Facing a Shortage of N95 Masks During COVID-19?

“Disposable filtering facepiece respirators (FFRs) are not approved for routine decontamination and reuse as standard of care. However, FFR decontamination and reuse may need to be considered as a crisis capacity strategy to ensure continued availability. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate FFRs.” -  Centers for Disease Control and Prevention (CDC)

What used to be routine and disposable, is now of concern to those that depend on single use N95 respirators (masks) to protect themselves from airborne infections, such as COVID-19. Wearing an N95 respirator for hours at a time (extended wear) or reusing a respirator several times (removing between uses) are practices used to ease shortages.

The National Institute for Occupational Safety and Health (NIOSH), along with the CDC, recognizes the possibility of N95 respirator depletion during a pandemic and developed recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators. The CDC favors extended use over reuse as it involves less touching of the respirator and less risk of contact transmission.  To make sure employees are following proper protocol, cities should have clearly written procedures in their respirator programs.

Current CDC guidelines on extending respirator supply:

• Minimize the number of staff who need to use respiratory protection through engineering and administrative controls.
• Use alternative respirators where feasible.
• Implement practices allowing the extended use and reuse of N95 masks when acceptable.
• Prioritize the use of N95 respirators for staff at the highest risk of contracting infection.

Reuse recommendations:

• Hang used respirators in a designated storage area where they cannot come into contact with each other or in a clean, breathable container like a paper bag.
• Avoid touching the inside of the respirator and if you do touch it, wash your hands.
• Use a pair of clean gloves when putting on a used respirator and performing user seal checks, then discard the gloves.
• Follow manufacturer guidelines on how many times a respirator can be worn, if no guideline exists use no more than five times.
• Follow the manufacturer’s user instructions for the respirators.Label containers used for respirators or the respirator itself (on the strap) with the user’s name.

As a last resort, the recommendation would be to decontaminate N95 filtering facepieces. This would make the mask safer, but not necessarily safe. There are three approved methods to decontaminating a mask:

• UV-C light
• Hydrogen peroxide vapor
• Moist heat

There are many consumer, and medical products out there that claim to decontaminate masks that are ineffective, so it’s important to follow the CDC guidelines on proper cleaning. Cleaning with alcohol, dunking the mask in hydrogen peroxide or other chlorine types of solutions will damage the masks and should not be used.

The following precautionary measures are to be used prior to using a decontaminated FFR:

• Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the FFR.
• Avoid touching the inside of the FFR.
• Use a pair of clean (non-sterile) gloves putting on a mask and perform a user seal check.
• Visually inspect the FFR to determine if its integrity has been compromised.
• Check that components such as the straps, nose bridge, and nose foam material did not degrade, which can affect the quality of the fit, and seal.
• If the integrity of any part of the FFR is compromised, or if a successful user seal check cannot be performed, discard the FFR and try another FFR.
• Users should perform a user seal check immediately after they put on each FFR and should not use an FFR on which they cannot perform a successful user seal check.

Note: CDC and NIOSH do not recommend that FFRs be decontaminated and then reused as standard care. This practice would be inconsistent with their approved use, but we understand in times of crisis that option may need to be considered when FFR shortages exist.

Additional Resources from OSHA:

Video: How to Perform a Seal Check with an N-95 Respirator

Video: Respiratory Fit Testing

Expanded Temporary Enforcement Guidance on Respiratory ProtectionFit-Testing for N95 Filtering Facepieces in All Industries During theCoronavirus Disease 2019 (COVID-19) Pandemic

Submitted by: Julie Jelen, Loss Control Consultant