FAQs- Personal Protective Equipment (PPE) > What is a reasonable hierarchy of allotment or use of available PPE in time of scarcity?

What is a reasonable hierarchy of allotment or use of available PPE in time of scarcity?

PPE (Masks, gowns, face shield) Access and (Extending) Use
posted on 7:19 PM, May 12, 2020

There is a hierarchy of PPE use and incorporation into exposure reduction practice that may help in time of scarcity. In an institution-wide coordinated system, PPE is only one component of exposure reduction.


A number of very important administrative, engineering, and work practice controls are as important as PPE and continuous efforts to improve these should be made. Some examples include:

  1. Avoiding and reducing exposure by limiting the number of personnel with direct patient contact
  2. Robust PCR testing of patients and staff initially by triage criteria
  3. Cohorting patients with probable or documented COVID-19
  4. Ensuring good room air exchanges by air handling units, use of fans, negative pressure rooms
  5. Consideration of other technologies (e.g., UV lights, ion generators) if and where appropriate
  6. Use of shielding when performing procedures
  7. Attention to hand hygiene
  8. Cleaning of “high-contact” surfaces
  9. Avoiding hand to face behaviors


If trained and available, the highest level of PPE protection (e.g., PAPR with HEPA filters) should be reserved for those with the highest risk of exposure (e.g., emergency physician performing frequent endotracheal intubations, pulmonologist performing bronchoscopy on COVID-19 patients in ICU). When masks and respirators are in short supply, the following considerations are reasonable steps in decreasing order of preference:

  1. Good (in-date) respirator (N-95) with fit testing in past for size/style/brand, and no physical changes
  2. Respirators from other countries with fit testing
  3. Expired N-95 respirator with fit testing
  4. Respirator without a formal fit test (qualitative seal demonstrated by exhaling against gloved hand; “user seal check”)
  5. Respirators from other countries without a fit test
  6. Expired respirators from other countries without a fit test
  7. Surgical masks
  8. Home-made devices (e.g., scarves)



FEMA has developed fact sheets addressed to both healthcare and non-healthcare settings emphasizing a 3-tier set of actions to Reduce, Reuse, and Repurpose PPE (protection from respiratory and skin/mucous membrane contact). These are available at:

Coronavirus (COVID-19) Pandemic: Addressing PPE Needs in Non-Healthcare Setting

Coronavirus (COVID-19) Pandemic: Personal Protective Equipment Preservation Best Practices

            Short Fact Sheet:


Medical Advisory Secretariat. Air cleaning technologies: an evidence-based analysis. Ontario Health Technology Assessment Series 2005;5(17). [Developed in response to 2003 SARS epidemic] Accessed May 7, 2020 at: