ONS Publishes Guidelines for Personal Protective Equipment Use During COVID-19 Pandemic

The Oncology Nursing Society (ONS) recently published interim guidelines – though they’re admittedly not ideal – on PPE usage in the midst of the epidemic.

Nurses and other healthcare professionals are facing personal protective equipment (PPE) shortages across the nation due to the coronavirus disease 2019 (COVID-19). The Oncology Nursing Society (ONS) recently published interim guidelines on PPE usage in the midst of the pandemic.

“Although ONS supports full protection of healthcare workers handling drugs for cancer treatment that the National Institute for Occupational Safety and Health (NIOSH) has deemed hazardous, nurses in clinical settings are facing difficult choices if recommended PPE supplies are not available,” ONS said in a statement. “In addition, they are making choices regarding the protection of themselves and their patients from potential COVID-19 infection and use of PPE for safe handling of hazardous cancer drugs.”

The society said that they support recommendations that prioritize the protection of healthcare workers and patients from COVID-19, and when it comes to treating patients with the virus, ONS recommends following guidelines set by the Centers for Disease Control and Prevention (CDC).

But when it comes to handling chemotherapy and other hazardous cancer drugs (based on the Table 1 NIOSH List), ONS published guidelines for nurses to follow during the COVID-19 outbreak. The guidelines follow a most- to least-recommended use of gowns, masks, eye protection, gloves, and shoe covers.

“Although ONS recognizes that these are not ideal, they are interim guidelines to support decision making and staff and patient safety in clinical care during the COVID-19 pandemic,” the statement said.

ONS recommendation

If recommendation is not available

Third choice


Disposable poly-coated gown

Regular, water-resistant, disposable gown

Cloth gown (facility laundered) for infection control and non-hazardous drugs


Mask with face and eye protection only if splashing is likely or for spill cleanup

Reserve N95s for symptomatic/COVID-positive patients, hazardous drug spills, and cleanup

Powered air purifying respirators (PARS)

Eye Protection

Mask with eye protection or goggles if splashing is likely/spill cleanup

Full-facepiece air purifying respirators or PARS


Double chemotherapy-tested gloves

Single chemotherapy-tested gloves

Double standard exam gloves

Shoe covers

Use only in area for compounding hazardous drugs

Work-only, washable shoes

“Evaluate workflows and processes to maximize efficiency and decrease waste of PPE supplies. Cluster care activities as much as possible and avoid touch contamination of surfaces,” the statement says.

Read more on the Coronavirus (COVID-19):

  • Nurses Share Their Strategies, Patient Concerns Regarding COVID-19
  • CDC Discusses COVID-19: Updates for Providers, Vaccine, and More
  • NCCN Offers Guidance for Cancer Centers Amid COVID-19 Pandemic
  • COVID-19 and Beyond: Oncology Nursing in Uncertain Times
  • Coronavirus: How Are You Responding?
  • Expert Addresses Coronavirus and Cancer Innovation
  • Amid Coronavirus Outbreak, Industrial-Grade Respirators Become Available to Healthcare Workers