Supply Exhaustion

Staff Equipment

1. Immediately find out what stocks you have of needed equipment:

• PPE (masks, gowns, gloves)

• Hand sanitizer

• Soap

• Cleaning disinfectant

2. Do a projection of what you use normally, and what you will need with COVID, i.e., the burn rate of equipment. What assumptions are you using to calculate this? Patients with masks too? Criteria for protection increase as community spread increases.

• See if what you have is even close.

• Public Health is working on this, but needs your feedback.

• If ONE element of PPE is missing - there is NO PPE.

Insufficient Materials

This will be an ongoing issue that Public Health will be working on. There may be limits to what can be done. You should anticipate this.

Staff safety is paramount. You may not be able to safely offer care.

Several US sites are reporting shortages.

An Alternative materials committee has been formed - they are planning and preparing for this.

You must understand that a paradigm shift may be required. In much of the world, not all material is disposable (e.g., cloth gowns used in Rwanda, etc.).

Cloth gowns are better than no gowns. They will need to be laundered in a specific way to ensure no contamination of workers handling soiled material.

Consider other sources: Construction companies, Vets, Dentists.

Masks

If there are no more masks, you will have to find alternatives. Hospitals in the US are now taking donations of cloth masks. These are not as good as medical masks. Their greatest use may be source control for asymptomatic health care workers.

A Cambridge paper has compared materials and made recommendations. The summary of the paper findings are shown in the graphic below.

Pillow cases, Cotton shirts and Tea Towels offer the tradeoff between protection, breathability and robustness.

Example of a cloth mask sewing pattern: https://thestitchingscientist.com/2020/03/how-to-sew-a-face-mask.html

Mask Sparing

Putting a cloth mask over a surgical mask or N95 may help extend the life of the surgical or N95 mask.

Cloth masks can be used to Prolong life of N95 masks (we call it Mask Sparing).

N95 Disinfection

There are guidelines to do this. The oven method may not be effective. Methods with a sterilizer have no official regulatory approval as of 2 April 2020 in parts of Canada.

Caution! - The N95 disinfection procedure is very involved. You better be very very sure all steps are followed and that people doing it don’t contaminate themselves.

Surgical Caps

Cloth surgical caps can also be sewn, similarly to cloth masks.

Here is an example of a sewing tutorial: https://m.youtube.com/watch?v=mb9SnhhdcFM#

A few notes on the pattern:

• Try using a double layer of 100% cotton all over the cap. This gives more protection than a single layer.

• You may want to adjust the measurements and shapes of the pattern, based on your own head size (the measurements in the video yield a large cap).

• If you want longer ties at the back, just add 3-4 inches to the narrow end of the piece that measures 17.5inches (total length would be 21inches or so).

• The elastic at the back may not be necessary for you.

Gowns

If there are not enough gowns, you will have to move to aprons made of impermeable material. While aprons are commonly used in disaster relief, you would have to construct your own:

• Garbage bags - 100-140 litre size, or obtain Butcher’s Aprons (Grocery Store)

• Cloth gowns may be in readier supply. Specific handling and laundry protocols will need to be followed.

• Intubation PPE shrouds can be made with smaller garbage bags 25-30 litre.

Hand Sanitizer

Hand sanitizer may run out. You must ensure you have adequate soap. Laundry detergent, dish soap or shampoo can all be used. Pharmacy can compound sanitizer if needed.

Cleaning products

You must ensure that you have enough. If needed, bleach solutions can be used - cheap and available. Make sure you have enough.

Your creativity will be needed here.

Patient Equipment

• Nasal prongs

• O2 masks

• O2

• O2 Concentrator?

• Surgical masks, N95?