How are hospitals handling a PPE shortage?

By Virginia Reid and Taylor Hurst

We will be keeping this resource updated on a rolling basis as new strategies and best practices are introduced. This checklist was last updated on May 12, 2020

A national shortage of personal protective equipment (PPE) is forcing U.S. health systems to deploy creative strategies to conserve and improvise alternatives to face masks, respirators, eye protection, and gowns, though their efficacy is unproven.

Here we’ve assembled a running list of strategies US health systems and hospitals are using to disinfect, reuse, and create their own PPE.

Many of the strategies below have not been FDA or NIOSH approved and should be used only as a last resort when standard PPE is unavailable. Consult CDC guidance before using any replacements for standard PPE.

Strategies to conserve FDA-compliant PPE

University of Nebraska Medical Center in Omaha, Nebraska, is sterilizing single-use respirators to last a week or longer using UV light. To sanitize the masks, staff place the N95s in paper bags and transport them to their disinfection room, where they hang the masks up on wires. Two UV light towers in the room decontaminate the masks within three to five minutes. After decontamination, staff return the masks to their original owners for reuse.

Duke Health in North Carolina is leveraging a method used for years in their biocontainment lab to sanitize N95s. The method uses specialized equipment to vaporize hydrogen peroxide. The gas permeates the layers of the mask to eliminate the virus without degrading the mask material. Duke researchers have confirmed the process does not affect fit and filtration of the masks.

Yale Medicine in Connecticut has repurposed a machine they typically use to fumigate hospital rooms with hydrogen peroxide to sanitize masks. The machine cleans the masks with hydrogen peroxide for about five hours, with additional time needed to extract the chemicals from the room and the masks. Based on preliminary research, the process killed three viruses similar to the novel coronavirus without affecting filtration. The recycled masks are being put in storage for now as backup if their hospitals experience an extreme shortage.

Baptist Health in Florida is sanitizing masks with a robot from Xenon Disinfection Services called the LightStrike. The machine cleans PPE using pulsed xenon ultraviolet light which disinfects each side of the mask for five minutes. Providers can then reuse the masks multiple times. The Xenon technology is currently in use at all four Baptist locations.

Atrium Health in North Carolina has moved their IV pumps and ventilator control panels out of the rooms COVID-19 patients are being treated in so that providers don’t have to change PPE each time they need to adjust the machines. The strategy has allowed them to decrease PPE usage by 70% over the past several weeks.

Partners HealthCare in Massachusetts is using Battelle’s CCDS Critical Care Decontamination System to sanitize up to 80,000 N95 respirators per day. The sanitization system uses a concentrated vaporized hydrogen peroxide cleaning method that allows staff to safely reuse N95s up to 30 times. The sanitization system received FDA emergency use authorization at the beginning of April. The sanitization site, one of four across the country, is set up in a former K-Mart store in Somerville, MA near the Partners HealthCare corporate headquarters.

Partners' Brigham and Women’s Hospital in Massachusetts is conserving PPE using their “B-Protected Covid-19 Booth” for testing. Staff can swab patients from inside the closed plastic polycarbonate booth by placing their hands through the portholes into attached thick rubber gloves. Staff inside the booth do not have to wear any PPE. BWH hopes to scale the booths across their sites of care to retain PPE for Covid patient care.

Researchers at the University of Southern California in Los Angeles, California have devised a method to build a UV disinfection system to sanitize face shields using plastic storage boxes, a reflective coating, and UV-c bulbs. Researchers at the Keck School of Medicine released a publicly available paper detailing the efficacy of the disinfection system and instructions to build the UV-c disinfection devices using readily available resources they found at a hardware store.

Novant Health in North Carolina is expanding PPE’s useful life by using a Bioquell decontamination machine to clean PPE with hydrogen peroxide. Leaders found they could clean 4,000 masks per day and get 30-40 uses from masks cleaned this way compared to the 3-4 uses before masks degrade when cleaned with UV light. With two of these devices purchased during SARS, Novant is using one at their biggest hospital and has the other rotating between their other facilities.

Emory Health in Georgia has developed a “warm zone model” on their inpatient nursing units to maintain staff safety while reducing PPE use and burn rates. To extend gown use, nurses cluster patient care to minimize the number of times they enter a patient’s room. Their publicly-available implementation guidance covers workflow and staffing between zones, physical setup and equipment, and tasks each team member is responsible for.

Homemade PPE alternatives

Boston Children's in Massachusetts conducted a small pilot study in their Surgical Innovation Fellowship for a DIY, low-cost respirator mask alternative. The respirator, made from an anesthesia mask, ventilator inline bacterial or viral filter, and elastic straps, cost under three dollars to produce. Providers can disassemble and reuse the mask until it shows visible signs of wear or contamination. The respirator is not approved for use at Boston Children's at this time, though researchers say they will use the device should the need arise.

Providence Health in Washington had their infection and control quality experts create homemade face-shields using supplies from Home Depot, including military-grade vinyl, industrial tape, foam, and elastic. Last week, the team and administrative staff assembled 500 face shields to send to their Seattle hospital, and are currently testing a prototype facemask made from surgical wrap material. Local furniture manufacturer Kaas Tailored and Nordstrom are working with Providence to produce these PPE prototypes and share specs with other manufacturers who want to help as part of their "100 Million Mask Challenge" campaign.

Henry Ford Health System staff in Michigan have turned to everyday items to fashion homemade face masks and shields as short-term PPE replacements as part of their Innovation Institute's challenge campaign. Staff created their prototyped mask with moisture wicking fabric, elastic bands, and air filter material, and they can wash the mask with a bleach cleaning solution for reuse. They made homemade face shields from materials including plastic sheets, elastic bands, and tongue depressors. Staff and volunteers plan to ramp up production of the homemade masks to 500-1,000 pieces per day to bridge the gap between their dwindling supply and their next shipment of standard supplies.

Deaconess Health System in Indiana posted a PDF template and video instructions for homemade fabric masks on their website along with directions for donating masks to hospitals in need. The system recognizes that providers should not use fabric masks to care for COVID-19 patients outside of a crisis situation, but says their orders for standard masks are on long back order. Providers can sterilize and reuse the masks as needed.

Cox Health in Missouri is working with Missouri State University researchers to 3D-print face shields made out from a non-assembled safety frames, zip ties, face shields and printed nosepieces. After they print the components, researchers use a laser cutter to fashion the clear face shields, and then snap all of the pieces together. Staff can disassemble and clean each component of the face shield. The directions for printing and assembling the shields are available on the Cox Health website.

Geisinger Health in Pennsylvania is 3D-printing replacement mask straps and clips for providers who have to reuse N95s multiple times. Their N95 sterilization process often causes their N95 straps to fail, so they have begun to make their own reusable straps and clips as a temporary solution to extend the life of their masks. The design files are publicly available at the linked site.

The Medical University of South Carolina in Charleston, South Carolina developed the “Self-Assembly Filtration for Emergencies (S.A.F.E) Cartridge System”, a modular HEPA filtration system that fits onto disposable hospital masks and 3D printed respirator alternatives. The filtration cartridges are an experimental prototype, but passed standard N95 fit tests. The publicly available files to print the filtration system are available at the linked site.

An Atrium Health critical care physician fashioned a N95 mask alternative to use in case of a critical respirator shortage from an inline ventilator filter and CPAP parts. A video with a full explanation of how to make the N95/100 mask alternative is posted at the linked site.

UCSF Medical Center in California is using 3D-printed face shields built from a printed headband, rubber bands, and a repurposed sheet of plastic typically used to cover bound reports. Each shield costs under a dollar and takes just over an hour to manufacture. UCSF hopes to partner with local manufacturers to scale production of the shields so that they can have shields for every UCSF clinician in contact with Covid patients.

Mercy Health is dispatching staff who have latent capacity or weren’t redeployed to care for Covid-19 patients to create 50,000 plastic face shields in a newly-created assembly line inside their Consolidated Services Center warehouse. The shields, assembled from foam insulation and plastic, are already being sent to hospitals across the Mercy system, and the process allows staff to receive regular income for alternate work.

Is your organization using a creative strategy to deal with PPE shortages that we should add to this list? Send Virginia Reid an email with a short description at ReidV@Advisory.com.

Next, Check Out

Your top resources for Covid-19 readiness

Learn More