Failure Rates During Reuse of Disposable N95 Masks in Clinical Practice in the Emergency Department.

Ronald Check,Leah Rivard,Rebecca Jeanmonod,Donald Jeanmonod,Kathleen Mcmahon,Johnathan Pester,Brian Kelly,Vamsi Balakrishnan

doi:10.5811/westjem.2021.1.49960

Ronald Check, Leah Rivard + Show 6 more

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https://doi.org/10.5811/westjem.2021.1.49960

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Abstract

IntroductionThe coronavirus 2019 pandemic caused a shortage of disposable N95 respirators, prompting healthcare entities to extend the use of these masks beyond their intended single-use manufacturer recommendation with a paucity of supporting research.MethodsWe performed a prospective cohort study of ED healthcare workers (HCW) (“subjects”) required to use respirators at an academic, Level I trauma center. Subjects had been previously fit tested and assigned an appropriately sized N95 mask per hospital protocol. Per study protocol, subjects were fit tested periodically throughout their shifts and on multiple shifts over the eight-week study period. Data points collected included the age of the mask, subjective assessment of mask seal quality, and fit test results. We analyzed the data using Fisher’s exact test, and calculated odds ratios (OR) to determine the failure rate of disposable N95 masks following reuse.ResultsA total of 130 HCWs underwent fit testing and 127 were included for analysis. Mask failure rate climbed after day 2 of use, with 33.3% of masks failing at day 3, 42.9% at day 4, and 50% at ≥ day 5. Categorizing the masks into those being used for two or fewer days vs those in use for three or more, failure was more common on day 3 of use or older compared to those in the first two days of use (41.8% vs 8.3%, P < 0.0001) with an OR of failure with an older mask of 7.9 (confidence interval [CI], 2.8–22.3). The healthcare workers’ assessment of poor seal was 33.3% sensitive (CI, 18.6–51.9) and 95.7% specific (CI, 88.8–98.6) for fit test failure.ConclusionDisposable N95 masks have significant failure rates following reuse in clinical practice. Healthcare personnel also performed poorly in assessing the integrity of the seal of their disposable respirators.

Highlights

The coronavirus 2019 pandemic caused a shortage of disposable N95 respirators, prompting healthcare entities to extend the use of these masks beyond their intended single-use manufacturer recommendation with a paucity of supporting research
Mask failure rate climbed after day 2 of use, with 33.3% of masks failing at day 3, 42.9% at day 4, and 50% at ≥ day 5
Our objectives were twofold: to determine the failure rate of disposable N95 filtering facepiece respirator (FFR) reused over multiple days in the emergency department (ED), and to evaluate whether healthcare workers (HCW) were able to recognize the functional performance of their masks

Summary

Introduction

The coronavirus 2019 pandemic caused a shortage of disposable N95 respirators, prompting healthcare entities to extend the use of these masks beyond their intended single-use manufacturer recommendation with a paucity of supporting research. Disposable respirator masks approved by NIOSH are designed as single- or limited-use respirators that an individual can mold to one’s face to ensure a proper seal and are intended for a single patient encounter. Chains and manufacturing have been hampered while demand has increased, and this imbalance in supply and demand will likely continue for some time. With critical shortages, it is neither economically nor logistically feasible to use disposable FFRs solely in their intended single-use capacity. The CDC responded by publishing guidelines for healthcare entities to implement protocols for extended use of respirators (donning for multiple patient encounters without doffing), as well as limited reuse protocols (donning and doffing multiple times with the same mask for an extended period of time) to extend the lifetime of their supplies.[5]

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