The purpose of this fact sheet is to provide American Indian and Alaskan Native communities, health centers, clinics, and governments with information on the procurement of Personal Protective Equipment (PPE) during the global pandemic caused by Coronavirus Disease 2019 (COVID-19).

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What is PPE?

Personal Protective Equipment (PPE) is specialized clothing or equipment worn by an employee for protection against infectious materials. PPE protects healthcare personnel by acting as a barrier between infectious materials and your skin, mouth, nose, or eyes.

 

Types of PPE:

  • Gloves
  • Masks and Respirators
  • Face Shields
  • Aprons
  • Gowns
  • Goggles

 

Indian Country Resources

The Centers for Disease Control (CDC) has a website with information on COVID-19 for Tribes and Tribal Organizations. View the CDC sequence for donning PPE here. The Indian Health Service (IHS) has compiled resources aimed at all sectors of Native American communities. The Navajo Department of Health has a factsheet on how to effectively wear N95 and Kn95 masks. IHS released guidance for tribes on accessing medical supplies and PPE through the Strategic National Stockpile. The National Congress of American Indians has a website dedicated to tracking resources and COVID-19 in Indian Country.

Request PPE
Short Version Long Version Resource Links

What PPE Your Organization Will Need for COVID-19

When determining what kind of PPE your organization will need, it is important to be aware that different employees/employers will require varying amounts of protection based on certain risk factors. For example, the CDC specifies here which type of PPE healthcare workers will specifically require when caring for patients with potential COVID-19. Find out how to determine what PPE you’ll need here from the Occupational Safety and Health Administration (OSHA).

The chart below (found here from OSHA) details the risk levels facing different types of employees. View specific WHO/FDA/OSHA/CDC standards for PPE.

VERY HIGH /
HIGH EXPOSURE RISK

High risk exposure jobs include those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem,
or laboratory procedures.

THESE JOBS INCLUDE:
  • Healthcare workers
  • Healthcare or lab personnel collecting or handling samples from known or suspected COVID-19 patients
  • Morgue workers performing autopsies
  • Healthcare delivery and support staff exposed to known or suspected COVID-19 patients
  • Medical transport workers moving COVID-19 patients in enclosed vehicles
MAY NEED TO WEAR SOME OR ALL OF:
  • Gloves
  • Gown
  • Face shield/goggles
  • Face mask or respirator depending on job tasks
  • Those in close contact with COVID-19 patients must wear a respirator
MEDIUM
EXPOSURE RISK

Include jobs requiring frequent and/or close contact with people who may be infected with coronavirus but are not known/suspected COVID-19 patients. In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers who may return from international locations with widespread COVID-19 transmission. In areas where there is ongoing community transmission, workers in this category may have contact with the general public.

THESE JOBS INCLUDE:
  • Gloves
  • Gown
  • Face shield/goggles
  • Face masks/respirators (in rare situations)
MAY NEED TO WEAR SOME COMBINATION OF:
  • Gloves
  • Gown
  • Face shield/goggles
  • Face masks/Respirators (in rare situations)
LOWER EXPOSURE RISK
(CAUTION)

These jobs do not require contact with people known to be, or suspected of being, infected with SARS-CoV-2 nor frequent close contact with (i.e., within 6 feet of ) the general public. Workers in this category have minimal occupational contact with the public and other coworkers.

THESE JOBS INCLUDE:
  • Office workers
  • Some delivery drivers
WHAT K IND OF PPE YOU’LL NEED:
  • Additional PPE is not recommended for workers in the lower exposure risk group. Workers should continue to use the PPE, if any, that they would ordinarily use for other job tasks.
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You know what to buy.
But how do you know who to trust?

It is important to ensure the PPE your tribe or organization purchases comes from reputable suppliers. There are steps you can take to make sure any potential supplier is legitimate, offering PPE that has met the specification detailed above and other Food and Drug Administration (FDA) and National Institute for Occupational Safety and Health (NIOSH) compliances. There are also red flags the Federal Bureau of Investigation (FBI) has identified that organizations can be on the lookout for which could reveal a supplier as non-reputable.

Request PPE
Short Version Long Version Resource Links

Verifying Legitimate Suppliers

The National Center is teaming up with Project N95 to create a database of verified PPE suppliers whose products are in line with CDC and other organizational standards. Project N95 is the National Clearinghouse for critical PPE and organizations may apply for access to its database of verified suppliers here.

  1. Request the following documentation and information (all credible vendors should be able to supply this information):
    • The vendor’s Business Registered Name and Trading Name
    • Factory and product certifications showing FDA/NIOSH compliance
    • A pricing list with stock-keeping unit (SKU) descriptions
    • Typical total production output per week/month by SKU
    • Clear photos or video of products and packaging
    • References (previous purchasers)
  2. Review and verify the provided information:
    • Ensure that the supplier is a legitimate company by looking them up on a business database such as Dun and Bradstreet
    • Verify the FDA manufacturing certificate by checking the FDA database
    • Independently verify the reference by calling the main number of the institution where the reference is employed and asking to be connected with them. Check to see if the buyer was satisfied with the quality of the product and the service provided. Verify the individual is employed at the stated institution by using LinkedIn
    • If the reference is a government or an organization that makes contracts and procurement officers (PO) publicly available, verify using a contract database.

Additional Advice for International Suppliers

  • Ensure the supplier is authorized to export the product.
  • Many countries have imposed export restrictions on certain PPE products.
    The International Trade Center tracks each country’s export restrictions and is updated daily; available here.
  • If the vendor is located in China, there must be approval by China’s National Medical Products Administration (NMPA). Otherwise Chinese customs authorities will detain a shipment before it is able to be exported. The vendor must also be on the FDA EUA list, found here.
  • CivStart and City Innovate have par tnered to identify top COVID-related govtech solutions and source problems for rapid procurement directly from state and local governments. Cities, counties, health centers, and local governments can use their COVID Solution Kit for free here.

 

 

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Red Flags

Keep an eye out for the below signs of fraud and illegitimate suppliers:

  • The price is vastly below market prices.
  • There is an unexplained urgency to transfer funds or a last-minute change in previously established wiring instructions
  • The seller initiates the contact with the buyer, especially from a difficult-to-verify channel such as by phone or personal email.
  • The seller cannot clearly explain the origin of the items or how they are available given current high demand.
  • The seller is unwilling or unable to provide concrete production numbers.
  • The seller is unable to provide a factory certification or provides documentation that does not match the product being sold.
  • The manufacturer is not listed in established databases such as FDA 510(k) databases, on the NIOSH list of approved N95 manufacturers, or addressed within an FDA Emergency Use Authorization or FDA Enforcement policy.

Employers: What’s Required

What’s Required
OSHA has guidance on preparing workspaces for COVID-19, information on protecting workers during a pandemic, and employer responsibilities concerning PPE.

  • Employers must provide appropriate PPE for employees
  • PPE is required for any potential infectious disease exposure
  • Employers must ensure PPE is disposed of or reusable PPE is
    cleaned, laundered, repaired, and stored after use

Employers are also required to conduct training on how to:

  • Use PPE properly
  • Be aware of when and what kind of PPE is necessary
  • Put on, adjust, wear, and take off PPE safely and appropriately
    according to CDC guidelines, and;
  • Maintain PPE properly
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How Tribes and Native-owned Businesses are Helping During COVID-19

  • Poarch Creek’s Muskogee Tech has transitioned from industrial manufacturing for
    aviation to producing PPE.
  • American Indian Graduate Center and American Indigenous Business Leaders teamed up to distribute care packages to Native Elders.
  • Autumn Harry, of the Pyramid Lake Paiute Tribe, is helping elders avoid grocery stores and social distance by catching, cleaning, and delivering fresh fish for dinner
Request PPE
Short Version Long Version Resource Links

State and Local Resources

The Tribal Law and Policy Institute has launched an Indian Country resource page with links to information and resources concerning relevant tribal and state issues and resources for addressing COVID-19 in American Indian and Alaska Native communities.

The Native Governance Center is aggregating resources specific to Indian Country, including from individual tribes, counties, and non-government organizations.

We encourage you to visit the National Center’s COVID-19 resource page

Item

Specification

Standards

Aprons

  • Polyester with PVC coating or 100%
    PVC or 100% rubber
  • Waterproof
  • Minimum basis weight: 250g/m2
  • Covering size: 70-90cm (w) X 120-150cm
    (h), or standard adult size

Face Shields

  • Made of clear plastic
  •  Anti-fog treatment on inside and
    outside of shield
  •  Completely cover the sides and length
    of the face
  •  Adjustable band to secure firmly
  •  May be reusable (made of robust
    material which can be cleaned and
    disinfected) or disposable
  • EU standard directive 86/686/EEC
  • EN 166/2002
  • ANSI/ISEA Z87.1-2010 or equivalent

Gloves

  • Material: nitrile or latex
  • Cuff length preferably reaches mid-forearm (minimum 280mm total length)

Sterile:

  • EU standard directive 93/42/EEC Class I
  • EN 455
  • ANSI/ISEA 105-2011
  • ASTM 6319-10 or equivalent

Non-sterile:

  • EU standard directive 93/42/EEC
    Class I
  • EN 455
  • EU standard directive 89/686/EEC Category III
  •  EN 374
  • ANSI/ISEA 105-2011
  • ASTM D6319-10 or equivalent

Goggles

  • Clear plastic lens with fog and scratch resistant treatments
  • Indirect venting to avoid fogging
  • Adjustable band to secure firmly
  • Flexible PVC frame to easily fit with all face contours with even pressure
  • May be reusable (if appropriately decontaminated) or disposable
  • EU standard directive 86/686/EEC
  • EN 166/2002
  • ANSI/ISEA Z87.1-2010 or equivalent

Gowns

  • Single use (disposable)
  • Fluid resistant
  • Length: mid-calf
  • Thumb/finger loops or elastic cuff to anchor sleeves in place
  • Light colors preferable to better detect possible contamination

Option 1: fluid penetration resistant

  • EN 13795 high performance
  • AAMI PB70 level 3 performance or above or equivalent

Option 2: blood-borne pathogens penetration resistant:

  • AAMI PB70 level 4 performance
  • EN 14126-B or equivalent

Medical Masks

  • High fluid resistance
  • Good breathability
  • Internal and external faces clearly identified
  • Structured design that does not collapse against the mouth (e.g., duckbill, cup shaped).
  • EN 14683 Type IIR performance
  • ASTM F2100 level 2 or level 3 or equivalent

Fluid resistance at minimum 120 mmHg pressure based on:

  • ASTM F1862-07
  • ISO 22609 or equivalent

Breathability:

  • MIL–M-36945C
  • EN 14683 annex C or equivalent

Filtration efficiency:

  • ASTM F2101
  • EN14683 annex B or equivalent

Respirators
(N95)

  • Good breathability with design that does not collapse against the mouth
  • Must make a tight seal around the mouth and nose

List of NIOSH approved:

List of respirators with EUAs from the FDA

  • EN 13795 high performance
  • AAMI PB70 level 3 performance or above or equivalent

Individual filtering facepiece respirators are required to have the following markings:

  • Name of approval holder/manufacturer business name or abbreviation, or a registered trademark
  • NIOSH in block letters or the NIOSH logo
  • NIOSH Testing and Certification approval number, e.g., TC-84A-XXXX
  • NIOSH filter series and filter efficiency level (N95, N99, N100, R95, P95, P99, P100)
  • Model # or part # represented by a series of numbers or alphanumeric markings, e.g., 8577 or 8577A
  • View a list of authorized imported, non-NIOSH approved respirators manufactured in China

Respirators
(NON-N95)

Same guidance as N95 Respirators. (see above). 3M compared some of the non-N95 respirators listed to the right that work just as well as N95 respirators.

List of NIOSH approved:

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