Corona ir s disease 2019 (COVID-19), ca sed b he COVID-19 ir s, as firs de ec ed in W han, China, in December 2019. On 30 Jan ar 2020, he

1

Ra i nal e f e nal ec i e e i men f c na i di ea e 2019 (COVID-19)

In e im g idance

27 Feb a 2020

Corona ir s disease 2019 (COVID-19), ca sed b he COVID-19 ir s, as firs de ec ed in W han, China, in December 2019. On 30 Jan ar 2020, he

WHO Direc or-General declared ha he c rren o break cons i ed a p blic heal h emergenc of in erna ional concern.

This doc men s mmari es WHO s recommenda ions for he ra ional se of personal pro ec i e eq ipmen (PPE) in heal hcare and comm ni se ings, as ell as d ring he handling of cargo; in his con e , PPE incl des glo es, medical masks, goggles or a face shield, and go ns, as ell as for specific proced res, respira ors (i.e., N95 or FFP2 s andard or eq i alen ) and aprons. This doc men is in ended for hose ho are in ol ed in dis rib ing and managing PPE, as ell as p blic heal h a hori ies and indi id als in heal hcare and comm ni se ings, and i aims o pro ide informa ion abo hen PPE se is mos appropria e.

WHO ill con in e o pda e hese recommenda ions as ne informa ion becomes a ailable.

Pre enti e measures for COVID-19 disease

Based on he a ailable e idence, he COVID-19 ir s is ransmi ed be een people hro gh close con ac and drople s, no b airborne ransmission. The people mos a risk of infec ion are hose ho are in close con ac i h a COVID-19 pa ien or ho care for COVID-19 pa ien s.

Pre en i e and mi iga ion meas res are ke in bo h heal hcare and comm ni se ings. The mos effec i e pre en i e meas res in he comm ni incl de:

performing hand h giene freq en l i h an alcohol-based hand r b if o r hands are no isibl dir or i h soap and a er if hands are dir ; a oiding o ching o r e es, nose and mo h;

prac icing respira or h giene b co ghing or snee ing in o a ben elbo or iss e and hen immedia el disposing of he iss e;

earing a medical mask if o ha e respira or s mp oms and performing hand h giene af er disposing of he mask;

main aining social dis ance (a minim m of 1 m) from indi id als i h respira or s mp oms.

Addi ional preca ions are req ired b heal hcare orkers o pro ec hemsel es and pre en ransmission in he heal hcare se ing. Preca ions o be implemen ed b heal hcare orkers caring for pa ien s i h COVID-19 disease incl de sing

PPE appropria el ; his in ol es selec ing he proper PPE and being rained in ho o p on, remo e and dispose of i . PPE is onl one effec i e meas re i hin a package ha comprises adminis ra i e and en ironmen al and engineering con rols, as described in WHO s I fec e e a d c f e de c- a d a de c- e ac e e a

fec hea h ca e (1). These con rols are s mmari ed here.

Ad a e c incl de ens ring he a ailabili of reso rces for infec ion pre en ion and con rol meas res, s ch as appropria e infras r c re, he de elopmen of clear infec ion pre en ion and con rol policies, facili a ed access o labora or es ing, appropria e riage and placemen of pa ien s, adeq a e s aff- o-pa ien ra ios and raining of s aff.

E e a a d e g ee g c aim a red cing he spread of pa hogens and red cing he con amina ion of s rfaces and inanima e objec s. The incl de pro iding adeq a e space o allo social dis ance of a leas 1 m o be main ained be een pa ien s and be een pa ien s and heal hcare orkers and ens ring he a ailabili of ell- en ila ed isola ion rooms for pa ien s i h s spec ed or confirmed COVID-19 disease.

COVID-19 is a respira or disease ha is differen from Ebola ir s disease, hich is ransmi ed hro gh infec ed bodil fl ids. D e o hese differences in ransmission, he PPE req iremen s for COVID-19 are differen from hose req ired for Ebola ir s disease. Specificall , co eralls (some imes called Ebola PPE) are no req ired hen managing COVID-19 pa ien s.

Disruptions in the global suppl chain of PPE

The c rren global s ockpile of PPE is ins fficien , par ic larl for medical masks and respira ors; he s ppl of go ns and goggles is soon e pec ed o be ins fficien also.

S rging global demand dri en no onl b he n mber of

COVID-19 cases b also b misinforma ion, panic b ing

and s ockpiling ill res l in f r her shor ages of

PPE globall . The capaci o e pand PPE prod c ion is

limi ed, and he c rren demand for respira ors and masks

canno be me , especiall if he idespread, inappropria e se

of PPE con in es.

Recommendations for optimi ing the a ailabilit of PPE.

In ie of he global PPE shor age, he follo ing s ra egies can facili a e op imal PPE a ailabili (Fig. 1).

F g. 1. S a eg e e he a a ab f e a ec e e e (PPE)

(1) M e he eed f PPE

The follo ing in er en ions can minimi e he need for PPE hile pro ec ing heal hcare orkers and o her indi id als from e pos re o he COVID-19 ir s in heal hcare se ings.

Consider sing elemedicine o e al a e s spec ed cases of COVID-19 disease (2), h s minimi ing he need for hese indi id als o go o heal hcare facili ies for e al a ion.

Use ph sical barriers o red ce e pos re o he COVID-19 ir s, s ch as glass or plas ic indo s.

This approach can be implemen ed in areas of he heal hcare se ing here pa ien s ill firs presen , s ch as riage areas, he regis ra ion desk a he emergenc depar men or a he pharmac indo

here medica ion is collec ed.

Res ric heal hcare orkers from en ering he rooms of COVID-19 pa ien s if he are no in ol ed in direc care. Consider b ndling ac i i ies o minimi e he n mber of imes a room is en ered (e.g., check i al signs d ring medica ion adminis ra ion or ha e food deli ered b heal hcare orkers hile he are performing o her care) and plan hich ac i i ies ill be performed a he bedside.

Ideall , isi ors ill no be allo ed b if his is no possible, res ric he n mber of isi ors o areas here COVID-19 pa ien s are being isola ed; res ric he amo n of ime isi ors are allo ed o spend in he area; and pro ide clear ins r c ions abo ho o p on and remo e PPE and perform hand h giene o ens re isi ors a oid self-con amina ion (see h ps:// . ho.in /csr/reso rces/p blica ions/p on akeoff PPE/en/).

(2) E e PPE e a a ed a d a a e PPE sho ld be sed based on he risk of e pos re (e.g., pe of ac i i ) and he ransmission d namics of he pa hogen (e.g., con ac , drople or aerosol). The o er se of PPE ill ha e a f r her impac on s ppl shor ages. Obser ing he follo ing recommenda ions ill ens re ha he se of PPE ra ionali ed.

The pe of PPE sed hen caring for COVID-19 pa ien s ill ar according o he se ing and pe of personnel and ac i i (Table 1).

Heal hcare orkers in ol ed in he direc care of pa ien s sho ld se he follo ing PPE: go ns, glo es, medical mask and e e pro ec ion (goggles or face shield).

Specificall , for aerosol-genera ing proced res (e.g., racheal in ba ion, non-in asi e en ila ion, racheos om , cardiop lmonar res sci a ion, man al en ila ion before in ba ion, bronchoscop ) heal hcare orkers sho ld se respira ors, e e pro ec ion, glo es and go ns; aprons sho ld also be

sed if go ns are no fl id resis an (1).

Respira ors (e.g., N95, FFP2 or eq i alen s andard) ha e been sed for an e ended ime d ring pre io s p blic heal h emergencies in ol ing ac e respira or illness hen PPE as in shor s ppl (3). This refers o earing he same respira or hile caring for m l iple pa ien s ho ha e he same diagnosis i ho remo ing i , and e idence indica es ha respira ors main ain heir pro ec ion hen sed for e ended periods. Ho e er, sing one respira or for longer han 4 ho rs can lead o discomfor and sho ld be a oided (4 6).

Among he general p blic, persons i h respira or s mp oms or hose caring for COVID-19 pa ien s a home sho ld recei e medical masks. For addi ional informa ion, see H e ca e f a e h

ec ed e c a (COVID-19) fec e e g h d , a d a age e f he c ac

For as mp oma ic indi id als, earing a mask of an pe is no recommended. Wearing medical masks hen he are no indica ed ma ca se nnecessar cos and a proc remen b rden and crea e a false sense of sec ri ha can lead o he neglec of o her essen ial pre en i e meas res. For addi ional informa ion, see Ad ce he e f a he c , d g h e ca e a d hea hca e

e g he c e f he e c a (2019- C V) b ea (8).

(3) C d a e PPE cha a age e echa .

The managemen of PPE sho ld be coordina ed hro gh essen ial na ional and in erna ional s ppl chain managemen mechanisms ha incl de b are no res ric ed o:

sing PPE forecas s ha are based on ra ional q an ifica ion models o ens re he ra ionali a ion of req es ed s pplies;

moni oring and con rolling PPE req es s from co n ries and large responders;

promo ing he se of a cen rali ed req es managemen approach o a oid d plica ion of s ock and ens ring s ric adherence o essen ial s ock managemen r les o limi as age, o ers ock and s ock r p res;

moni oring he end- o-end dis rib ion of PPE;

moni oring and con rolling he dis rib ion of

PPE a ailabili

U e PPE appropria el

Minimi e PPE need

Coordina e PPE ppl chain

Handling cargo from affected countries

The ra ionali ed se and dis rib ion of PPE hen handling cargo from and o co n ries affec ed b he COVID-19 o break incl des follo ing hese recommenda ions.

Wearing a mask of an pe is no recommended hen handling cargo from an affec ed co n r . Glo es are no req ired nless he are sed for

pro ec ion agains mechanical ha ards, s ch as ma occ r hen manip la ing ro gh s rfaces.

Impor an l , he se of glo es does no replace he need for appropria e hand h giene, hich sho ld be performed freq en l , as described abo e.

When disinfec ing s pplies or palle s, no addi ional PPE is req ired be ond ha is ro inel recommended. To da e, here is no epidemiological informa ion o s gges ha con ac i h goods or prod c s shipped from co n ries affec ed b he COVID-19 o break ha e been he so rce of COVID-19 disease in h mans. WHO ill con in e o closel moni or he e ol ion of he COVID-19 o break and ill pda e recommenda ions as needed.

Tab e 1. Rec e ded e f e a ec e e e (PPE) be ed he c e f COVID-19 d ea e, acc d g he e g, e e a d e f ac

Se g Ta ge e e a e Ac T e f PPE ced e

Hea hca e fac e I a e fac e Pa ien room

Heal hcare orkers Pro iding direc care o COVID-19 pa ien s.

Medical mask Go n Glo es

E e pro ec ion (goggles or face shield).

Aerosol-genera ing proced res performed on COVID-19 pa ien s.

Respira or N95 or FFP2 s andard, or eq i alen . Go n

Glo es E e pro ec ion Apron

Cleaners En ering he room of

COVID-19 pa ien s.

Medical mask Go n

Hea d glo es E e pro ec ion (if risk of splash from organic ma erial or chemicals).

Boo s or closed ork shoes

Visi ors

En ering he room of a

COVID-19 pa ien

Medical mask Go n Glo es O her areas of pa ien ransi

(e.g., ards, corridors). All s aff, incl ding heal hcare

orkers. An ac i i ha does no

in ol e con ac i h COVID-19 pa ien s.

No PPE req ired

Triage

Heal hcare orkers Preliminar screening no

in ol ing direc con ac

Main ain spa ial dis ance of a leas 1 m.

No PPE req ired Pa ien s i h respira or

s mp oms.

An Main ain spa ial dis ance of

a leas 1 m.

Pro ide medical mask if olera ed b pa ien . Pa ien s i ho respira or

s mp oms.

An No PPE req ired

Labora or Lab echnician Manip la ion of respira or

samples. Medical mask

Go n Glo es

E e pro ec ion (if risk of splash)

Adminis ra i e areas All s aff, incl ding heal hcare orkers.

Adminis ra i e asks ha do no in ol e con ac i h COVID-19 pa ien s.

No PPE req ired

O a e fac e Cons l a ion room

Heal hcare orkers Ph sical e amina ion of

pa ien i h respira or s mp oms.

Medical mask Go n Glo es E e pro ec ion Heal hcare orkers Ph sical e amina ion of

pa ien s i ho respira or s mp oms.

PPE according o s andard preca ions and risk assessmen . Pa ien s i h respira or

s mp oms.

An Pro ide medical mask if

olera ed.

Pa ien s i ho respira or s mp oms.

An No PPE req ired

Cleaners Af er and be een

cons l a ions i h pa ien s i h respira or s mp oms.

Medical mask Go n

Hea d glo es E e pro ec ion (if risk of splash from organic ma erial or chemicals).

Boo s or closed ork shoes Wai ing room

Pa ien s i h respira or s mp oms.

An Pro ide medical mask if

olera ed.

Immedia el mo e he pa ien o an isola ion room or separa e area a a from o hers; if his is no feasible, ens re spa ial dis ance of a leas 1 m from o her pa ien s.

Pa ien s i ho respira or s mp oms.

An No PPE req ired

Adminis ra i e areas All s aff, incl ding heal hcare orkers.

Adminis ra i e asks No PPE req ired Triage

Heal hcare orkers Preliminar screening no

in ol ing direc con ac

Main ain spa ial dis ance of a leas 1 m.

No PPE req ired Pa ien s i h respira or

s mp oms.

An Main ain spa ial dis ance of

a leas 1 m.

Pro ide medical mask if olera ed.

Pa ien s i ho respira or s mp oms.

An No PPE req ired

C

Home

Pa ien s i h respira or s mp oms.

An Main ain spa ial dis ance of

a leas 1 m.

Pro ide medical mask if olera ed, e cep hen sleeping.

Caregi er En ering he pa ien s room, b no pro iding direc care or assis ance.

Medical mask

Caregi er Pro iding direc care or hen handling s ool, rine or as e from COVID-19 pa ien being cared for a home.

Glo es Medical mask

Apron (if risk of splash) Heal hcare orkers Pro iding direc care or

assis ance o a COVID-19 pa ien a home

Medical mask Go n Glo es E e pro ec ion P blic areas (e.g., schools,

shopping malls, rain s a ions).

Indi id als i ho respira or s mp oms

An No PPE req ired

P f e

Adminis ra i e areas All s aff An No PPE req ired

Screening area

S aff Firs screening ( empera re

meas remen ) no in ol ing direc con ac

Main ain spa ial dis ance of a leas 1 m.

No PPE req ired

S aff Second screening (i.e.,

in er ie ing passengers i h fe er for clinical s mp oms s gges i e of COVID-19 disease and ra el his or ).

Medical mask Glo es

Cleaners Cleaning he area here

passengers i h fe er are being screened.

Medical mask Go n

Hea d glo es E e pro ec ion (if risk of splash from organic ma erial or chemicals).

Boo s or closed ork shoes Temporar isola ion area

S aff En ering he isola ion area,

b no pro iding direc assis ance.

Main ain spa ial dis ance of a leas 1 m.

Medical mask Glo es S aff, heal hcare orkers Assis ing passenger being

ranspor ed o a heal hcare facili .

Medical mask Go n Glo es E e pro ec ion

Cleaners Cleaning isola ion area Medical mask

Go n

Hea d glo es E e pro ec ion (if risk of splash from organic ma erial or chemicals).

Boo s or closed ork shoes Amb lance or ransfer

ehicle

Heal hcare orkers Transpor ing s spec ed COVID-19 pa ien s o he referral heal hcare facili .

Medical mask Go ns Glo es E e pro ec ion Dri er

In ol ed onl in dri ing he pa ien i h s spec ed COVID-19 disease and he dri er s compar men is separa ed from he COVID-19 pa ien .

Main ain spa ial dis ance of a leas 1 m.

No PPE req ired

Assis ing i h loading or nloading pa ien i h s spec ed COVID-19 disease.

Medical mask Go ns Glo es E e pro ec ion No direc con ac i h pa ien

i h s spec ed COVID-19, b no separa ion be een dri er s and pa ien s compar men s.

Medical mask

Pa ien i h s spec ed COVID-19 disease.

Transpor o he referral heal hcare facili .

Medical mask if olera ed

Cleaners Cleaning af er and be een

ranspor of pa ien s i h s spec ed COVID-19 disease

o he referral heal hcare facili .

Medical mask Go n

Hea d glo es E e pro ec ion (if risk of splash from organic ma erial or chemicals).

Boo s or closed ork shoes

S ec a c de a f a d e e ea a g h b c hea h e ga

C

An here Rapid response eam

in es iga ors.

In er ie s spec ed or confirmed COVID-19 pa ien s or heir con ac s.

No PPE if done remo el (e.g., b elephone or ideo conference).

Remo e in er ie is he preferred me hod.

In-person in er ie of s spec ed or confirmed COVID-19 pa ien s i ho direc con ac .

Medical mask

Main ain spa ial dis ance of a leas 1 m.

The in er ie sho ld be cond c ed o side he ho se or o doors, and confirmed or s spec ed COVID-19 pa ien s sho ld ear a medical mask if olera ed.

In-person in er ie i h as mp oma ic con ac s of COVID-19 pa ien s.

Main ain spa ial dis ance of a leas 1 m.

No PPE req ired The in er ie sho ld be performed o side he ho se or o doors. If i is necessar

o en er he ho sehold en ironmen , se a hermal imaging camera o confirm ha he indi id al does no ha e a fe er, main ain spa ial dis ance of a leas 1 m and do no o ch an hing in he ho sehold en ironmen .

a

In addi ion o sing he appropria e PPE, freq en hand h giene and respira or h giene sho ld al a s be performed. PPE sho ld be discarded in an appropria e as e con ainer af er se, and hand h giene sho ld be performed before p ing on and af er aking off PPE.

b

The n mber of isi ors sho ld be res ric ed. If isi ors m s en er a COVID-19 pa ien s room, he sho ld be pro ided i h clear ins r c ions abo ho o p on and remo e PPE and abo performing hand h giene before p ing on and af er remo ing PPE;

his sho ld be s per ised b a heal hcare orker.

c

This ca egor incl des he se of no- o ch hermome ers, hermal imaging cameras, and limi ed obser a ion and q es ioning, all hile main aining a spa ial dis ance of a leas 1 m.

d

All rapid response eam members m s be rained in performing hand h giene and ho o p on and remo e PPE o a oid self-con amina ion.

For PPE specifica ions, refer o WHO s no el corona ir s (COVID-19) disease commodi packages a h ps:// . ho.in /emergencies/ ha - e-do/pre en ion-readiness/disease-commodi -packages/dcp-nco .pdf? a=1.

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© World Heal h Organi a ion Some righ re er ed Thi ork i a ailable nder he CC BY NC SA IGO licence

WHO reference n mber: WHO/2019-nCo /IPC PPE_ se/2020.1