On January 21, 2021, the Centers for Disease Control and Prevention (CDC) released an updated summary to help healthcare facilities optimize supplies of isolation gowns when there is limited availability during the COVID-19 pandemic. The CDC recommendations include the following:
Surge capacity: This refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. Three general classifications are used to describe surge capacity and will help staff prioritize measures to conserve isolation gown supplies along the continuum of care. They are meant to be considered and implemented sequentially.
- Conventional capacity: These measures consist of engineering, administrative, and PPE controls that should already be implemented in general infection prevention and control plans in healthcare settings.
- Contingency capacity: These measures can be used temporarily during periods of expected isolation gown shortages, and should only be implemented after considering and implementing conventional capacity strategies. Contingency capacity strategies may be needed when there is uncertainty if future supplies will be adequate.
- Crisis capacity: These strategies are not consistent with U.S. standards of care but may be necessary during periods of known gown shortages. They should only be used after considering and implementing conventional and contingency capacity strategies, and should only be considered when the supply is unable to meet the facility’s current or anticipated utilization rate.
Deciding to implement contingency and crisis strategies should be based on the following:
- Facilities understand their current isolation gown inventory and supply chain.
- Facilities understand their isolation gown utilization rate.
- Facilities are in communication with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional supplies.
- Facilities have already implemented other engineering and administrative control measures including using physical barriers, limiting number of patients going to the hospital or outpatient settings, using telemedicine whenever possible, excluding all healthcare personnel (HCP) who are not directly involved in patient care from patient encounters, limiting face-to-face HCP encounters with patients, excluding visitors to patients with known or suspected COVID-19, and cohorting patients and/or HCP.
- Facilities have provided HCP with required education and training, including having them demonstrate competency with donning and doffing any PPE used to perform job responsibilities, such as provision of patient care.
Conventional Capacity Strategies include the following: Nonsterile, disposable patient gowns are appropriate for use by HCP when caring for patients with suspected or confirmed COVID-19, and using gown alternatives that offer equivalent or higher protection. The CDC does not recommend the use of more than one isolation gown at a time by HCP when providing care to patients with suspected or confirmed COVID-19.
Contingency Capacity Strategies include the following: Consider the use of coveralls. Use gowns beyond the manufacturer-designated shelf life for training. Use gowns or coveralls conforming to international standards. Prioritize gowns for higher risk activities.
Crisis Capacity Strategies include extending the use of isolation gowns. The same gown may be worn by the same HCP when interacting with more than one patient in the same location and known to be infected with the same infectious disease (COVID-19 patients residing in an isolation cohort). Gown alternatives include disposable laboratory coats, reusable (washable) patient gowns, and disposable aprons. Disposable gowns should not be re-used, and reusable gowns should not be reused before laundering.
A complete list of CDC recommendations to optimize the supply of isolation gowns can be accessed at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html.
The CDC Personal Protective Equipment Burn Rate Calculator can be accessed at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html.
Compliance Perspective
Issue
Each facility’s Emergency Preparedness Plan should include strategies to implement when isolation gowns and other PPE supplies are limited. Facilities must routinely monitor their use of isolation gowns and other PPE stock levels and anticipated deliveries in order to determine appropriate capacity strategies.
Discussion Points
- Review your facility’s Emergency Preparedness Plan to ensure it addresses the most recent recommendations from the CDC for isolation gown and other PPE capacity strategies. Revise the Emergency Preparedness Plan as appropriate so it remains current.
- Train all staff on the Emergency Preparedness Plan, including capacity strategies prior to implementation of those strategies. Document that the trainings occurred and file the signed training document in each employee’s education file.
- Periodically audit levels of all PPE to ensure that supplies are adequate and that there are no anticipated shortages. Determine that the current capacity strategy is being followed by all.
