If you need to order masks or other personal protective equipment, click here for more information. Please note that PPE supplies are unpredictable given worldwide demand. Plan ahead!
Revised Provincial PPE Requirements (April 21)
On April 21, 2020, Shared Health issued newly revised PPE guidelines. The guidelines apply risk levels to inform the level of PPE needed for patient interactions. The new guidelines provide advice to conserve your PPE, while also prioritizing care settings for PPE delivery given the potential for PPE supply shortages.
Doctors Manitoba has reviewed the two new documents. They are lengthy, but you are encouraged to review them in full. We have provided a summary below, along with our advice as you consider applying these revised guidelines in your practice setting.
Shared Health PPE Requirements and Reources
- Shared Health’s PPE Requirements, a summary by care setting.
- Shared Health’s PPE Supply Framework, lengthy document including risk levels and prioritization plans for distributing PPE.
- Frequently Asked Questions about PPE
Shared Health’s COVID-19 Risk Zones
Shared Health has now developed three “risk zones” with different PPE requirements:
- The Red Zone involves providing care to known COVID-19 patients
- The Orange Zone involves contact with suspect COVID-19 patients
- The Green Zone involves contact with non-COVID-19 patients.
The PPE you need depends on two key factors: the “zone” or risk level of your patient encounters and the care setting you work in.
- Procedure masks should be used in all settings, but the same mask can be used for your shift, and only changed if it is damp, soiled or damaged. N95 masks are only recommended for aerosol-generating medical procedures.
- Eye protection may be needed depending on risk level and care setting. For example, for “green zone” care in primary care, eye protection may not be required. When eye protection is needed, it should be used for the full shift and cleaned and disinfected when possible for reuse.
- Gowns and gloves are only needed in orange and red zones, unless recommended for non-COVID cases such as MRSA or scabies according to long-established infection prevention and control precautions. In orange zones, gowns and gloves are required but they should be changed between patients. In red zones, gloves and gowns can be worn across multiple covid-19 positive patients.
- Strict hand hygiene is critical.
Shared Health has now posted extensive PPE guidance for various settings of care on their PPE provider resources page.
Pre-COVID PPE Guidelines (for Green Zone care)
The existing infection prevention and control guidelines are still in effect and should continue to be used for patient encounters in the Green Zone (no COVID-19 suspected):
- Use your point of care assessment to determine risk and appropriate PPE
- Use routine precautions all the time, including proper hand hygiene
- Use enhanced droplet/contact precautions only when appropriate, including mask, gloves, gown and eye protection.
These precautions include identifying patients with respiratory symptoms and keeping a safe distance (6 feet) until you can wear appropriate personal protective equipment. In most cases, this involves a surgical/procedure mask and possibly other equipment, depending on your point of care assessment.
Shared Health’s Plans to Prioritize PPE Deliveries
Recognizing how volatile and unpredictable the PPE supply chain is worldwide, Shared Health has also introduced a “framework” to guide how PPE is used and allocated. They reinforce the need to conserve PPE, meaning not to use more than recommended, to use items for full shift across multiple patients, or reuse after appropriate cleaning and disinfection.
If the recommended conservation efforts still do not stabilize the supply of PPE, it will, essentially, be rationed by Shared Health. Provincial authorities have prioritized care settings based on the risk to providers and patients. This includes:
- Priority 1A: Hospitals and emergency response services.
- Priority 1B: LTC facilities, along with child protection and community living disability protection workers.
- Priority 1C: COVID-19 screening, testing and assessment sites, as well as in-home and isolation shelter care for known and suspect COVID-19 cases
- Priority 2: Primary care and specialty clinics, public health, in-home care for non-COVID cases, as well as child care settings, group homes and correctional facilities
Shared Health’s document goes on to recommend shifting as much patient care to virtual visits as possible. Doctors Manitoba continues to press for additional virtual visit tariffs so you can provide more care to patients through phone and video, thus conserving PPE for patients who must be seen in person. Learn more about virtual care in our resource centre.
Doctors Manitoba’s Advice to Physicians on PPE
It’s important you are protected. Guidelines that are changed regularly, and orders that go undelivered are frustrating and can erode your confidence in the provincial health system. We are supporting you by making it as easy as possible to stay up-to-date on the guidelines and your obligations as a physician, pressing for predictable and reliable PPE deliveries from Shared Health, and identifying PPE supply alternatives for you as well.
With these new guidelines, our advice is to reflect on how you can best implement and follow the guidelines in your practice setting, recognizing each is unique in different ways. The Shared Health document recommends primary care clinics banding together and providing in-person care at one location and virtual care at others. We’ve also heard of other community practices creating zones within their clinic space, so any respiratory or potential COVID-19 cases are seen in an isolated area of the clinic with designated staff and doctors using the stricter PPE guidelines.
It’s important to consider ordering through Shared Health, even if you have little confidence in their ability to deliver right now. They need to know how much demand there is. However, it’s also prudent to explore alternative suppliers. You can contact us for help. For physicians in immediate need, we have a limited supply of some medical and non-medical grade PPE.
As always, we want to know what you think. How will the new PPE guidelines impact your practice. How do you want Doctors Manitoba to respond on physicians’ behalf. Get in touch and let us know.
When is an N95 mask required?
The public health advice states that N95 masks are only required for Aerosol-Generating Medical Procedures, or AGMPs, such as intubation or bronchoscopy. There is a concise outline from Shared Health on AGMP’s in acute and sub-acute settings.Shared Health has prepared a poster on procedure/surgical masks vs N95s.
You should be fit tested for an N95 mask if you anticipating needing to wear one. Shared Health has outlined fit testing priorities.
How do I safely put on PPE?
Doffing, or removing PPE, is an exposure risk. New provincial guidelines now recommend continuing to wear masks and eye protection across multiple patients unless it is wet, soiled or damaged.
How do I safely extend the use of PPE or clean PPE?
Provincial PPE guidelines now recommend continuing to wear masks and eye protection across multiple patients unless it becomes wet, soiled or damaged. Gowns and gloves, if required, need to be changed after each patient encounter unless care is solely focused on COVID-19 positive patients.
Eye protection may be able to be cleaned and reused. Shared Health has issued instructions on cleaning and reuse of eye protection.
Gowns and gloves should not be used across multiple patients and are not recommended for every patient encounter as outlines above. Gloves are single use, but some gowns can be laundered and reused.
What if I have concerns about how the PPE advice applies to the procedures that I perform?
What do I do if the recommended PPE is not available?
It is important for physicians to review CPSM’s advice on reconciling physicians’ duty to continue providing care with the need to follow PPE guidelines and protect the health of the physician workforce to see us through the pandemic.
For community-based physicians, you should:
- First try ordering through your normal supplier
- Next, try Shared Health Logistics. They have created a new online ordering portal and you can request access by emailing Shared Health Logistics at SCMCommandIntake@sharedhealthmb.ca. You can also try ordering by calling 204-926-6050 or 1-877-477-4773. Press 2 when prompted and if you are asked to leave a message, include your clinic name, contact information, the number of physicians in the practice and hours of operation. Shared Health is maintaining a central supply of PPE and has outlined their guidelines for appropriate ordering.
It’s important to consider ordering through Shared Health, even if you have little confidence in their ability to deliver right now given the shortage of PPE supplies. They need to know how much demand there is. However, it’s also prudent to explore alternative suppliers.
- Doctors Manitoba may be able to offer assistance for physicians who cannot secure needed PPE through their normal supplier or Shared Health.
Please complete our PPE assistance request to if you are having difficulty in securing PPE.
Where can I learn more?
If you have concerns about PPE or would like tips or assistance in sourcing PPE, please contact Doctors Manitoba for assistance at PPEconcerns@doctorsmanitoba.ca.