What strategies does the CDC recommend for optimizing use of N95 masks

The antiviral properties of the N95 masks have made them one of the most valuable items throughout the year with the COVID-19 pandemic. For over eight months now we’ve been hearing about this item on the news, talking about whether or not the USA was equipped to meet the demands of the pandemic.

With shortages happening all over the country, it’s safe to say N95 masks will be a valuable supply for a long time. This is why the Centers for Disease Control and Prevention (CDC) has a series of recommendations for optimizing the use of these effective face masks.

N95 masks and why shortages are happening

N95 masks are a type of respirator according to the National Institute for Occupational Safety and Health (NIOSH). This institution, part of the CDC, is in charge of developing measures to prevent occupational diseases or injuries. They test and regulate respirators, and make sure they meet the standards for each respirator type inside their filtration rate classification.

This classification names respirators according to their resistance to oil and filtration rate. The first characteristic is indicated with the letters N, R, or P, meaning not resistant, resistant, or oil-proof, respectively. The second characteristic is the percentage of minimum particulate filtration efficacy, which can be either 95, 99, or 100%.

In the case of N95 respirators, they’re any type of respirator that can filter out at least 95% of all non-oil based airborne particles, since they’re not resistant to oil and have a filtration efficacy of 95%. This makes them the best option for particles that don’t contain oil, like the flu virus or the coronavirus, or smoke and dust. For this reason, these respirators have been very important for healthcare workers during the COVID-19 pandemic, and shortages have been devastating for them.

The shortages of this respirator were expected to happen before the pandemic was announced, and quickly became a reality in the most affected countries. People began to buy this respirator in bulk and wholesale, the most popular ones being the 3M N95 masks like the 3M 8210 and 3M 8511, along with other supplies like surgical masks, reusable cloth masks, KN95 masks, gloves, and face shields.

Quickly, it became a reality that the United States’ emergency stockpile for respirators wasn’t enough. And even though companies ramped their production of N95 masks, the truth is that the scarcity of the raw material used to make them, and the rapid increase of the demand, is making this measure be not as effective.

CDC strategies for N95 mask optimization

The CDC bases their recommended strategies for the optimization of N95 masks and all types of PPE a hierarchy that has been previously used to control occupational hazards. The hierarchy is represented by elimination, substitution, engineering controls, administrative controls, and personal protective equipment (PPE), in that order from the most to the least effective.

To control and prevent infectious diseases, like COVID-19, the first two steps of the hierarchy which are elimination, referring to physically removing the hazard, and substitution, which refers to replacing the hazard for another one, aren’t considered options for healthcare settings. On the other hand, the last three steps of the hierarchy, which are engineering and administrative controls and PPE, are often used to reduce and avoid exposure to respiratory pathogens.

Inside the PPE used more often to control the exposure to diseases transmitted through airborne particles, N95 respirators are the most used items, but their effectiveness depends on the proper use and fit of the respirator. They’re disposable face masks, so they can only be used once and then discarded and replaced with a new one.

The CDC recommends that, to prevent airborne transmitted diseases, a combination of interventions across all the hierarchy controls and not only PPE is the optimal way to achieve this. This provides additional protection, so if one intervention fails, control and prevention can still be happening.

They talk about a concept called surge capacity, referring to the ability to manage any sudden increase in the volume of patients that could challenge or exceed the capacity of a facility. There are no official measurements to distinguish daily patient care capacity from surge capacity, but the latter is a useful framework to approach the decreased supply of N95 respirators we’ve been experiencing during the COVID-19 pandemic. For this, the CDC has what they’ve called a PPE Burn Rate Calculator, to help healthcare centers optimize and plan the use of their respiratory protection equipment.

The three general levels used to describe surge capacity, used to measure and conserve N95 mask supplies, are:

  • Conventional capacity: measures of engineering, administrative, and PPE controls, that should be implemented in general prevention and control plans in any healthcare setting.
  • Contingency capacity: these measures can be used temporarily when N95 mask shortages are expected.
  • Crisis capacity: these are the strategies that need to be considered when shortages of N95 respirators are a known fact.

The optimization strategies the CDC offers a wide range of options for when supplies and PPE are running low or are non-existent. For each level of capacity, they list several strategies pertaining to the last three levels on the efficacy hierarchy mentioned above. You can have a read and get more information on this on their website.

 

During these times, we have to help our healthcare workers as much as possible, and this can only be done by wearing face-coverings in public. Anyone who uses any type of face mask is helping out the doctors and nurses on the frontline. You can find many options for sale online, including face masks in a smaller size for kids. 

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