make n95 respirator on masks for coronavirus n95

• Gowns

  coronavirus, coronavirus symptoms

  What testing and standards should I consider when looking for CDC-recommended protective clothing?
  • CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids outlines the scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare.
  • Many organizations have published guidelines for the use of personal protective equipment (PPE) in medical settings. The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI): ANSI/AAMI PB70:2012pdf icon external icon describes the liquid barrier performance and classification of surgical and isolation gowns for use in health care facilities.
  • As with any type of PPE, the key to proper selection and use of protective clothing is to understand the hazards and the risk of exposure. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures, and types of contact, and duration and type of tasks to be performed by the user of the PPE. (Technical Information Report (TIR) 11 pdf icon external icon[AAMI 2005]).
  • For gowns, it is important to have sufficient overlap of the fabric so that it wraps around the body to cover the back (ensuring that if the wearer squats or sits down, the gown still protects the back area of the body).
• What type of gown is recommended for patients with suspected or confirmed COVID-19?
  • Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings are appropriate for use by patients with suspected or confirmed COVID-19.
• What types of gowns are available for healthcare personnel to protect from COVID-19?
  • While the transmissibility of COVID-19 is not fully understood, gowns are available that protect against microorganisms. The choice of the gown should be made based on the level of risk of contamination. Certain areas of surgical and isolation gowns are defined as “critical zones” where direct contact with blood, body fluids, and/or other potentially infectious materials is most likely to occur. (ANSI/AAMI PB70pdf icon external icon).
  • If there is a medium to high risk of contamination and need for a large critical zone, isolation gowns that claim moderate to high barrier protection (ANSI/AAMI PB70 Level 3 or 4pdf icon external icon) can be used.
  • For healthcare activities with low, medium, or high risk of contamination, surgical gowns (ANSI/AAMI PB70 Levels 1-4pdf icon external icon), can be used. These gowns are intended to be worn by healthcare personnel during surgical procedures.
  • If the risk of bodily fluid exposure is low or minimal, gowns that claim minimal or low levels of barrier protection (ANSI/AAMI PB70 Level 1 or 2pdf icon external icon) can be used. These gowns should not be worn during surgical or invasive procedures, or for medium to high-risk contamination patient care activities.
• What is the difference between gowns and coveralls?
  • CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids provides additional comparisons between gowns and coveralls.
  • Gowns are easier to put on and, in particular, to take off. They are generally more familiar to healthcare workers and hence more likely to be used and removed correctly. These factors also facilitate training in their correct use.
  • Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. Surgical/isolation gowns do not provide continuous whole-body protection (e.g., they have possible openings in the back, and typically provide coverage to the mid-calf only).
  • The level of heat stress generated due to the added layer of clothing is also expected to be less for gowns when compared to coveralls due to several factors, such as the openings in the design of gowns and total area covered by the fabric.
• How do I put on (don) and take off (doff) my gown?
  • Check to see if your facility has guidance on how to don and doff PPE.  The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
  • If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.pdf icon
  • It is important for Health Care Providers (HCP) to perform hand hygiene before and after removing PPE. Hand hygiene should be performed by using an alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.
• Is it acceptable for emergency medical services to wear coveralls as an alternative to gowns when COVID-19 is suspected in a patient needing emergency transport?
  • Unlike patient care in the controlled environment of a healthcare facility, care and transport by EMS present unique challenges because of the nature of the setting. Coveralls are an acceptable alternative to gowns when caring for and transporting suspect COVID-19 patients.  While no clinical studies have been done to compare gowns and coveralls, both have been used effectively by healthcare workers in clinical settings during patient care. CDC’s Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids guidance provides a comparison between gowns and coveralls, including test methods and performance requirements. Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well.  This added coverage may be necessary for some work tasks involved in medical transport. However, coveralls may lead to increased heat stress compared to gowns due to the total area covered by the fabric. Training on how to properly remove (doff) a coverall is important to prevent self-contamination. Comparatively, gowns are easier to put on and, in particular, to take off.

Gloves

• What type of glove is recommended to care for suspected or confirmed COVID-19 patients in healthcare settings?
  • Nonsterile disposable patient examination gloves, which are used for routine patient care in healthcare settings, are appropriate for the care of patients with suspected or confirmed COVID-19.
• What standards should be considered when choosing gloves?
  • The American Society for Testing and Materials (ASTM)external icon has developed standards for patient examination gloves.
  • Standard specifications for nitrile gloves, natural rubber gloves, and polychloroprene gloves indicate higher minimum tensile strength and elongation requirements compared to vinyl gloves.^1,2,3,4
  • The ASTM has developed standards for patient examination gloves. Length requirements for patient exam gloves must be a minimum of 220mm-230mm depending on glove size and material type.^1,2,3,4
• Is double gloving necessary when caring for suspected or confirmed CoVID-19 patients in healthcare settings?
  • CDC Guidance does not recommend double gloves when providing care to suspected or confirmed 2019-COVID patients.
• Are extended length gloves necessary when caring for suspected or confirmed COVID-19 patients in healthcare settings?
  • According to CDC Guidance, extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. Extended length gloves can be used, but CDC is not specifically recommending them at this time.
• How I do put on (don) and take off (doff) my gloves?
  • Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
  • If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPEpdf icon.
  • It is important for HCP to perform hand hygiene after removing PPE. Hand hygiene should be performed by using an alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds.  If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Footnotes
¹ASTM D6319-Standard Specification for Nitrile Examination Gloves for Medical Applications
²ASTM D3578 Standard Specification for Rubber Examination Gloves
³ASTM D5250 Standard Specification for Poly(vinyl chloride) Gloves for Medical Application
⁴ASTMD 6977 Standard Specification for Polychloroprene Examination Gloves for Medical Application

Respirators

• Should I wear a respirator in public?
  • CDC does not recommend the routine use of respirators outside of workplace settings (in the community). Most often, the spread of respiratory viruses from person-to-person happens among close contacts (within 6 feet). CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching your eyes or nose, and covering your cough or sneeze with a tissue. People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.
• What is a respirator?
  • A respirator is a personal protective device that is worn on the face or head and covers at least the nose and mouth. A respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases or vapors. Respirators, including those intended for use in healthcare settings, are certified by the CDC/NIOSH.
• What is an N95 filtering facepiece respirator (FFR)?
  • An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 microns) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.
• What makes N95 respirators different from facemasks (sometimes called a surgical mask)?
  • Infographic: Understanding the difference between surgical masks and N95 respiratorspdf icon
  • N95 respirators reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets. N95 respirators are tight-fitting respirators that filter out at least 95% of particles in the air, including large and small particles.
  • Not everyone is able to wear a respirator due to medical conditions that may be made worse when breathing through a respirator. Before using a respirator or getting fit-tested, workers must have a medical evaluation to make sure that they are able to wear a respirator safely.
  • Achieving an adequate seal to the face is essential. United States regulations require that workers undergo an annual fit test and conduct a a user seal checks each time the respirator is used. Workers must pass a fit test to confirm a proper seal before using a respirator in the workplace.
  • When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.
  • Unlike NIOSH-approved N95s, facemasks are loose-fitting and provide only barrier protection against droplets, including large respiratory particles. No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent leakage around the edge of the mask when the user inhales.
  • The role of facemasks is for patient source control, to prevent contamination of the surrounding area when a person coughs or sneezes.  Patients with confirmed or suspected COVID-19 should wear a facemask until they are isolated in a hospital or at home. The patient does not need to wear a facemask while isolated.
• What is a Surgical N95 respirator and who needs to wear it?
  • A surgical N95 (also referred to as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings. In times of shortage, only HCP who are working in a sterile field or who may be exposed to high-velocity splashes, sprays, or splatters of blood or body fluids should wear these respirators, such as in operative or procedural settings. Most HCP caring for confirmed or suspected COVID-19 patients should not need to use surgical N95 respirators and can use standard N95 respirators.
  • If a surgical N95 is not available for use in operative or procedural settings, then an unvalved N95 respirator may be used with a face shield to help block high-velocity streams of blood and body fluids.
• My employees complain that Surgical N95 respirators are hot and uncomfortable – what can I do?
  • The requirements for surgical N95 respirators that make them resistant to high-velocity streams of body fluids and help protect the the sterile field can result in a design that has a higher breathing resistance (makes it more difficult to breath) than a typical N95 respirator. Also, surgical N95 respirators are designed without exhalation valves which are sometimes perceived as warmer inside the mask than typical N95 respirators. If you are receiving complaints, you may consider having employees who are not doing surgery, not working in a sterile field, or not potentially exposed to high-velocity streams of body fluids wear a standard N95 with an exhalation valve.
• My N95 respirator has an exhalation valve, is that okay?
  • An N95 respirator with an exhalation valve does provide the same level of protection to the wearer as one that does not have a valve. The presence of an exhalation valve reduces exhalation resistance, which makes it easier to breathe (exhale). Some users feel that a respirator with an exhalation valve keeps the face cooler and reduces moisture build up inside the facepiece. However, respirators with exhalation valves should not be used in situations where a sterile field must be maintained (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.

• How can I tell if a respirator is NIOSH-approved?
  • The NIOSH approval number and approval label are key to identifying NIOSH-approved respirators. The  NIOSH approval label can be found on or within the packaging of the respirator or sometimes on the respirator itself. The required labeling of NIOSH-Approved N95 filtering facepiece respiratorspdf icon  includes the NIOSH name, the approval number, filter designations, lot number, and model number to be printed on the respirator. You can verify that your respirator approvals are valid by checking the NIOSH Certified Equipment List (CEL).
• How do I know if my respirator is expired?
  • NIOSH does not require approved N95 filtering facepiece respirators (FFRs) be marked with an expiration date. If an FFR does not have an assigned expiration date, you should refer to the user instructions or seek guidance from the specific manufacturer on whether time and storage conditions (such as temperature or humidity) are expected to have an effect on the respirator’s performance and if the respirators are nearing the end of their shelf life.
• What do I do with an expired respirator?
  • In times of increased demand and decreased supply, consideration can be made to use N95 respirators past their intended shelf life. However, the potential exists that the respirator will not perform to the requirements for which it was certified. Over time, components such as the strap and nose bridge may degrade, which can affect the quality of the fit and seal. Prior to the use of N95 respirators, the HCP should inspect the respirator and perform a seal check. Additionally, expired respirators may potentially no longer meet the certification requirements set by NIOSH. For further guidance, visit Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response.
• What methods should healthcare facilities consider in order to avoid unintentional loss of PPE during COVID-19?
  • Monitoring PPE supply inventory and maintaining control over PPE supplies may help prevent unintentional product losses that may occur due to theft, damage, or accidental loss. Inventory systems should be employed to track daily usage and identify areas of higher than expected use.  This information can be used to implement additional conservation strategies tailored to specific patient care areas such as hospital units or outpatient facilities.  Inventory tracking within a health system may also assist in confirming PPE deliveries and optimizing the distribution of PPE supplies to specific facilities.
    

    Coronavirus Disease 2019 (COVID-19) Situation Summary

    This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.
    
    
    

    Background

    CDC is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in almost 70 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
    On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concern external icon” (PHEIC). On January 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19.
    

    Source and Spread of the Virus

    Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with this new virus (named SARS-CoV-2).
    The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV.  All three of these viruses have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.
    Early on, many of the patients at the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Person-to-person spread was subsequently reported outside Hubei and in countries outside China, including in the United States. Some international destinations now have apparent community spread with the virus that causes COVID-19, including in some parts of the United States. Community spread means some people have been infected and it is not known how or where they became exposed. Learn what is known about the spread of this newly emerged coronaviruses.
    

    Situation in U.S.

  • Imported cases of COVID-19 in travelers have been detected in the U.S.
  • Person-to-person spread of COVID-19 was first reported among close contacts of returned travelers from Wuhan.
  • During the week of February 23, CDC reported community spread of the virus that causes COVID-19 in California (in two places), Oregon and Washington. Community spread in Washington resulted in the first death in the United States from COVID-19, as well as the first reported case of COVID-19 in a health care worker, and the first potential outbreak in a long-term care facility.

  Illness Severity

  Both MERS-CoV and SARS-CoV have been known to cause severe illness in people. The complete clinical picture with regard to COVID-19 is not fully understood. Reported illnesses have ranged from mild to severe, including illness resulting in death. While information so far suggests that most COVID-19 illness is mild, a reportexternal icon out of China suggests serious illness occurs in 16% of cases. Older people and people with certain underlying health conditions like heart disease, lung disease, and diabetes, for example, seem to be at greater risk of serious illness.
  Learn more about the symptoms associated with COVID-19.
  There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.
  

  Risk Assessment

  Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on the characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications). The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic. As community spread is detected in more and more countries, the world moves closer toward meeting the third criteria, the worldwide spread of the new virus.
  Reported community spread of COVID-19 in parts of the United States raises the level of concern about the immediate threat for COVID-19 for those communities. The potential public health threat posed by COVID-19 is very high, to the United States and globally.
  At this time, however, most people in the United States will have the little immediate risk of exposure to this virus. This virus is NOT currently spreading widely in the United States. However, it is important to note that current global circumstances suggest it is likely that this virus will cause a pandemic. This is a rapidly evolving situation and the risk assessment will be updated as needed.
  Current risk assessment:
  
• For most of the American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
• People in communities where ongoing community spread with the virus that causes COVID-19 has been reported are at elevated, though still relatively low risk of exposure.
• Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
• Close contacts of persons with COVID-19 also are at elevated risk of exposure.
• Travelers returning from affected international locations  

  What May Happen

  More cases of COVID-19 are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in communities in the United States. It’s likely that at some point, widespread transmission of COVID-19 in the United States will occur.
  Widespread transmission of COVID-19 would translate into large numbers of people needing medical care at the same time. Schools, childcare centers, workplaces, and other places for mass gatherings may experience more absenteeism. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and transportation industry may also be affected. Health care providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy.
  

  CDC Response

  Global efforts at this time are focused concurrently on containing the spread and mitigating the impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat. The public health response is multi-layered, with the goal of detecting and minimizing introductions of this virus in the United States. CDC is operationalizing all of its pandemic preparedness and response plans, working on multiple fronts to meet these goals, including specific measures to prepare communities to respond to local transmission of the virus that causes COVID-19. There is an abundance of pandemic guidance developed in anticipation of an influenza pandemic that is being repurposed and adapted for a COVID-19 pandemic.
  

  Highlights of CDC’s Response

• CDC established a COVID-19 Incident Management System on January 7, 2020. On January 21, CDC activated its Emergency Operations Center to better provide ongoing support to the COVID-19 response.
• The U.S. government has taken unprecedented steps with respect to travel in response to the growing public health threat posed by this new coronavirus:
  • Effective February 2, at 5pm, the U.S. government suspended entry of foreign nationals who have been in China within the past 14 days.
    • U.S. citizens, residents, and their immediate family members who have been in Hubei province and other parts of mainland China are allowed to enter the United States, but they are subject to health monitoring and possible quarantine for up to 14 days.

• • On February 29, the U.S. government announced it was suspending entry of foreign nationals who have been in Iran within the past 14 days.

• • CDC has issued the following travel guidance related to COVID-19:
    • China — Level 3, Avoid Nonessential Travel — updated February 22;
    • Hong Kong — Level 1, Practice Usual Precautions — issued February 19;
    • Iran — Level 3, Avoid Nonessential Travel — updated February 28;
    • Italy — Level 3, Avoid Nonessential Travel — updated February 28;
    • Japan — Level 2, Practice Enhanced Precautions — updated February 22;
    • South Korea — Level 3, Avoid Nonessential Travel — updated February 24.
  • CDC also recommends that all travelers reconsider cruise ship voyages into or within Asia at this time.
• CDC is issuing clinical guidance, including:
  • On January 30, CDC published guidance for healthcare professionals on the clinical care of  COVID-19 patients.
  • On February 3, CDC posted guidance for assessing the potential risk for various exposures to COVID-19 and managing those people appropriately.
  • On February 27, CDC updated its criteria to guide evaluation of persons under investigation for COVID-19.
  • On February 28, CDC issued a Health Alert Network (HAN): Update and Interim Guidance on Outbreak of COVID-19.
• CDC has deployed multidisciplinary teams to support state health departments case identification, contact tracing, clinical management, and communications.

CDC has worked with the Department of State, supporting the safe return of Americans who have been stranded as a result of the ongoing outbreaks of COVID-19 and related travel restrictions. CDC has worked to assess the health of passengers as they return to the United States and provided continued daily monitoring of people who are quarantined.

CDC Recommends

• Everyone can do their part to help us respond to this emerging public health threat:
  • It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed.
  • If you are a healthcare provider, be on the look-out for:
    • People who recently traveled from China or another affected area and who have symptoms associated with COVID-19, and
    • People who have been in close contact with someone with COVID-19 or pneumonia of unknown cause. (Consult the most recent definition for patients under investigation [PUIs].)
  • If you are a healthcare provider or a public health responder caring for a COVID-19 patient, please take care of yourself and follow recommended infection control procedures.
  • If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, call your healthcare provider and tell them about your symptoms and your exposure.

• If you are a resident in a community where person-to-person spread of COVID-19 has been detected and you develop COVID-19 symptoms, call your healthcare provider and tell them about your symptoms.
• For people who are ill with COVID-19, but are not sick enough to be hospitalized, please follow CDC guidance on how to reduce the risk of spreading your illness to others. People who are mildly ill with COVID-19 are able to isolate at home during their illness.
• If you have been in China or another affected area or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement and activity for up to 14 days. Please follow instructions during this time. Your cooperation is integral to the ongoing public health response to try to slow spread of this virus.

 masks for coronavirus amazon

VENUS V-4400 Flat Fold Respirator with NIOSH N95 Certification

• Added protection from airborne viruses 
• Venus V-4400 is NIOSH approved N95 mask