PPE Recommendations/Update - Please Read

March 23, 2020

Dear Colleagues:

We continue to hear concerns/need for clarification about PPE Guidance for patients suspected of having COVID-19. I have attached a slide set that delineates the current recommendations. Please review as soon as you can. It is imperative that we use our PPE judiciously as we move forward with unknown needs facing us.


Notable Highlights:


  1. For patients with Influenza Like Illnesses (ILI), COVID positive patients, Persons Under Investigation (PUI) who are NOT receiving aerosolized treatments a Level 3 Mask provides safe protection and is preferred given limits on N95 availability. Gowns, gloves and goggles or face shield are mandatory.


  1. For patients with ILI, COVID positive patients, Persons Under Investigation (PUI) who are receiving aerosolized treatments – intubation, bronchoscopy, BIPAP, CPAP or nebulized therapy – N95 or PAPR is required in addition to gowns, gloves and goggles or face shield.


  1. Pediatric patients undergoing elective intubation or patients undergoing urgent/emergent intubation require N95 masks or PAPR in addition to gowns, gloves and goggles or face shield.


  1. Aerosolize procedures should be performed in negative pressure rooms.


  1. High flow oxygen e.g. > 6 liters per nasal cannula is NOT considered an aerosolizing situation.


  1. We are advocating for extended use and reuse of masks for caregivers in select situations. Definition of extended use and reuse can be found at Guidance for Extended Use and Limited Reuse of N95 Respirators.


  1. Processes are being implemented for collection of masks, goggles and facemasks for reprocessing.



Thank you in advance for your work on assessing all procedures and surgeries with respect to need to perform.


There has been a tremendous community outpouring regarding donation of PPE for our use. Please direct inquiries/donations opportunities to Bill Myers @ Bill.Myers@HCAHealthcare.com




Bill and Tony


Anthony M Spensieri, MD MBA FHM 

Chief Medical Officer


Mission Hospital   l   Mission Health

509 Biltmore Avenue, Asheville, NC 28801

P 828.213.1267   l   M 804.536.8878