April 2, 2020

To Protect Workers, Healthcare Facilities Turn to Extended Use, Reuse of N95s

As healthcare facilities across the United States adopt practices once considered unthinkable, such as reuse of N95 respirators, to protect workers coping with a surge of COVID-19 patients, occupational health and safety professionals are working to ensure these practices are implemented as safely as possible.

A webinar hosted yesterday by the National Institute of Environmental Health Sciences featured presentations by OEHS professionals and industrial hygienists who presented practical information for healthcare facilities that face rapidly dwindling supplies of respirators and other PPE.

One of the presenters, Shawn Gibbs, PhD, CIH, referred to extended use and reuse of N95s as “the least worst of the worst ideas” under consideration at healthcare facilities. Gibbs, a professor of occupational and environmental hygiene at the Indiana University School of Public Health, referred throughout his presentation to CDC’s guidance for extended use and limited reuse of N95 respirators. The guidance defines extended use as wearing the same N95 respirator for repeated close contact with several patients, without removing it. Reuse involves using the same respirator for multiple encounters but removing it after each. According to CDC, in previous pandemics and outbreaks of respiratory pathogens, “limited” reuse—a restriction on the number of times the same respirator may be worn—has been widely adopted.

Because extended use involves less touching of the respirator, and therefore less risk of transmitting pathogens, CDC favors it over reuse. According to CDC, in other industries, workers wear respirators for up to eight hours at a time, but in workplaces where dust is not an issue, such as healthcare facilities, the duration of use will be determined by hygienic concerns and not a predetermined number of hours.

A respirator must maintain its fit and function to be appropriate for safe extended use, according to CDC. Gibbs said that wearing a respirator for long periods will cause it to form to an individual’s face and may result in bruising and cuts. Healthcare workers also need to be wary of straining the respirator straps, which may break from extended use over days, Gibbs said.

Administrative and engineering controls, such as barriers that prevent droplet spray from patients, are necessary to limit potential contamination of the respirator, according to the CDC guidelines. The agency urges respiratory protection program managers to create written guidance for healthcare workers on how to reduce contact transmission after putting on a respirator. These actions include discarding respirators after aerosol-generating procedures or when contaminated with blood, nasal, or respiratory secretions, or other bodily fluids. Cleanable face shields worn over the respirator may help reduce contamination. Respirators that are clearly damaged or difficult to breathe through should be discarded.

In facilities where respirator reuse is permitted, additional training of healthcare workers may be needed to emphasize the importance of avoiding contact with the respirator surface. If no guidance on reuse is available from the respirator manufacturer, CDC recommends no more than five uses per device.

Gibbs emphasized that respirators must be properly stored between uses in order to prevent contamination. They should not be stored in sealable plastic bags or other nonbreathable containers, he said. Other vital practices for healthcare workers include proper hand hygiene and the masking of infectious patients.