Health Alert
UPDATED PERSONAL PROTECTIVE EQUIPMENT (PPE) GUIDANCE FOR CORONAVIRUS DISEASE 2019 (COVID-19)

The Delaware Division of Public Health (DPH) is issuing this health advisory to provide the healthcare community with guidance regarding the level of Personal Protective Equipment (PPE) when treating or assessing suspected or confirmed 2019 novel coronavirus (COVID-19) patients.

Summary

The Delaware Division of Public Health is supporting health care agencies that elect to adopt the World Health Organization’s (WHO) guidelines for the use of PPE when treating patients with suspected or confirmed 2019 novel coronavirus (COVID-19).

Background

After review of the recent guidance from the World Health Organization (WHO), recommendations from other state health departments, and discussion with subject matter experts in Delaware, the Division of Public Health (DPH) will support the interim guidance issued on February 27, 2020, by the World Health Organization regarding the rational use of personal protective equipment (PPE) for coronavirus disease 2019 (COVID-19) in healthcare and community settings.

The current COVID-19 global outbreak constitutes a public health emergency of international concern. Based on the available evidence, WHO has determined that the COVID-19 virus is transmitted between people through close contact and droplets, not by airborne transmission. In this context, the recommended PPE includes gloves, medical masks, goggles or a face shield, and gowns. For specific aerosol-generating procedures as identified by WHO including: tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy, healthcare workers should use respirators such as N95, eye protection, gloves, gowns, and aprons if gowns are not fluid-resistant. COVID-19 is a respiratory disease that is different from Ebola virus disease, which is transmitted through infected bodily fluids. Due to these differences in transmission, the PPE requirements for COVID-19 are different from those required for Ebola virus disease.

Recommendations

The World Health Organization (WHO) is recommending the following actions for healthcare workers to protect themselves from suspected and confirmed COVID-19 cases:
Providing direct care to suspected or confirmed COVID-19 patients: Medical mask, gown, gloves, eye protection.
Aerosol-generating procedures performed on suspected or confirmed COVID-19 patients: N95 (or higher) respirator, gown, gloves, eye protection (goggles or face shields).

However, DPH recommends that individual risk assessments for COVID-19 exposures based on setting, personnel and type of activity, be performed to determine if the WHO guidance will effectively provide adequate protection, or if additional PPE and other measures are needed to protect those at risk.

Additional Information

WHO:
https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf

Arizona Department of Health Services:
https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-provider-resources

Washington State Department of Health:
http://www.wsha.org/wp-content/uploads/DOH-Letter-healthcare-PPE-COVID-19.pdf

Oregon Health Advisory:
https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/DISEASESAZ/Emerging%20Respitory%20Infections/COVID-19-Provisional-Guidance-Healthcare-Infection-Prevention-Control.pdf

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