May 25, 2022

Implementing EHMRs in Healthcare

By Ed Rutkowski

NASHVILLE, Tennessee (May 25, 2022)—Two representatives from a regional hospital system joined AIHce EXP 2022 yesterday to discuss practical considerations related to distributing elastomeric half-mask respirators, or EHMRs, to a large population of healthcare workers and training them on their proper use. EHMRs are NIOSH-approved, tight-fitting respirators that can be cleaned, disinfected, and reused. Because of these properties, EHMRs have potential to meet the needs of healthcare workers and can ease concerns about PPE supply during shortages of N95 filtering facepiece respirators.

Prior to the COVID-19 pandemic, most healthcare facilities relied on N95 FFRs. But severe shortages at the onset of the pandemic created high demand for respiratory protection for healthcare workers. “It was trying times,” said Hope Waltenbaugh, the vice president of surgical services at Allegheny Health Network. Waltenbaugh, who was trained as an operating room nurse, arranged to have a team of surgeons, nurses, and support staff wear the masks and provide feedback.

“The first thing they said was, ‘We feel safe’” wearing EHMRs, Waltenbaugh said.

While EHMRs and FFRs provide an equal level of protection, healthcare workers’ acceptance of the new devices was vital to their success. Waltenbaugh felt that the decision to first seek workers’ approval instead of simply mandating EHMRs helped overcome barriers to their use. “Instead of us forcing it down their throat, we sat down, they decided, and we moved forward,” Waltenbaugh said.

The AHN system includes 12 hospitals, most located in western Pennsylvania, and comprises more than 20,000 staff. Once the decision was made to distribute EHMRs, AHN rationed them at first to conserve supply. High priority workers, such as those who participate in sterilizing surgical instruments, were the first to get the masks. Eventually, AHN acquired enough EHMRs to provide one to every worker, thanks in part to AHN’s relationship with MSA, a respirator manufacturer headquartered near Pittsburgh.

Waltenbaugh’s colleague Sara Angelili, AHN’s director of perioperative education, was responsible for implementing EHMRs across nine hospitals and training workers on how to properly wear and clean the devices. To help acclimate workers to EHMRs, they were given written instructions and videos, followed by small group demonstrations on how to don, doff, and decontaminate the respirators, as well as how to perform a seal check. After the workers received this training, they were required to demonstrate the skills they had learned. According to Angelili, surveys indicated that 93 percent of staff members were satisfied with their training and 97 were confident they knew how to use them correctly.

Angelili was enthusiastic about EHMRs. “You can fit somebody with an elastomeric in the same amount of time” as an N95 FFR, she said. AHN staff found that the silicone facepiece of EHMRs fit more diverse types of faces than FFRs; according to Angelili, AHN achieved a 94 percent success rate with staff fits. She also mentioned a study that compared EHMRs to N95 FFRs in a healthcare setting and found that EHMRs maintained their seals for longer.

Teaching staff how to decontaminate EHMRs was more challenging. The decontamination process requires the user to dilute a chemical, a task that nurses aren’t used to performing. Training emphasized the distinction between cleaning and disinfecting, identified EPA-approved wipes for coronavirus, and provided instruction on the appropriate number of wipes and the proper contact time, Angelili said.

Ed Rutkowski is editor in chief of The Synergist.

Related: Read “Reusable Respirators for Healthcare Use” in the November 2021 issue of The Synergist.

View more Synergist coverage of the conference on the highlights page on AIHA’s website.