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ABSTRACT: Creativity in Chaos: COVID-19 and PPE

By Patricia James, BS, RN, CNOR

Background: Since February 2020 COVID-19 became almost synonymous with personal protective equipment (PPE). Gowns, N-95 masks, and face shields were required in intensive care units (ICU)s, floor units as well as the operating rooms (OR). To protect the limited supply of the PPE in the OR, a tight supply chain inventory was needed to prevent shortages or product disappearance.

Methods: All surgical masks were removed from outside ORs. An allotted number of surgical masks were bagged up and given daily to the circulator assigned to the room, sign out and sign in upon return of masks. Inventory of the number of masks used was noted daily in the inventory reports. N-95 masks requests were signed out to the individual. Assigned N-95 masks were reprocessed through Bioquell® technology. Once reprocessed and returned to the OR, a shoe storage bag slot was labeled with the employee’s name for pick up. One OR office was turned into a locked perioperative hospital store manned 24/7. All PPE allotted to the perioperative services (anesthesia, pre/post anesthesia, surgery and nursing) is stored, maintained and inventoried. Controlled air purifying respirators (CAPRs), batteries for CAPRs and CAPR shields kept in this office, are signed out and returned to perioperative hospital storeroom at end of shift. Additional efforts included returning to using cloth isolation gowns during intubation and extubation to prevent overuse of plastic isolation gowns that were in very limited supply.

Results: Staff that needed accommodation away from patient care were assigned to the perioperative hospital store. In conjunction with perioperative supply chain a daily inventory completed to determine need of products in a timely manner. Staffed 24/7, access to needed supplies were maintained in a secure location, yet accessible when needed.

Conclusion: During an unprecedented time, rethinking normal practices, reducing usage of disposable gowns, maintaining a close inventory and using out of the box thinking provides needed resources both in product and manpower.

– Patricia James, BS, RN, CNOR, is the Nurse Manager Main OR at the University of Rochester. She may be reached via email at


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