Improvement Insights

A critical look at latest academic and publications research including The Joint Commission Journal on Quality and Patient Safety as well as Health Research Services initiatives with partner organizations.

Reusable Elastomeric Respirators and Health Care Surges

04/15/2020

Stella Hines, MD, MSPH, is assistant professor at the University of Maryland School of Medicine in Baltimore

The National Academies of Sciences, Engineering and Medicine recommends that reusable elastomeric respirators be considered for routine and surge use in health care respiratory protection programs (RPPs), provided cleaning and disinfection protocols are specified.

Additionally, the Centers for Disease Control and Prevention (CDC) recommends inclusion of reusable elastomeric respirators as one strategy to preserve N95 respirators (N95s) during periods of shortage in health care settings.

Reusable elastomeric respirators, while infrequently used in health care, are commonly used in general industry.  These respirators are approved by the National Institute for Occupational Safety and Health (NIOSH), just like N95s.  

Protection Level
Similarly, elastomeric respirators are tight-fitting, negative pressure respirators and require a fit-test.  They are made by various manufacturers and come in different sizes.  They provide an Assigned Protection Factor of 10, which is classified by the Occupational Safety and Health Administration (OSHA) as the same level of protection as an N95.  Some experts believe that the level of protection afforded by these respirators may actually be higher, given the greater reliability of the seal between the mask and the face. Elastomeric respirator face masks connect to filters.  Plastic cartridge-covered filters can be used and not replaced unless they either become soiled or noticeably hard to breathe through.  These respirators can be worn with eye protection or face shields.

Cleaning and Disinfection 
Elastomeric respirators can be cleaned and disinfected repeatedly.  Cleaning involves removal of soiling agents, like facial oils. Disinfection involves removal of microbial agents.  Evidence-based protocols for both exist. Evidence-based protocols cover effectiveness of common disinfectants against the H1N1 virus on elastomeric respirators , reprocessing methods designed to minimize errors and demonstration of respirator durability and function.  Disinfection can be accomplished by use of standard Environmental Protection Agency (EPA)-registered hospital disinfectant wipes with claims against the appropriate microbial agent (such as SARS-CoV-2), while cleaning is accomplished by removal of the cartridge filters and submersion or sponge-cleaning in soapy water or via automated methods.

Respirators may be assigned to individuals or shared, provided that thorough cleaning and disinfection has occurred.  Users must know their face mask size and adjust the straps to achieve proper fit.  Before each use, users perform seal checks to assure the integrity of the seal, which is taught during training.  In a crisis situation in which fit-testing may be untenable, assurance of seal by performing seal checks may provide assurance.

The University of Maryland Medical Center (UMMC) and Faculty Physicians Inc. (FPI) practices have utilized elastomeric respirators as components of their OSHA-compliant respiratory protection programs since 2009’s H1N1 influenza pandemic, when N95 respirators became scarce.  They are the primary form of respiratory protection for FPI employees performing clinical duties and part of the COVID-19 response for certain UMMC health care workers.  

Health care worker user acceptance, storage, cleaning and disinfection practices of these respirators during non-pandemic use has been studied and published by Hines et al. in previous NIOSH-supported research featured here, as well as in the Journal of the International Society for Respiratory Protection and the American Journal of Infection Control.

Stella Hines, MD, MSPH, is assistant professor at the University of Maryland School of Medicine in Baltimore. She is an occupational medicine physician and a pulmonologist engaged in research, clinical care and education. She has received research funding from CDC-NIOSH to study the acceptability and feasibility of elastomeric respirator use in health care, and from the United States Department of Defense and the Department of Veterans Affairs for research related to exposure-related lung disease. She previously served as medical director of Employee Health for the outpatient clinical practices at the University of Maryland and now serves as associate national medical director for the Building Trades National Medical Screening Program for former construction workers of Department of Energy sites.