Extended Use and Limited Reuse of PPE and N95

Extended Use and Limited Reuse of Disposable Facemasks, Respirators and Protective Eyewear

Overview

Respirators include powered air purifying respirators (PAPRs) and disposable N95 respirators. Protective eyewear includes face shields and goggles. These recommendations are temporary while there are national and international shortages of protective equipment.

Purpose

• To prevent a shortage or exhaust our supply of facemasks, respirators and eye protection.
• To ensure that our staff have access to the necessary supplies to perform patient care safely.

Directions

• Extended use refers to the practice of wearing the same N95 respirator for repeated encounters with several patients, without removing the respirator between the encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms, clinics or hospital units.
  • Eye protection may be left in place with the N95 respirator for extended use.
• Reuse refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (‘doffing’) between at least some of the encounters. The respirator is stored in between encounters and reused.
  • Reuse of full face shields will be permitted. Face shields will be dedicated for use by individual healthcare personnel. Disinfection of the face shield will be required between uses.

Guiding Principles

• Extended use is preferred over reuse on the assumption that it is safer for the employee to leave their mask and eye protection in place, to reduce the risk of self-contamination through frequent donning and doffing of the same equipment.
• Facemasks, PAPR hoods, N95s and eye protection can be reused in a careful and limited way during periods of short supply.
• Guidance is for reuse by a single person (no sharing). This principle applies to respirators and eye protection.
• Disposable N95 respirators worn for COVID-19 PUIs may be reused or worn for extended use as long as they were not worn during an aerosol generating procedure or have reached the end of their use by being damaged or moist from sweat or insensible fluid loss through breathing.
• The use of N95 respirators is prioritized for those personnel at the highest risk of contracting or experiencing complications of infection.
• Limit room traffic where possible by ensuring that only those essential for patient care enter the room; strategies include bundling of care, limiting or avoiding bedside clinical teaching, limiting operating room Label the N95 respirator and paper storage bag with the user’s name before using to prevent reuse by another individual. Write name on mask where straps are attachment or on elastic straps of N95 mask.
• Full face shields are dedicated to individual healthcare personnel as the foam piece and elastic band cannot be adequately disinfected between uses. Reuse of full-face shields is permitted following disinfection guidelines. Label the full-face shield across the top with name prior to first use.

Guidance for Re-use and Extended Use of Facemasks (surgical / procedure masks)

• Doff facemask
  • Perform hand hygiene
  • Remove the procedure mask by holding the ear loops. The front is contaminated, so remove slowly and carefully.
  • After removing facemask, visually inspect for contamination, distortion in shape/form. If contaminated or wet the mask should be discarded.
  • If the facemask is NOT visibly contaminated or distorted, carefully store in the paper bag to avoid destroying the shape of the mask.
  • The facemask should be stored in a well-ventilated container (i.e., paper bag with handles) with user name & date.

A disposable facemask can be worn for several hours if not wet or distorted, and not touched while delivering patient care.

Guidance for Re-use and Extended Use of Respirators and full face shield

Extended use is preferred over re-use. You can continue to wear the N95 respirator and eye protection for your entire shift. N95 and eye protection may be removed and stored appropriately for re-use later.

Storage of Previously Worn Disposable N95 Respirators

• After removing N-95, visually inspect for contamination, distortion in shape/form. If contaminated/wet, creased or bent, N95 should be discarded.
  • A disposable N95 can be worn for several hours and multiple shifts if not wet or distorted, not touched while delivering patient care, and not involved in an aerosol-generating procedure (per CDC and NIOSH, pandemic response).

Instructions for the LIMITED REUSE of Full Face Shields

Reuse of full face shields

• Full face shields are dedicated to individual healthcare personnel as foam piece and elastic head band cannot be adequately disinfected between personnel.
• Don gloves and adequately disinfect inside then outside surfaces, avoid using germicidal wipe on foam and elastic band.
• Store reused full face shield alongside your labeled paper bag containing your re-used N95

Alternative respiratory protection strategy:

• When mask supplies are limited and does not permit using facemasks to protect N95s for re-use, it is most effective to put a procedure mask on patients for extended use. If the patient is masked then this prevents contamination of the healthcare personnel N95.
• A suitable setting would include a palliative care ward setting where patients could wear a face mask

References

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH)

https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

https://www.cdc.gov/niosh/topics/hcwcontrols/pandemic-planning.html

This document was adapted from Guidance for Extended Use and Reuse of Facemasks, Respirators, and Protective Eyewear, University of Maryland.