Public Health England (PHE) has published new guidance on optimising the supply of personal protective equipment (PPE) and the use of PPE when in short supply, recommending the re-use of items including face masks.

If PPE stock runs dangerously low, PHE's new emergency guidance has required clinicians to consider reusing masks, gowns and visors marked single use or seeking alternative kit when treating COVID-19 patients. The guidance from the PHE came amid concerns that supplies of crucial gowns could run out over the weekend.

The PHE stressed that reusing PPE in the manner laid out should be considered as “temporary measures until the global supply chain is adequate to meet the UK’s needs”.

The guidance, which has been sanctioned by the Health and Safety Executive (HSE) and aligned with World Health Organization (WHO) advice, stated: “Some of the PPE in the NHS COVID-19 ensemble is designated by the manufacturers as being single use...However, the HSE recognises that some compromise is needed to optimise the supply of PPE in times of extreme shortages.”

The guidance went on to stress: “These are exceptional circumstances and do not reflect HSE’s standard approach".

The updated advice on reuse is that masks should be removed and discarded if soiled, damaged, or hard to breathe through. Masks with elastic ear hooks should be reused, but tie-on face masks are less suitable because they are more difficult to remove. Hand hygiene should be performed before removing the face mask.

When reusing face masks, they should be carefully folded so the outer surface is held inward and against itself to reduce likely contact with the outer surface during storage. The folded mask should be stored between uses in a clean sealable bag or box which is marked with the person’s name and is then properly stored in a well-defined place. Hand hygiene should also be performed after removing the face mask.

Some models of PPE cannot be physically reused as they deform once being donned and do not go back to original condition, meaning it would be difficult to re-don and achieve a fit check. Fit checks should be performed each time a respirator is donned if it is reused.

The Royal College of Nursing (RCN) warned that the updated advice has not been approved by the college. The guidance had been developed "without full and formal consultation with the RCN", according to RCN Chief Executive and General Secretary Dame Donna Kinnair.

She added: “It is unacceptable that any healthcare setting in the UK does not provide PPE as required by HSE and set out in the existing guidance. Only sound scientific evidence or safety concerns should change the guidance.”

The Healthcare Infection Society and the Infection Prevention Society (HISIPS) has also said it was not consulted on the guidance and said some of the recommendations “conflict with infection prevention and control (IPC) best practice”.

“Guidance: Considerations for Acute Personal Protective Equipment (PPE) Shortages”, issued on 17 April, is available here.

Last reviewed 20 April 2020