EB: There are safe ways to reuse personal protective equipment (PPE). There is guidance on how to do this safely as well as what the current research indicates. Please take some time to review this link and learn more.
TT: It is okay for the hospital to reuse PPE. Because of the global shortage of PPE, the WHO and CDC have released recommendations that it is acceptable to reuse PPE. It is important to note that PPE and manufacturers have made a disclaimer that PPEs do not guarantee you protection against a specific disease. The FDA does not do studies on performance evaluation of each PPE against viruses such as COVID-19 or flu.
If a PPE does provide protection against a specific disease, the PPE label will make that claim. The purpose of having the PPE is to serve as a “non-disease specific barrier” to body fluids, solids, airborne particles, or other substances (FDA, 2020). This claim was made directly on the FDA website.
NIOSH does research on N95 filtering face-piece respirators. You can learn more about the National Personal Protective Laboratory here.
Nurses are at the frontline of this pandemic, but as a nurse, it is important to not overreact. Nurses will need to be mindful of which procedures (i.e., intubation, extubation, open suctioning, manual ventilation before intubation, turning patients to the prone position, disconnecting the patient from the ventilator) could generate aerosols.
Note airborne transmission of COVID-19 during these procedures is a possibility. If you are near a clinician doing a particular procedure such as intubating or extubating a COVID-19 patient or you interact with a patient that is infected with TB, then it is recommended the nurse or clinician should use a fitted N-95 respirator. Keep in mind that we do not know what is the exact transmission of COVID-19 when these procedures are performed.
During these times when PPE shortages are apparent, clinicians should exercise caution. There will be vendors that will sell gowns, face masks, N95 respirators, and PPEs that are not FDA-approved. To check if your PPE is FDA-approved, you can visit this site.
The purpose of the FDA site below is to “demonstrate that the device to be marketed is as safe and effective, that is, substantially equivalent, to a legally marketed device.” I have provided an example using FXX to find all the FDA-approved surgical masks that nurses and providers should be using. If you don’t know the specific code of the PPE, you can use the specific codes below:
Here are screenshots of how to look for an FDA-approved PPE such as surgical masks:
EB: The CDC has provided some information on using expired respirators. More information can be found here.
TT: Due to worldwide shortage of PPEs, many healthcare facilities are using expired N95 respirators. The suggested maximum number of reuses for an N95 respirator is no more than five uses based on preliminary data. I have provided information from the National Institute for Occupational Safety and Health (NIOSH) with regards to reuse or extended use. Prior to seeing a patient, nurses must do a N95 respirator seal check to make sure the integrity of the expired N95 is not compromised.
According to NIOSH, these are the recommendations:
Before COVID-19 outbreak, China was producing half of the world’s supplies. According to a New York Times (2020) article written by Mariel Padilla, China increased their production of face masks by 12-fold but hoarded most of its supplies. Without a major supplier like China to continue to manufacture and share supplies for the world, we will continue to face PPE shortages.
Even though we have noticed that healthcare providers should have access to PPEs, what is contributing to the shortage is the public buying N95 face masks and various surgical masks when the odds of getting infected is higher from touching a contaminated surface than from droplets traveling through the air.
EB: These decisions will be based on supplies available to you, and I know that in California there are some difficult situations. Wearing masks all the time often results in more facial touching because they are uncomfortable. That being said, something is better than nothing. Remember that covering the source is a critical component, so if we can get a mask on the symptomatic patient or person, that helps to limit spread.
TT: I do question the efficacy of these makeshift masks. At the beginning of this document, I posted an FDA link. These PPEs have been tested for efficacy and approved by FDA. While psychologically, a makeshift mask will make the nurse feel better thinking that she has some protection from breathing droplets or airborne particles in the hospital, she is not actually protecting herself. The safest way to protect from airborne particles is the N95 respirator and a makeshift mask does not receive any approval that it is as effective as an N95 mask.
EB: Quite a while. They were originally designed for very dusty environments, and the healthcare setting is typically very clean. Moisture is probably the biggest issue that would impact the filtration or contamination of internal aspects of the respirator… if you are reusing them.
TT: N95 respirators are quite sturdy and meant to last until the N95 respirator becomes deformed or damaged. The exact duration of how long N95 respirator lasts depends on how it is used during the shift. If you expose the N95 respirator to too much moisture or it gets damaged or soiled during the shift, it is a good idea to replace it. Ideally, N95 respirators that are cleared by FDA are designed for single use.
EB: The supplies of PPE are part of a national response but are controlled at a local level. Working with your local public health and healthcare coalitions to get your supply information to them will help the Federal government get the supplies to areas of greatest need. This is most important for hospital administrators.
TT: Although PPEs are being resupplied, supplies are depleting fast. China produces half of the world’s supply of face masks. During the COVID-19 outbreak, China had to stop export of its face masks to the world. Production of face masks was twelve-fold after the COVID-19 outbreak in Wuhan, China. Now that COVID-19 incidences have gone down, China is exporting masks to countries that are requesting them.
Unfortunately, the US is not one of China’s recipients for face masks. This leads to other domestic companies producing N95 and face masks. However, the problem with domestic companies making N95 respirators and face masks is none of these PPEs have received FDA’s approval for use.