Personal Protective Equipment - Conserving Facemasks and Respirators During a Critical Shortage

How should organizations conserve facemasks* and respirators** during critical shortage?

Any examples are for illustrative purposes only.

When access to respirators or facemasks may be limited, such as during a pandemic, facilities should consider current regulation, evidence-based guidelines(EBG) and expert guidance, such as: The CDC has provided three strata for situations when facemask and/or respirator supplies are limited or not available, and strategies for contingency and crisis situations including assumptions or steps that the facility has taken at those points. 

For example, key points that may be helpful in determining facility practices related to N95 respirators:
  • Consider alternatives that may be available for N95 respirators, which include: 
    • Reusable elastomeric respirators with appropriate filters or cartridges
    • Powered air purifying respirators (PAPR)
    • A respirator of equal or higher protection (e.g. N99 or N100 filtering facepieces) 
    • N95 respirators with expiration dates beyond the manufacturer-designated shelf life
  • Extended use is favored over reuse for respirators because it is expected to involve less touching of the respirator and therefore less risk of contact transmission – organizations should assess the risk and provide clear instruction for staff. If reuse is favored, consider the following:
    • Hand hygiene: Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary, for comfort or to maintain fit).
    • Donning and doffing:  Use a pair of clean (non-sterile) gloves when donning a used N95 respirator and performing a user seal check. Discard gloves after the N95 respirator is donned and any adjustments are made to ensure the respirator is sitting comfortably on the face with a good seal.
    • Storage:  Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses. To minimize potential cross-contamination, store respirators so that they do not touch each other and the person using the respirator is clearly identified. Storage containers should be disposed of or cleaned regularly.
Practices NOT supported by evidence-based guidelines (EBG)
  • Disinfecting/reprocessing disposable respirators (and facemasks) is NOT recommended because the integrity of the respirator may be compromised. Examples of disinfecting/reprocessing which are NOT recommended include:
    • Washing facemasks or respirators with soap and water
    • Spraying facemasks or respirators with disinfectant after use
    • High-level disinfection of facemasks or respirators 
    • Sterilizing facemasks or respirators
  • The reuse of disposable facemasks or respirators is not recommended if contaminated with blood, respiratory or nasal secretions, or other bodily fluids.
  • Using tape to secure facemasks or respirators to faces/skin is not recommended as it makes safe removal more difficult and can lead to damage of skin.
In all cases, it is ESSENTIAL that leadership provide clear communication to staff of strategies to conserve facemasks and\or respirators being implemented and the reason for those strategies being necessary be communicated to ensure full compliance.

* Facemask (e.g., surgical or procedural mask):  A surgical mask (facemask) is a loose-fitting disposable device that creates a physical barrier between the mouth/nose of wearer and potential contaminants in the environment.

** Respirators:  A respirator is a personal protective device that is worn on the face, covers at least the nose and the mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particle (e.g. dust and infectious agent(s).  Types of respirators include N95s, elastomeric filtering facepiece, and powered air-purifying respirators (PAPRs).

Additional Resources:
U.S. Department of Labor Issues Temporary Enforcement Guidance for Respirator Fit-Testing in Healthcare during COVID-19 Outbreak
Last updated on March 24, 2020
Manual: Ambulatory
Chapter: Infection Prevention and Control IC

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