April 01, 2020
Purchase and Wearing of Personal Protective Equipment by Anesthesiologists and other Anesthesia Professionals
COVID-19 community transmission is becoming widespread, and reports of health care workers becoming infected are increasing. Post-procedure infection in apparently healthy patients is also reported. CDC guidance addresses the care of known, potential (persons under investigation) and non-infected individuals.1 This guidance contains recommendations for appropriate personal protective equipment (PPE), including respirators (e.g., N95 masks), face shields or goggles, gowns and gloves. However, there is no CDC guidance to address the care of patients who are in the incubation period, or patients who are minimally or not symptomatic. What is appropriate PPE sufficient to protect the caregivers for this group of patients is unknown.
Anesthesiologists and other anesthesia professionals are understandably concerned for their own safety, working with known and unknown COVID-19 patients in the operating room, ICU and other facility areas, where they often perform airway management during aerosolizing procedures. On the other hand, some health care facilities do not have sufficient PPE available because of supply chain issues, and they are unable to provide adequate PPE to front-line anesthesia professionals. There is specific concern with inadequate supplies of N95 filtering facepiece respirators.
The National Institute for Occupational Safety and Health (NIOSH) maintains a list of approved disposable particulate filtering facepiece respirators.2 In addition, the FDA has issued several Emergency Use Authorizations (EUA) addressing the emergency use of personal respiratory protective devices during the COVID-19 outbreak.3 One FDA EUA allows health care personnel to use certain industrial respirators during the COVID-19 outbreak in health care settings. Respirators with higher filtration capability than 95% (i.e., 99-100% ratings) exist for industrial use. Another FDA EUA authorizes the use of equivalent imported, non-NIOSH-approved disposable filtering facepiece respirators.3,4 However, homemade fabric masks provide inadequate protection and should not be used in health care except in dire emergencies.5
In these situations:
- Known and PUI COVID-19 patients
- Patients of unknown status in geographic areas with significant community transmission, and
- When the facility is unable to supply sufficient PPE
The American Society of Anesthesiologists supports that anesthesia professionals may purchase and wear alternate approved respirators, if they choose to do so. The Joint Commission also supports “allowing staff to bring their own standard face masks or respirators to wear at work.”6 There are no regulatory prohibitions that forbid health care professionals from wearing PPE when not required to. It is inappropriate for facilities to prohibit their employees from purchasing and wearing approved PPE.
Personal purchase of approved N95 or other respirators is clearly suboptimal. However, if PPE that is sufficient for personal safety cannot be supplied by the facility, ASA strongly supports that anesthesia professionals may purchase and wear alternate approved respirators that are equivalent to or better than N95 respirators, if they so choose.