Rational use of personal protective equipment

for coronavirus disease 2019 (COVID-19)

Interim guidance
27 February 2020
PPE appropriately; this involves selecting the proper PPE and
being trained in how to put on, remove and dispose of it.
Coronavirus disease 2019 (COVID-19), caused by the
COVID-19 virus, was first detected in Wuhan, China, in
PPE is only one effective measure within a package that
December 2019. On 30 January 2020, the
comprises administrative and environmental and engineering
WHO Director-General declared that the current outbreak
controls, as described in WHO’s Infection prevention and
constituted a public health emergency of international
control of epidemic- and pandemic-prone acute respiratory
concern.
infections in health care (1). These controls are summarized
This document summarizes WHO’s recommendations for the here.
rational use of personal protective equipment (PPE) in  Administrative controls include ensuring the
healthcare and community settings, as well as during the availability of resources for infection prevention and
handling of cargo; in this context, PPE includes gloves, control measures, such as appropriate infrastructure, the
medical masks, goggles or a face shield, and gowns, as well development of clear infection prevention and
as for specific procedures, respirators (i.e., N95 or control policies, facilitated access to laboratory testing,
FFP2 standard or equivalent) and aprons. This document is appropriate triage and placement of patients, adequate
intended for those who are involved in distributing and staff-to-patient ratios and training of staff.
managing PPE, as well as public health authorities and  Environmental and engineering controls aim at
individuals in healthcare and community settings, and it aims reducing the spread of pathogens and reducing the
to provide information about when PPE use is most contamination of surfaces and inanimate objects. They
appropriate. include providing adequate space to allow social distance
WHO will continue to update these recommendations as new of at least 1 m to be maintained between patients and
information becomes available. between patients and healthcare workers and ensuring
the availability of well-ventilated isolation rooms for
patients with suspected or confirmed COVID-19 disease.

Preventive measures for COVID-19 disease COVID-19 is a respiratory disease that is different from
Based on the available evidence, the COVID-19 virus is Ebola virus disease, which is transmitted through infected
transmitted between people through close contact and bodily fluids. Due to these differences in transmission, the
droplets, not by airborne transmission. The people most at PPE requirements for COVID-19 are different from those
risk of infection are those who are in close contact with a required for Ebola virus disease. Specifically, coveralls
COVID-19 patient or who care for COVID-19 patients. (sometimes called Ebola PPE) are not required when
managing COVID-19 patients.
Preventive and mitigation measures are key in both healthcare
and community settings. The most effective preventive Disruptions in the global supply chain of
measures in the community include:
 performing hand hygiene frequently with an
PPE
alcohol-based hand rub if your hands are not visibly The current global stockpile of PPE is insufficient,
dirty or with soap and water if hands are dirty; particularly for medical masks and respirators; the supply of
 avoiding touching your eyes, nose and mouth; gowns and goggles is soon expected to be insufficient also.
 practicing respiratory hygiene by coughing or Surging global demand − driven not only by the number of
sneezing into a bent elbow or tissue and then COVID-19 cases but also by misinformation, panic buying
immediately disposing of the tissue; and stockpiling − will result in further shortages of
 wearing a medical mask if you have respiratory PPE globally. The capacity to expand PPE production is
symptoms and performing hand hygiene after limited, and the current demand for respirators and masks
disposing of the mask; cannot be met, especially if the widespread, inappropriate use
 maintaining social distance (a minimum of 1 m) of PPE continues.
from individuals with respiratory symptoms.

Additional precautions are required by healthcare workers to

protect themselves and prevent transmission in the healthcare
setting. Precautions to be implemented by healthcare workers
caring for patients with COVID-19 disease include using

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 Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance

Recommendations for optimizing the  The type of PPE used when caring for COVID-19
patients will vary according to the setting and type
availability of PPE. of personnel and activity (Table 1).
In view of the global PPE shortage, the following strategies  Healthcare workers involved in the direct care of
can facilitate optimal PPE availability (Fig. 1). patients should use the following PPE: gowns,
gloves, medical mask and eye protection (goggles or
Fig. 1. Strategies to optimize the availability of personal
face shield).
protective equipment (PPE)
 Specifically, for aerosol-generating procedures
(e.g., tracheal intubation, non-invasive ventilation,
Minimize PPE tracheostomy, cardiopulmonary resuscitation,
need
manual ventilation before intubation, bronchoscopy)
healthcare workers should use respirators, eye
protection, gloves and gowns; aprons should also be
used if gowns are not fluid resistant (1).
 Respirators (e.g., N95, FFP2 or equivalent standard)
have been used for an extended time during previous
public health emergencies involving acute respiratory
illness when PPE was in short supply (3). This refers
(1) Minimize the need for PPE to wearing the same respirator while caring for
multiple patients who have the same diagnosis
The following interventions can minimize the need for without removing it, and evidence indicates that
PPE while protecting healthcare workers and other respirators maintain their protection when used for
individuals from exposure to the COVID-19 virus in extended periods. However, using one respirator for
healthcare settings. longer than 4 hours can lead to discomfort and should
 Consider using telemedicine to evaluate suspected be avoided (4−6).
cases of COVID-19 disease (2), thus minimizing the  Among the general public, persons with respiratory
need for these individuals to go to healthcare symptoms or those caring for COVID-19 patients at
facilities for evaluation. home should receive medical masks. For additional
 Use physical barriers to reduce exposure to the information, see Home care for patients with
COVID-19 virus, such as glass or plastic windows. suspected novel coronavirus (COVID-19) infection
This approach can be implemented in areas of the presenting with mild symptoms, and management of
healthcare setting where patients will first present, their contacts (7).
such as triage areas, the registration desk at the  For asymptomatic individuals, wearing a mask of any
emergency department or at the pharmacy window type is not recommended. Wearing medical masks
where medication is collected. when they are not indicated may cause unnecessary
 Restrict healthcare workers from entering the rooms cost and a procurement burden and create a false
of COVID-19 patients if they are not involved in sense of security that can lead to the neglect of other
direct care. Consider bundling activities to minimize essential preventive measures. For additional
the number of times a room is entered (e.g., check information, see Advice on the use of masks in the
vital signs during medication administration or have community, during home care and in healthcare
food delivered by healthcare workers while they are settings in the context of the novel coronavirus
performing other care) and plan which activities will (2019-nCoV) outbreak (8).
be performed at the bedside.

Ideally, visitors will not be allowed but if this is not possible, (3) Coordinate PPE supply chain management
restrict the number of visitors to areas where COVID-19 mechanisms.
patients are being isolated; restrict the amount of time visitors
The management of PPE should be coordinated through
are allowed to spend in the area; and provide clear essential national and international supply chain management
instructions about how to put on and remove PPE and perform mechanisms that include but are not restricted to:
hand hygiene to ensure visitors avoid self-contamination (see
 using PPE forecasts that are based on rational
https://www.who.int/csr/resources/publications/putontakeoff
quantification models to ensure the rationalization of
PPE/en/). requested supplies;
 monitoring and controlling PPE requests from
(2) Ensure PPE use is rationalized and appropriate countries and large responders;
PPE should be used based on the risk of exposure (e.g., type  promoting the use of a centralized request
of activity) and the transmission dynamics of the pathogen management approach to avoid duplication of stock
(e.g., contact, droplet or aerosol). The overuse of PPE will and ensuring strict adherence to essential stock
have a further impact on supply shortages. Observing the management rules to limit wastage, overstock and
following recommendations will ensure that the use of stock ruptures;
PPE rationalized.  monitoring the end-to-end distribution of PPE;
 monitoring and controlling the distribution of
PPE from medical facilities stores.

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 Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance

 Importantly, the use of gloves does not replace the

need for appropriate hand hygiene, which should be
Handling cargo from affected countries performed frequently, as described above.
The rationalized use and distribution of PPE when  When disinfecting supplies or pallets, no additional
handling cargo from and to countries affected by the PPE is required beyond what is routinely
COVID-19 outbreak includes following these recommended. To date, there is no epidemiological
recommendations. information to suggest that contact with goods or
products shipped from countries affected by the
 Wearing a mask of any type is not recommended COVID-19 outbreak have been the source of
when handling cargo from an affected country. COVID-19 disease in humans. WHO will continue to
 Gloves are not required unless they are used for closely monitor the evolution of the COVID-19
protection against mechanical hazards, such as may outbreak and will update recommendations as needed.
occur when manipulating rough surfaces.

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 Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance

Rasional penggunaan peralatan pelindung pribadi untuk penyakit coronavirus 2019 (COVID-19) Panduan interim 27
Februari 2020 Coronavirus penyakit 2019 (COVID-19), disebabkan oleh virus COVID-19, pertama kali terdeteksi di Wuhan,
Cina, pada Desember 2019. Pada tanggal 30 Januari 2020, WHO Direktur Jenderal menyatakan bahwa wabah saat ini
merupakan keadaan darurat kesehatan masyarakat dari keprihatinan internasional. Dokumen ini merangkum rekomendasi
WHO untuk penggunaan peralatan pelindung diri (PPE) pribadi secara rasional dalam pengaturan kesehatan dan masyarakat,
serta selama penanganan kargo; dalam konteks ini, PPE termasuk sarung tangan, masker medis, kacamata atau perisai
wajah, dan gaun, serta untuk prosedur tertentu, respirator (yaitu, N95 atau FFP2 standar atau setara) dan celemek. Dokumen
ini ditujukan bagi mereka yang terlibat dalam mendistribusikan dan mengelola PPE, serta otoritas kesehatan masyarakat dan
individu dalam kesehatan dan pengaturan masyarakat, dan bertujuan untuk...
a
In addition to using the appropriate PPE, frequent hand hygiene and respiratory hygiene should always be performed. PPE should
be discarded in an appropriate waste container after use, and hand hygiene should be performed before putting on and after taking
off PPE.
b
The number of visitors should be restricted. If visitors must enter a COVID-19 patient’s room, they should be provided with clear
instructions about how to put on and remove PPE and about performing hand hygiene before putting on and after removing PPE;
this should be supervised by a healthcare worker.
c
This category includes the use of no-touch thermometers, thermal imaging cameras, and limited observation and questioning, all
while maintaining a spatial distance of at least 1 m.
d
All rapid response team members must be trained in performing hand hygiene and how to put on and remove PPE to avoid
self-contamination.
For PPE specifications, refer to WHO’s novel coronavirus (COVID-19) disease commodity packages at
https://www.who.int/emergencies/what-we-do/prevention-readiness/disease-commodity-packages/dcp-ncov.pdf?ua=1.

References
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Health Organization; 2014
(https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf;jsessionid=BE25F8EAA4F631126E78390906
050313?sequence=1, accessed 27 February 2020).
2. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Geneva: World
Health Organization; 2009 (Global Observatory for eHealth Series, 2; https://apps.who.int/iris/handle/10665/44497, accessed
27 February 2020).
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programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic. Am J Infect Control.
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Rasional penggunaan peralatan pelindung pribadi untuk

penyakit coronavirus 2019 (COVID-19) Panduan
interim 27 Februari 2020 Coronavirus penyakit 2019
(COVID-19), disebabkan oleh virus COVID-19,
pertama kali terdeteksi di Wuhan, Cina, pada Desember
2019. Pada tanggal 30 Januari 2020, WHO Direktur
Jenderal menyatakan bahwa wabah saat ini merupakan
keadaan darurat kesehatan masyarakat dari keprihatinan
internasional. Dokumen ini merangkum rekomendasi
WHO untuk penggunaan peralatan pelindung diri (PPE)
pribadi secara rasional dalam pengaturan kesehatan dan
masyarakat, serta selama penanganan kargo; dalam
konteks ini, PPE termasuk sarung tangan, masker medis,
kacamata atau perisai wajah, dan gaun, serta untuk
prosedur tertentu, respirator (yaitu, N95 atau FFP2
standar atau setara) dan celemek. Dokumen ini
ditujukan bagi mereka yang terlibat dalam
mendistribusikan dan mengelola PPE, serta otoritas
kesehatan masyarakat dan individu dalam kesehatan dan
pengaturan masyarakat, dan bertujuan untuk...

6
 Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance

4. Janssen L, Zhuang Z, Shaffer R. Criteria for the collection of useful respirator performance data in the workplace. J Occup
Environ Hyg. 2014;11(4):218–26. doi:10.1080/15459624.2013.852282.
5. Janssen LL, Nelson TJ, Cuta KT. Workplace protection factors for an N95 filtering facepiece respirator. J Occup Environ Hyg.
2007;4(9):698–707. doi:10.1080/15459620701517764.
6. Radonovich LJ Jr, Cheng J, Shenal BV, Hodgson M, Bender BS. Respirator tolerance in health care workers. JAMA.
2009;301(1):36–8. doi:10.1001/jama.2008.894.
7. Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and
management of their contacts: interim guidance, 4 February 2020. Geneva: World Health Organization; 2020
(WHO/nCov/IPC/HomeCare/2020.2; https://apps.who.int/iris/handle/10665/331133, accessed 27 February 2019).
8. Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel
coronavirus (2019-nCoV) outbreak: interim guidance, 29 January 2020. Geneva: World Health Organization; 2020
(WHO/nCov/IPC_Masks/2020; https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-
home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak, accessed 27 February 2020).

© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO
licence.

WHO reference number: WHO/2019-nCov/IPC PPE_use/2020.1

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