Medical PPE (personal protective equipment) has been one of the main focuses during the pandemic since healthcare workers are needing extra protection to work in an environment with high exposure to the virus. These items were once found for sale online very easily, and regular people that didn’t work in the healthcare field could buy them even in bulk and wholesale.
Now, with such a high demand and the production not being able to match it, shortages of PPE, particularly N95 masks, are affecting the healthcare centers around the United States. Popular models like the 3M 8210 and 3M 8511, both 3M N95 masks, are hard to find. N95 masks are considered the best masks for virus protection because of their high antiviral properties.
With the struggle to find these important respirators, the Centers for Disease Control and Prevention (CDC) has some protocols healthcare providers can use to decontaminate and reuse N95 masks.
Protocols to decontaminate N95 masks according to the CDC
The CDC has some recommendations that can help extend the time one respirator can last inside a healthcare setting. As we know, respirators, often referred to as FFPs (filtering facepieces) or FFRs (filtering facepiece respirators), are disposable masks intended for single-use, and with the shortages of this valuable item, reusing it safely would be a great solution. FFRs are used in work settings in which respiratory hazards, like dust, smoke, or viruses like the flu, are present. KN95 masks and N95 respirators are a type of FFRs. In the USA, respirators are regulated by NIOSH (we’ll talk about them later).
These recommendations can be used during situations like the pandemic we’re experiencing, in which healthcare centers are not receiving the number of supplies needed to work safely. N95 masks aren’t the only items that are scarce though, with items like gowns, gloves, surgical masks, face shields, and sanitizer being some of the most difficult to find.
The CDC encourages the practice they call “limited reuse” of FFRs in public health emergencies like the COVID-19 pandemic. On their website, you can find all the information regarding this practice, and they define it as “the practice of using the same N95 FFR or other filtering facepiece respirator for multiple encounters with patients but removing it after each encounter”. They make sure to differentiate this practice from extended use, which they define as the cases in which “the same FFR is worn continuously for encounters with multiple patients”.
Between encounters with patients in which the same FFP is going to be reused, they need to be properly stored, but they also recommend to decontaminate the N95 respirators and other FFPs. Decontamination has been listed as part of the limited reuse strategy, and a combination of the two could be necessary during situations in which supplies are scarce.
The CDC defines the process of decontamination as “a process to reduce the number of pathogens on used FFRs before reusing them”. They say that it’s a practice with the main goal of limiting as much as possible the possibility or probability of having self-contamination. This is the situation in which a person gets infected with a certain pathogen by inoculating it with their hands if these are contaminated.
As the CDC highlights on their website, the practice of decontamination and subsequent reuse of respirators is only recommended to be implemented if there is a shortage of FFPs. They also point out that certain respirators are not recommended by them to be put through decontamination processes for reuse, like respirators with exhalation valves and those respirators that aren’t approved by NIOSH (the National Institute for Occupational Safety and Health).
Several decontamination methods can be used for respirators, but the CDC clearly states that no method is universally usable under their recommendations. The choice of the method and whether or not a specific FFR model can be decontaminated should be done under the guidance of the manufacturer. If there is not information or guidance available from the manufacturer regarding decontamination of a specific model, third-parties like decontamination companies, research laboratories, or safety organizations can provide the guidance instead to decide which the best method of decontamination is.
The CDC lists three characteristics that make a decontamination method and effective one for FFPs:
- Reduces the pathogen burden
- Doesn’t affect the filtration performance or fit
- Doesn’t leave a residual chemical hazard on it
According to NIOSH, as of April of 2020, they’ve concluded that some decontamination methods are potentially good options for respirators, including moist heat, vaporous hydrogen peroxide, and ultraviolet germicidal irradiation. The Food and Drug Administration (FDA) issued some Emergency Use Authorizations (EUAs) for several decontamination systems for respirators to be reused in healthcare settings, with the first one being issued in March. In June, however, some of these EUAs were reissued, leaving out the use of the systems on unvalved respirators and those manufactured in China.
It’s important, and the CDC highlights, that the choice of the decontamination process needs to be evaluated for each respirator model, following the guidance from the manufacturer or a third-party. The goal of this is to fully understand the effects the process may have on the FFR’s efficacy, including the performance and the fit of the mask.
Lastly, the CDC points out that all responsibility for demonstrating the effectiveness of the decontamination process, paying special attention to the effectiveness in eliminating the SARS-CoV-2 (the virus that causes COVID-19), is on the employer.
We finish this informative piece by reminding our readers to stay protected by wearing reusable cloth masks, which are recommended for the general public by the CDC. To help out ease the shortages of medical PPE, these medical-grade respirators we talked about should be reserved for healthcare workers and other frontline workers. Anyone who uses a face-covering, including kids over the age of 2 years old as recommended by the CDC with a face mask size that fits their face, is helping reduce the spread of the virus.