Centre for Disease Control (CDC) and National Institute for Occupational Safety and Health (NIOSH) are two reputable organizations working to ensure the safety and security of the general public from any physical injury and medical infections. N95 respirators are the type of Personal Protective Equipment (PPE) which is a half-face mask. It is designed to give a proper facial seal around the nose and the mouth area to prevent any infectious agent from getting in and out of an infected person.
N95 respirator has a very high efficiency to filter our microorganism ranging from the size 0.3 microns to the large bacteria and virus. This respirator is designed for one-time use only because, after every decontamination process, the N95 respirator loses its filtration efficiency and will not work as a physical barrier between outside environments.
N95 Respirator Shortage
Center for Disease Control (CDC) and National Institute for Occupational Safety and Health (NIOSH) both regulate N95 respirator to ensure high filtration efficiency and comfortable durability. Personal Protective Equipment (PPE) recommended the use of NIOSH-approved N95 respirators in all health care settings. During the outbreak of the COVID-19 pandemic N95 respirators have become the only survival kit because the virus was spreading very rapidly and experts have already mentioned that the only way to get rid of this pandemic is to stop the spread of this virus.
For this reason, there were known shortages in N95 respirator all across the world. At that time CDC and NIOSH had come up with the strategy to optimize the supply of N95 respirator during the time of shortage. This strategy includes the reuse of filter face piece respirator and the reuse of N95 after decontamination.
CDC developed the strategy for “Before the crisis” and “during the crisis”. These guidelines recommended to all health care institutes are: There should be a specific number of people who need to use respiratory protection including N95 respirator. Health care institutions should also use alternatives of N95 respirator which includes other face piece respirators, electrometric half-face mask, full face piece air-purifying respirators where feasible.
Implement the use and reuse of N95 respirators during the COVID-19 pandemic. All health care practitioners will be on top priority for using N95 respirators because they are at the highest risk of getting complications of the infections. CDC and NIOSH also published the guidance related to implementing recommended approaches for the reuse of decontaminated supply of N95 respirators to the health care settings.
These recommendations were only made due to the shortage of N95 respirators in all health care set-ups.
Contingency strategy simply stands for the strategies that were recommended at the time before the crisis came. The strategy includes:
- N95 respirators should be used for a longer period. All nurses and health care practitioners should use an N95 respirator during the visit of more than two patients before being removed (whereas, the conventional N95 respirator is allowed to be used for one patient contact then discarded).
- N95 respirators should be used for a longer time duration beyond the manufacturer designated mask life for fit, testing, and training.
This recommendation was made to control the shortage of N95 respirators in the future but it will soon fail due to the rapid increase in the number of coronavirus affected persons.
After the implementation of all contingencies strategies, the problem of the shortage of N95 respirators is still not subsided. To meet the demand for N95 respirators in the pandemic CDC also recommends a crisis strategy. The strategy includes:
- Filtering Face piece respirators including all N95 respirators should be used beyond its manufacturer designated shelf life.
- All respirators can be used in health care settings that are similar to the NIOSH approved respirators but not NIOSH approved. They can be approved by any country’s standard.
- To meet the demand for N95 respirators. It was recommended to all health care practitioners to take their masks in a paper bag between the visit of the patients.
- N95 respirators should only be recommended in health care set-ups and not for general public use.
Extended Use Recommendation
This method is highly preferred over reuse because it involves less touching of the respirators therefore contains less risk of contact transmission. To maintain the safe extended use the respirator should have a proper fit and functions. Extended use of the N95 respirator will be allowed in health care set-ups with proper instructions. It was clearly mentioned to discard the respirator if the mask became damaged and the wearer feels any difficulty to breathe through.
The reuse of N95 respirator is not considered safe and is not a highly recommended method because by every donned and doffed the N95 respirator loses its efficiency. However, there is also a guideline which is recommended by the manufacturer for the reuse of N95 respirators that includes strict adherence to hand hygiene, proper donning and doffing techniques, physical inspection, and user seal check.
These above-mentioned recommendations and strategies have been given by the CDC and NIOSH to ensure the continuous availability of N95 respirators in all health care settings. Although these recommendations have many potential benefits but also have some risks as many respirators and devices have not been cleared by the FDA (Food and Drug Administration). The main concern for the extended use of a respirator is that it can cause additional discomfort to the wearer.