LAUSR

Dear Editor The ongoing Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic has resulted in shortage of personal protective equipment (PPE) worldwide [1]. The first positive case in Singapore was reported on 23 January 2020 when the outbreak began [2]. As the numbers of suspect and confirmed SARS-CoV-2 cases in Singapore rose, the largest proportion of them were cared for at the National Centre for Infectious Diseases (NCID), a purpose-built facility designed to strengthen Singapore’s capabilities in infectious disease management. We describe rates of PPE utilization during the outbreak and the impact of practicing extended use N95 respirators [3] and eye protection on their usage in outbreak wards. We conducted the study between 1 February and 2 March 2020. All suspect and confirmed cases of SARSCoV-2 were admitted to a single isolation room (12 air exchanges per hour). We included all patients admitted to both the general ward and intensive care unit. Healthcare workers (HCW) involved in their care were required to don full PPE comprising N95 respirator, eye protection, full sleeve gown and surgical gloves. HCW were advised to cluster clinical activities (for example blood taking, physical examination), and use ViSi Mobile (ViSi®), a wearable remote vital signs monitor, for routine monitoring to minimize entry into patient rooms. Prior to 4 February 2020, N95 respirators and eye protection were single-patient use. On 4 February, reusable goggles were issued to each HCW. On 8 February, a directive was issued recommending extended use of N95 respirators and eye protection for repeated encounters with different patients, without changing between patients unless visibly contaminated or dislodged (Supplementary Appendix Floor Plan). Gowns and gloves remained as single-patient use. During study period, a daily ward-level stocktake calculating the difference in balance PPE compared to preceding day, accounting for supplies replenished, was defined as utilization rate per day. A daily ward census was recorded. We applied linear regression using STATA 15.0 to compare change in PPE utilization per 100 patient-days (β) before and after extended use. A total of 77 confirmed and 725 suspect cases were admitted during study period. Intensive care unit (ICU) admissions contributed to 199 (8.1%) patient-days (Fig. 1). The average utilization rate of single-use eye and N95 respirators per 100 patient-days reduced as a result of extended use policy. The average utilization rate of single-use eye protection and N95 respirators