Disposable N95 Respirators Research Articles

A re-usable, locally manufactured, half-face respirator provides better protection than fitted disposable N95 masks

BACKGROUND The coronavirus disease 2019 pandemic has led to persistent shortages of respiratory protective equipment in many jurisdictions. Re-usable industrial respirators have been proposed and deployed as an alternative, but also face severe supply limitations. Numerous respirator designs have been proposed since the start of the current pandemic, but few have been systematically tested on healthcare workers (HCWs). OBJECTIVE In this paper, we describe a locally manufactured respirator named ‘Duo’ that includes separate, valved, inspiratory and expiratory pathways and accommodates up to two filters. Duo was compared with the disposable commercial N95 in a cohort of 41 HCWs using standardised quantitative fit-testing. DESIGN A prospective observational cross-sectional study. SETTING Conducted between May and June 2020 among HCWs at Toronto General Hospital. PARTICIPANTS Forty-one HCWs of both sexes working at Toronto General Hospital. MAIN OUTCOME MEASURES Quantitative fit-testing involving seven tests as prescribed by Canadian standard CSA Z94.4-18. We measured the median overall fit-factors; the individual manoeuvre fit-factors and pass rate. RESULTS The median [IQR] overall fit-factors were 2947 [2228 to 4405] and 77.2 [51.9 to 152.1] for the Duo and disposable N95 respirators respectively (P < 0.0001). The overall pass rate of quantitative fit-testing fitted disposable N95 was 58.5% (24/41), and 100% for the Duo. CONCLUSIONS A re-usable, locally manufactured, half-face respirator performs better than fitted disposable N95 masks as assessed by quantitative fit-testing. This can help address the global supply disruption for a better response to future pandemics. The device requires further modification and testing to optimise exhalation flow resistance, and full conformance with technical standards is required for regulatory approval.

Elastomeric half-mask respirator disinfection practices among healthcare personnel.

Disposable N95 respirator shortages during the COVID-19 and 2009 H1N1 influenza pandemics highlighted the need for reusable alternatives, such as elastomeric half-mask respirators (EHMRs). Two US medical organizations deployed reusable EHMRs during the COVID-19 response. In addition to wipe-based disinfection following patient care episodes expected per local policies at both organizations, postshift centralized cleaning and disinfection (C&D) was expected at one site (A), permitting shared-pool EHMR use, and optional at the other (Site B), where EHMRs were issued to individuals. Using a survey, we evaluated disinfection practices reported by EHMR users and predictors of disinfection behaviors and perceptions. Surveys assessed EHMR disinfection practices, occupational characteristics, EHMR use frequency, training, and individual-issue versus shared-pool EHMR use. Of 1080 EHMR users completing the survey, 76% reported that they disinfect the EHMR after each patient encounter, which was the expected practice at both sites. Increasing EHMR use, recall of disinfection training, and work in intensive care or emergency settings significantly influenced higher reporting of this practice. 36% of respondents reported using centralized C&D, although reporting was higher at the site (A) where this was expected (53%). Confidence in cleanliness of the EHMR following centralized C&D was not influenced by individual versus shared-pool EHMR issue. Most EHMR users reported adherence with expected post-care individual-based disinfection of EHMRs but did not necessarily use standardized, centralized C&D. Future efforts to limit reliance on behavior related to respirator disinfection may improve EHMR implementation in healthcare to avert dependence on single-use, disposable N95 respirators.

1919. Implementation of Hydrogen Peroxide Vapor (HPV) Decontamination of N95 Respirators for Reuse During COVID-19 Pandemic

Abstract Background To ensure an adequate supply of N95 respirators in response to the global shortages caused by the COVID-19 pandemic, we evaluated and implemented hydrogen peroxide vapor (HPV) to reprocess disposable N95 respirators. Previous work performed by our team showed that HPV was effective in eradicating viable viruses from experimentally contaminated N95 respirators and that they retained their breathability and filtering efficiency for 3 cycles of HPV disinfection. Methods A multidisciplinary team worked by performing experiments and PDSA cycles to develop the ultimate process. Key processes and stakeholders were identified and engaged in operations decisions. Results The respirator reprocessing program was successfully implemented. One of the critical components for its success was the implementation of a Personal Protective Equipment (PPE) liaison program which was developed to create a process and local, unit-level champion for the collection of used N95s and to educate the staff on the program and provide guidance per the hospitals’ PPE policy. A courier system was implemented for the collection, transport and delivery of bulk containers of respirators between facilities. Facility Services designed and constructed a centralized respirator reprocessing center to include a receiving location, a negative pressure decontamination area to sort and stage the respirators on racks, two HPV reprocessing rooms and a clean room to receive the reprocessed N95s and to repackage and label for distribution. Standard operating procedures, staff training and competencies, and logs for documentation were created. Within 18 weeks (March 13, 2020 through July 2020), nearly 32,000 N95 respirators were reprocessed and packaged for redistribution utilizing the 2 HPV disinfection rooms and 5 full time employees. As built, there was capacity to reprocess 5,000 respirators per day and evaluated by the U. S. Food and Drug Administration (FDA) led to the issue of an Emergency Use Authorization. Conclusion This scalable program enabled YNHHS to ensure an adequate supply of respirators for the safety of staff during the COVID-19 pandemic and global shortages of PPE. A multidisciplinary team and leadership commitment to provide resources for space and personnel were critical for program success. Disclosures All Authors: No reported disclosures.

A scoping review of the benefits of face mask use on pedestrian and bicyclist exposure to air pollutants

IntroductionA growing body of research suggests that pedestrians and bicyclists are exposed to substantial levels of harmful air pollutants, including particulate matter and carbon monoxide, during their daily commutes. Disposable and cloth face masks are well-known personal interventions for pedestrian and bicyclist pollutant exposure. However, there is a lack of consistent messaging from public health officials regarding how effective these masks are.Methods: This study used a scoping review to assess the existing literature on face masks as a personal intervention against the harmful effects of air pollution for pedestrians and bicyclists. ResultsThe studies reviewed suggested that face mask use improves health measures in pedestrians after walks in polluted urban areas. Specifically, disposable N95 respirators were the most effective commercially available face masks models evaluated, with surgical masks and cloth masks with exhalations vents also effective. Additionally, perceptions of face masks against air pollution were generally positive among citizens. ConclusionAlthough the scope of the evidence reviewed was relatively limited, it consistently suggested that mask use may be an effective and inexpensive personal intervention against air pollution for pedestrians and bicyclists. Public health organizations should consider encouraging the continued use of face masks as a personal abatement strategy of air pollution exposure during the post-pandemic stage.

The Effectiveness of Cipto Mangunkusumo Hospital Ultraviolet Germicidal Irradiation (UVGI) Chamber for N95 Respirators Disinfection in COVID-19 pandemics: A Preliminary Study

Introduction: During the COVID-19 pandemic, where the disease might spread in a medical facility setting, the common problems found in every country is the shortage of personal protective equipment (PPE) for medical personnel – especially the disposable N95 respirators. Thus, a higher amplitude to disinfect and reuse N95 is urgently needed. In this study, we designed an effective and safe disinfection methods through an Ultraviolet Germicidal Irradiation (UVGI) chamber in Dr. Cipto Mangunkusumo Hospital to control the shortage of PPE by disinfecting and reusing disposable N95 respirators. Purpose: To evaluate the dosage and effectiveness of UV-C radiation for disposable N95 respirators disinfection in our designated UVGI chamber. Methods: This study used a cross-sectional design to determine the dose and the effectiveness of UV-C radiation in eradicating SARS-CoV 2 on disposable N95 respirators. Results: Using two different distances from the light source, we confirmed the inverse square law of UV-C radiation power. Irradiation for 2 hours with a radiation dose of 1080 mJ/cm2 resulted in undetected SARS-CoV-2 gene based on PCR examination in 10 out of 10 samples. Conclusion: This UVGI chamber is a potential solution for hospitals or medical facilities to overcome the limitations that occurred in the pandemic by disinfecting PPE.

Cost of Personal Protective Equipment During the First Wave of COVID-19

Background: As the world prepared for and responded to the COVID-19 pandemic in early 2020, a rapid increase in demand for personal protective equipment (PPE) led to severe shortages worldwide. Acquisition of PPE in the general market was an integral part of pandemic response, along with the safeguarding of hospital supplies. We seek to quantify the difference in cost per unit (CPU) of PPE during the first wave of COVID-19 compared to prepandemic prices. Methods: We performed a retrospective review of market prices for PPE during the first surge of the pandemic in Chicago. Cost of PPE was tabulated and compared with prepandemic prices. The maximum cost per unit (CPU) of PPE was tabulated for each week, and the average cost throughout the pandemic was calculated. Disposable gowns, washable gowns, N95 respirators, face masks, and gloves were included in our analysis. Results: PPE prices were significantly higher during the pandemic compared to prepandemic prices (Figure 1). Disposable gown CPU peaked at $12 during the first week of March, 13.7 times higher than prepandemic prices, and the average gown CPU was 7.5 times higher than prepandemic prices. N95 respirators had a peak CPU of $12, and average CPU was 8 times higher than prepandemic prices. Face-mask CPU peaked at $0.55, 11 times higher, and averaged 9 times higher the regular price. Gloves averaged 2.5 times higher than the prepandemic CPU. Conclusions: Market prices for PPE were significantly elevated during the first weeks of the pandemic and remained high throughout the first wave of COVID-19. Multiple factors likely contributed to high prices, including demand shock, disrupted supply chains, and a rush to acquisition by healthcare systems and the general population alike. The impact of COVID-19 on prices highlights the importance of supply chains and national stockpiles for pandemic preparedness.Funding: NoDisclosures: None

Sterilization and sanitizing of 3D-printed personal protective equipment using polypropylene and a Single Wall design

BackgroundThe emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic during the fall of 2019 and into the spring of 2020 has led to an increased demand of disposable N95 respirators and other types of personal protective equipment (PPE) as a way to prevent virus spread and help ensure the safety of healthcare workers. The sudden demand led to rapid modification, development, and dissemination of 3D printed PPE. The goal of this study was to determine the inherent sterility and re-sterilizing ability of 3D printed PPE in order to provide sterile equipment to the healthcare field and the general public.MethodsSamples of polylactic acid (PLA), thermoplastic polyurethane (TPU) (infill-based designs) and polypropylene (single-wall hollow design) were 3D printed. Samples were inoculated with E. coli for 24 h and then sanitized using various chemical solutions or heat-based methods. The samples were then incubated for 24- or 72-h in sterile LB medium at 37°C, and bacterial growth was measured by optical density at 600nm. Statistical analysis was conducted using GraphPad Prism v8.2.1.ResultsSignificant bacterial growth was observed in all PLA and TPU based samples following re-sterilization, regardless of the methods used when compared to controls (p < 0.05). The single-walled hollow polypropylene design was not only sterile following printing, but was also able to undergo re-sanitization following bacterial inoculation, with no significant bacterial growth (p > 0.05) observed regardless of sanitization method used.ConclusionThe cost effectiveness, ease of sanitization, and reusability of 3D printed PPE, using our novel single-walled polypropylene design can help meet increased demands of PPE for healthcare workers and the general public that are needed to help decrease the viral transmission of the coronavirus disease of 2019 (COVID-19) pandemic. 3D printing also has the potential to lead to the creation and production of other sterile material items for the healthcare industry in the future. The ability to re-sterilize 3D printed PPE, as our design shows, would also contribute less to the increase in biomedical waste (BMW) being experienced by COVID-19.

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

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.

Cellulose, nanocellulose, and antimicrobial materials for the manufacture of disposable face masks: A review

Cellulose is among the most promising renewable and biodegradable materials that can help meet the challenge of replacing synthetic fibers currently used in disposable N95 respirators and medical face masks. Cellulose also offers key functionalities that can be valued in filtration applications using approaches such as nanofiltration, membrane technologies, and composite structures, either through the use of nanocellulose or the design of functional composite filters. This paper presents a review of the structures and compositions of N95 respirators and medical face masks, their properties, and regulatory standards. It also reviews the use of cellulose and nanocellulose materials for mask manufacturing, along with other (nano)materials and composites that can add antimicrobial functionality to the material. A discussion of the most recent technologies providing antimicrobial properties to protective masks (by the introduction of natural bioactive compounds, metal-containing materials, metal-organic frameworks, inorganic salts, synthetic polymers, and carbon-based 2D nanomaterials) is presented. This review demonstrates that cellulose can be a solution for producing biodegradable masks from local resources in response to the high demand due to the COVID-19 pandemic and for producing antimicrobial filters to provide greater protection to the wearer and the environment, reducing cross-contamination risks during use and handling, and environmental concerns regarding disposal after use.

Modified full-face snorkel masks as reusable personal protective equipment for hospital personnel.

Here we adapt and evaluate a full-face snorkel mask for use as personal protective equipment (PPE) for health care workers, who lack appropriate alternatives during the COVID-19 crisis in the spring of 2020. The design (referred to as Pneumask) consists of a custom snorkel-specific adapter that couples the snorkel-port of the mask to a rated filter (either a medical-grade ventilator inline filter or an industrial filter). This design has been tested for the sealing capability of the mask, filter performance, CO2 buildup and clinical usability. These tests found the Pneumask capable of forming a seal that exceeds the standards required for half-face respirators or N95 respirators. Filter testing indicates a range of options with varying performance depending on the quality of filter selected, but with typical filter performance exceeding or comparable to the N95 standard. CO2 buildup was found to be roughly equivalent to levels found in half-face elastomeric respirators in literature. Clinical usability tests indicate sufficient visibility and, while speaking is somewhat muffled, this can be addressed via amplification (Bluetooth voice relay to cell phone speakers through an app) in noisy environments. We present guidance on the assembly, usage (donning and doffing) and decontamination protocols. The benefit of the Pneumask as PPE is that it is reusable for longer periods than typical disposable N95 respirators, as the snorkel mask can withstand rigorous decontamination protocols (that are standard to regular elastomeric respirators). With the dire worldwide shortage of PPE for medical personnel, our conclusions on the performance and efficacy of Pneumask as an N95-alternative technology are cautiously optimistic.

EFFECTS OF ULTRAVIOLET C (UVC) LIGHT AND DRY HEAT ON FILTRATION PERFORMANCE OF N95 RESPIRATOR MASK

Background: The emergence of the Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) creates one of the most pressing issues with a severe shortage of personal protective equipment (PPE) particularly N95 respirators in healthcare settings worldwide. Recently, possible strategies to decontaminate disposable N95 respirators, including using ultraviolet C (UVC) irradiation and heat treatment, were reported to consider safely reusing the respirators. However, both methods create potential risks to reduce the ability of the respirator filter especially when exposed to these methods multiple times resulting in infectious agents passing through the filter.&#x0D; Objective: The study aimed to ensure the effectiveness of UVC and dry heat to decontaminate N95 respirators.&#x0D; Methods: N95 respirators were exposed continually to UVC and dry heat at 70°C. Then the ability of the aerosol penetration was assessed by introducing an aerosol containing a rotavirus used as a delegate for SARS-CoV2. The existence of the rotavirus at both external (front) and internal surfaces (back) of the N95 respirators was investigated using RT-PCR.&#x0D; Results: UVC and dry heat administered at a 30-minute cycle up to 5 cycles did not change the filtration performance of the N95 respirators. Our results suggested that the reuse of disposable N95 respirators decontaminated by either UVC or dry heat could be possible under the test conditions used.&#x0D; Conclusion: To reuse N95 respirators, UVC and dry heat were useful to apply amid the pandemic of respiratory diseases.

Quantitative Fit Tested N95 Respirator-Alternatives Generated With CT Imaging and 3D Printing: A Response to Potential Shortages During the COVID-19 Pandemic

Rationale and ObjectiveThree-dimensional (3D) printing allows innovative solutions for personal protective equipment, particularly in times of crisis. Our goal was to generate an N95-alternative 3D-printed respirator that passed Occupational Safety and Health Administration (OSHA)-certified quantitative fit testing during the COVID-19 pandemic.Materials and Methods3D printed prototypes for N95 solutions were created based on the design of commercial N95 respirators. Computed tomography imaging was performed on an anthropomorphic head phantom wearing a commercially available N95 respirator and these facial contour data was used in mask prototyping. Prototypes were generated using rigid and flexible polymers. According to OSHA standards, prototypes underwent subsequent quantitative respirator fit testing on volunteers who passed fit tests on commercial N95 respirators.ResultsA total of 10 prototypes were 3D printed using both rigid (n = 5 designs) and flexible materials (n = 5 designs), Prototypes generated with rigid printing materials (n = 5 designs) did not pass quantitative respirator fit testing. Three of the five prototypes with flexible materials failed quantitative fit testing. The final two prototypes designs passed OSHA-certified quantitative fit tests with an overall mean fit factor of 138 (passing is over 100).ConclusionThrough rapid prototyping, 3D printed N95 alternative masks were designed with topographical facial computed tomography data to create mask facial contour and passed OSHA-certified quantitative respiratory testing when flexible polymer was used. This mask design may provide an alternative to disposable N95 respirators in case of pandemic-related shortages. Furthermore, this approach may allow customization for those that would otherwise fail fit testing on standard commercial respirators.

Subject validation of reusable N95 stop-gap filtering facepiece respirators in COVID-19 pandemic.

The COVID-19 pandemic has unveiled widespread shortages of personal protective equipment including N95 respirators. Several centers are developing reusable stop-gap respirators as alternatives to disposable N95 respirators during public health emergencies, using techniques such as 3D-printing, silicone moulding and plastic extrusion. Effective sealing of the mask, combined with respiratory filters should achieve 95% or greater filtration of particles less than 1um. Quantitative fit-testing (QNFT) data from these stop-gap devices has not been published to date. Our team developed one such device, the "SSM", and evaluated it using QNFT. Device prototypes were iteratively evaluated for comfort, breathability and communication, by team members wearing them for 15-30min. The fit and seal were assessed by positive and negative pressure user seal checks. The final design was then formally tested by QNFT, according to CSA standard Z94.4-18 in 40 volunteer healthcare providers. An overall fit-factor >100 is the passing threshold. Volunteers were also tested by QNFT on disposable N95 masks which had passed qualitative fit testing (QLFT) by institutional Occupational Health and Safety Department. The SSM scored 3.5/5 and 4/5 for comfort and breathability. The median overall harmonic mean fit-factors of disposable N95 and SSM were 137.9 and 6316.7 respectively. SSM scored significantly higher than disposable respirators in fit-test runs and overall fit-factors (p <0.0001). Overall passing rates in disposable and SSM respirators on QNFT were 65% and 100%. During dynamic runs, passing rates in disposable and SSM respirators were 68.1% and 99.4%; harmonic means were 73.7 and 1643. We present the design and validation of a reusable N95 stop-gap filtering facepiece respirator that can match existent commercial respirators. This sets a precedence for adoption of novel stop-gap N95 respirators in emergency situations.

7 Failure Rates during Reuse of Disposable N95 Masks in Clinical Practice in the Emergency Department

The COVID-19 pandemic caused a worldwide shortage of personal protective equipment, specifically disposable N95 respirators, prompting health care entities to extend the use of these masks beyond their intended single-use manufacturer recommendation with a paucity of supporting research. We sought to explore the failure rate when reusing single-use N95 respirators through repeated fit testing in an emergency department (ED).

368 Efficacy of Continuous Use Disposable N95 Masks in Clinical Practice in the Emergency Department

During the 2020 COVID-19 pandemic, many emergency departments (EDs) in the United States initiated continuous use of N95 disposable respirators rather than disposing of respirators after each patient encounter in order to conserve personal protective equipment. This study investigates the efficacy of wearing disposable n95 respirators continuously throughout an ED shift using qualitative fit testing as a measure of appropriate mask seal and function.

Demystifying theoretical concerns involving respirators with exhalation valves during COVID-19 pandemic

Demystifying theoretical concerns involving respirators with exhalation valves during COVID-19 pandemic

Adapting re-usable elastomeric respirators to utilise anaesthesia circuit filters using a 3D-printed adaptor - a potential alternative to address N95 shortages during the COVID-19 pandemic.

SummaryThe COVID‐19 pandemic has increased the demand for disposable N95 respirators. Re‐usable elastomeric respirators may provide a suitable alternative. Proprietary elastomeric respirator filters may become depleted as demand increases. An alternative may be the virus/bacterial filters used in anaesthesia circuits, if they can be adequately fitted onto the elastomeric respirators. In addition, many re‐usable elastomeric respirators do not filter exhaled breaths. If used for sterile procedures, this would also require modification. We designed a 3D‐printed adaptor that permits elastomeric respirators to interface with anaesthesia circuit filters and created a simple modification to divert exhaled breaths through the filter. We conducted a feasibility study evaluating the performance of our modified elastomeric respirators. A convenience sample of eight volunteers was recruited. Quantitative fit testing, respiratory rate and end‐tidal carbon dioxide were recorded during fit testing exercises and after 1 h of wear. All eight volunteers obtained excellent quantitative fit testing throughout the trial. The mean (SD) end‐tidal carbon dioxide was 4.5 (0.5) kPa and 4.6 (0.4) kPa at baseline and after 1 h of wear (p = 0.148). The mean (SD) respiratory rate was 17 (4) breaths.min−1 and 17 (3) breaths.min−1 at baseline and after 1 h of wear (p = 0.435). Four out of eight subjects self‐reported discomfort; two reported facial pressure, one reported exhalation resistance and one reported transient dizziness on exertion. Re‐usable elastomeric respirators to utilise anaesthesia circuit filters through a 3D‐printed adaptor may be a potential alternative to disposable N95 respirators during the COVID‐19 pandemic.

Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators

This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage.

The N95 Mask Flunks a Big Clinical Trial

Most clinicians assume that disposable N95 respirators (the tight facial masks that are individually fitted) must be more effective than plain paper

Clinician Beliefs and Attitudes Regarding Use of Respiratory Protective Devices and Surgical Masks for Influenza.

While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America's Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility's respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially relieve shortages of disposable N95s but also may require significant education efforts so that clinicians are aware of the characteristics of alternative personal protective equipment.