating procedures in healthcare settings FAQ
      • ​​​One of the following should be worn by HCP while in the facility and for protection during resident care encounters: 
        • ​A NIOSH-approved N95 respirator OR 
        • A respirator approved under standards used in other countries that are similar to NIOSH-approved N95 filtering facepiece respirators OR 
        • A well-fitting facemask (e.g., selection of a facemask with a nose wire to help the facemask conform to the face; selection of a facemask with ties rather than ear loops; use of a mask fitter; tying the facemask’s ear loops and tucking in the side pleats; fastening the facemask’s ear loops behind the wearer’s head; use of a cloth mask over the facemask to help it conform to the wearer’s face).
          • ​Additional information about strategies to improve fit and filtration are available in the resourceImprove the Fit and Increase the Filtration of Your Mask to Reduce the Spread of COVID-19
          • If implementing new strategies or equipment to improve fit, HCP should receive training on how to safely put on and remove their facemask and the facility protocol for cleaning and disinfecting any reusable equipment (e.g., fitter). They should also ensure that any new strategies do not impede their vision or ability to breathe. 
        • ​​​Eye protection should be worn during patient care encounters to ensure the eyes are also protected from exposure to respiratory secretions. 

Note: While the CDC does not clearly define what metrics to use to determine moderate to substantial community transmission, providers may be able to use CMS’ color-coding methodology to determine community transmission levels.  

In addition, the CDC outlines the following expectations for PPE in specific situations, including: 

  • ​In an outbreak: The CDC recommends that during an outbreak, providers should care for all residents using an N95 or higher-level respirator, eye protection (i.e., goggles or a face shield that covers the front and sides of the face), gloves, and gown. This includes anywhere direct care is provided, including dining rooms, therapy, etc. An outbreak is defined as a single new case of COVID-19 in a staff person or a nursing home onset infection in a resident. 

  • When managing residents with close contact: HCP should wear an N95 or higher-level respirator, eye protection (i.e., goggles or a face shield that covers the front and sides of the face), gloves, and gown when caring for these residents. 

Note: AHCA/NCAL recognizes that staff may have unanticipated encounters with residents outside of their room, which may result in them interacting with residents without full PPE or an N95. We encourage providers to develop policies and procedures to adhere to this CDC guidance, recognizing that there may be circumstances where full PPE or an N95 is not worn during a patient encounter. Providers should be prepared to share the policies and procedures with surveys and show they are making good faith efforts to meet this guidance. Providers should train and empower staff to monitor each other to support consistent and appropriate PPE use.  

If PPE shortages exist, providers should follow the CDC’s Optimization Strategies. However, when this occurs, facilities need to document that:  

  • ​The PPE shortage exists;  
  • All their efforts to obtain PPE; and  
  • They reached out to their state health departments to notify them of the shortage and seek assistance in gaining additional PPE.  ​
Providers are strongly encouraged to read the CDC’s interim infection prevention and control recommendations to prevent COVID-19 spread in nursing homes for additional guidance not included here. Finally, providers should also follow any local or state health guidance in place. 

Please email COVID19@ahca.org​ with any questions.