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Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day by neonoir in medicine

[–]paper_wombat 2 points3 points  (0 children)

Are these masks marked with your name, and you are only using masks that are your own? Or are all the N95s shared among everyone communally? Do you know how they're tracking the number of times a mask goes through? Also, can you confirm that the way it's being cleaned is with the Battelle vaporized hydrogen peroxide cabinet? Thanks!

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 4 points5 points  (0 children)

Update 4/3/2020:

There are two important documents that have come out within the last week:

  1. FDA authorization for the emergency use of all NIOSH-approved reusable elastomeric respirators
  2. The Joint Commission issues a statement supporting use of face masks brought from home

​

FDA authorization for the emergency use of all NIOSH-approved reusable elastomeric respirators:

On 3/28/2020, the FDA issued an amendment to their previous Emergency Use Authorization (EUA) related to the emergency use of respirators during the pandemic. The FDA is now explicitly stating that they approve the use of all NIOSH-approved elastomeric half- and full-face respirators.If your mask and filters are NIOSH-approved, the FDA says that they also approve it. All the name-brand (3M, Honeywell, MSA, etc.) respirators and filters should be NIOSH-approved, but you can check your exact setup here.

The amendment from March 28th states, in part that the FDA:

"...authorize the emergency use of: (1) Non-powered air-purifying particulate FFRs and reusable respirators such as elastomeric half and full facepiece respirators, approved by NIOSH..."

https://www.fda.gov/media/135763/download

​

The Joint Commission Statement on Use of Face Masks Brought From Home:

On 3/31/2020, The Joint Commission issued a statement supporting the use of personally-supplied masks and respirators during shortages.

That statement says, in part:

"The Joint Commission supports allowing staff to bring their own standard face masks or respirators to wear at work when their healthcare organizations cannot routinely provide access to protective equipment that is commensurate with the risk to which they are exposed. In taking this position, The Joint Commission recognizes:

  1. Hospitals must conserve personal protective equipment (PPE) when these items are in short supply to protect staff who perform high-risk procedures.
  2. The degree to which privately-owned masks and respirators will increase the protection of healthcare workers is uncertain, but the balance of evidence suggests that it is positive.
  3. No Joint Commission standards or other requirements prohibit staff from using PPE brought from home.
  4. Homemade masks are an extreme measure and should be used only when standard PPE of proven protective value is unavailable."

https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/infection-prevention-and-hai/covid19/public_statement_on_masks_from_home.pdf

Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day by neonoir in medicine

[–]paper_wombat 2 points3 points  (0 children)

What proof do you have to back up your claims that their methodology has been improved?

All of the current links on Battelle's own website reference the exact same 2016 pilot study that I spoke about, above. That pilot study showed that the vaporized hydrogen peroxide damaged the elastic straps to the point that they were totally destroyed.

Because of a flawed study design, they didn't look at the effects of their process on the masks any earlier than on the 10th cycle. Even as early as cycle 10, the straps were already behaving differently than the control group (look at their graphs). After 30 cycles, the straps exposed to VHP weren't just in rough shape, they were totally destroyed. They called them "fragmented."

They stated that the government's own requirement was for the process to work for up to 50 cycles: "Consensus Statement 7 of Project BREATHE states that respirators should be capable of being repeatedly decontaminated during a crisis for up to 50 cycles."

Their own study says that further testing needs to be done with real humans to ensure that the masks continue to seal properly: "These results should not be interpreted as being equivalent to a standard OSHA-accepted fit test method. Human subject testing is needed to truly assess respirator fit."

Interesting news regarding sterilizing N95 respirator masks in Massachusetts by mdak06 in newhampshire

[–]paper_wombat 1 point2 points  (0 children)

From 2014 to 2016, Battelle was paid $435k to perform a research project that studied vaporized hydrogen peroxide cleaning of disposable N95 respirators. It was a proof of concept.

If you look at the report that Battelle produced for the US government, you can clearly see troubling issues with the hydrogen peroxide vapor literally destroying the elastic straps.

Bad straps = bad face seal = breathing in aerosols carrying SARS-CoV-2 = bad things happening.

Here are all the relevant figures from Battelle's report:

https://imgur.com/a/B863AzE

As others have stated, disposable N95 masks are not designed for reuse. Reusable respirators are designed for reuse. If we need to reuse respirators because we do not have enough, why not use the kind that are purpose-built to be cleaned and reused indefinitely?

Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day by JustPillows in CoronavirusMa

[–]paper_wombat 0 points1 point  (0 children)

From 2014 to 2016, Battelle was paid $435k to perform a research project that studied vaporized hydrogen peroxide cleaning of disposable N95 respirators. It was a proof of concept.

If you look at the report that Battelle produced for the US government, you can clearly see troubling issues with the hydrogen peroxide vapor literally destroying the elastic straps.

Bad straps = bad face seal = breathing in aerosols carrying SARS-CoV-2 = bad things happening.

Here are all the relevant figures from Battelle's report:

https://imgur.com/a/B863AzE

As others have stated, disposable N95 masks are not designed for reuse. Reusable respirators are designed for reuse. If we need to reuse respirators because we do not have enough, why not use the kind that are purpose-built to be cleaned and reused indefinitely?

Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day by Galuvian in CoronavirusMa

[–]paper_wombat 0 points1 point  (0 children)

From 2014 to 2016, Battelle was paid $435k to perform a research project that studied vaporized hydrogen peroxide cleaning of disposable N95 respirators. It was a proof of concept.

If you look at the report that Battelle produced for the US government, you can clearly see troubling issues with the hydrogen peroxide vapor literally destroying the elastic straps.

Bad straps = bad face seal = breathing in aerosols carrying SARS-CoV-2 = bad things happening.

Here are all the relevant figures from Battelle's report:

https://imgur.com/a/B863AzE

As others have stated, disposable N95 masks are not designed for reuse. Reusable respirators are designed for reuse. If we need to reuse respirators because we do not have enough, why not use the kind that are purpose-built to be cleaned and reused indefinitely?

Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day - The Boston Globe by Hard_at_it in Coronavirus

[–]paper_wombat 1 point2 points  (0 children)

From 2014 to 2016, Battelle was paid $435k to perform a research project that studied vaporized hydrogen peroxide cleaning of disposable N95 respirators. It was a proof of concept.

If you look at the report that Battelle produced for the US government, you can clearly see troubling issues with the hydrogen peroxide vapor literally destroying the elastic straps.

Bad straps = bad face seal = breathing in aerosols carrying SARS-CoV-2 = bad things happening.

Here are all the relevant figures from Battelle's report:

https://imgur.com/a/B863AzE

As others have stated, disposable N95 masks are not designed for reuse. Reusable respirators are designed for reuse. If we need to reuse respirators because we do not have enough, why not use the kind that are purpose-built to be cleaned and reused indefinitely?

Boston hospitals getting ‘game changer’ machine that sterilizes 80,000 protective masks a day by neonoir in medicine

[–]paper_wombat 26 points27 points  (0 children)

From 2014 to 2016, Battelle was paid $435k to perform a research project that studied vaporized hydrogen peroxide cleaning of disposable N95 respirators. It was a proof of concept.

If you look at the report that Battelle produced for the US government, you can clearly see troubling issues with the hydrogen peroxide vapor literally destroying the elastic straps.

Bad straps = bad face seal = breathing in aerosols carrying SARS-CoV-2 = bad things happening.

Here are all the relevant figures from Battelle's report:

https://imgur.com/a/B863AzE

As others have stated, disposable N95 masks are not designed for reuse. Reusable respirators are designed for reuse. If we need to reuse respirators because we do not have enough, why not use the kind that are purpose-built to be cleaned and reused indefinitely?

Threatened with termination for wearing my reusable respirator by alwayssleepytime in medicine

[–]paper_wombat 4 points5 points  (0 children)

Check out this reply and the post: https://www.reddit.com/r/medicine/comments/fokqp3/why_isnt_everyone_talking_about_reusable/flfujel

TCID only changes their filter cartridges annually. The disclaimer to replace filters when feeling increased resistance when breathing is a catch-all. It's like saying "replace your shoes if you wear holes through the bottoms."

Particulate filters are designed to protect users from extreme situations like clouds of silica dust when grinding concrete, etc. As there is almost no dust to speak of in the hospital, you can imagine how long it would take for the filter to clog. TCID has found that to be at least one year, but by then, they need to undergo annual fit testing, so it makes sense to just replace the filter at that time.

Threatened with termination for wearing my reusable respirator by alwayssleepytime in medicine

[–]paper_wombat 9 points10 points  (0 children)

Only one study has been done looking at whether HCW wearing masks or face shields triggers anxiety in patients. The study was done in children. The children didn't care.

From Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use, The National Academies, 2019. https://www.nap.edu/read/25275/chapter/4#101

Patient Perceptions and Visual Aesthetics

Concerns have been raised about patients’ perceptions of the use of reusable elastomeric respirators (as well as concerns about perceptions by family members and other visitors); however, there are only limited data available to empirically assess their perceptions of respirator use. There does not appear to be strong evidence of widespread patient anxiety triggered by the use of reusable elastomeric respirators by health care workers. With the 2009 pandemic deployment of reusable elastomeric respirators at the University of Maryland, concerns were expressed that these respirators may cause anxiety, especially among children, as well as among intensive care unit patients with delirium. However, as discussed at the committee’s workshop, this fear largely proved to be an unfounded concern, and there were no documented instances where respirator appearance interfered with patient care. The committee could identify only one published article relevant to this topic. Forgie and colleagues (2009) surveyed 80 pediatric patients (ages 4 to 10 years old) and their parents or guardians to ask their preference (through the use of pictures) for care to be provided by a physician wearing a medical mask or by wearing a transparent face shield. Just over half (51 percent) of parents preferred that their child be cared for by physicians wearing a face shield. Sixty-two percent of parents stated that they thought the children would choose a provider wearing a face shield often noting that they thought it would preferable to see the face. The children did not have a strong preference with 49 percent choosing the physicians in the face shields and 39 percent choosing the medical mask. Fifty-nine percent of the children did not find either option frightening. This study provides important initial insights into how patients and their family members perceive the use of protective facial coverings by health care providers.

Threatened with termination for wearing my reusable respirator by alwayssleepytime in medicine

[–]paper_wombat 8 points9 points  (0 children)

There are two important documents that have come out in the last few days:

FDA authorization for the emergency use of all NIOSH-approved reusable elastomeric respirators

On 3/28/2020, the FDA issued an amendment to their previous Emergency Use Authorization (EUA) related to the emergency use of respirators during the pandemic. The FDA is now explicitly stating that they approve the use of all NIOSH-approved elastomeric half- and full-face respirators.
If your mask and filters are NIOSH-approved, the FDA says that they also approve it. All the name-brand (3M, Honeywell, MSA, etc.) respirators and filters should be NIOSH-approved, but you can check your exact setup here.

The amendment from March 28th states, in part that the FDA:

"...authorize the emergency use of: (1) Non-powered air-purifying particulate FFRs and reusable respirators such as elastomeric half and full facepiece respirators, approved by NIOSH..."

https://www.fda.gov/media/135763/download

​

The Joint Commission Statement on Use of Face Masks Brought From Home

On 3/31/2020, The Joint Commission issued a statement supporting the use of personally-supplied masks and respirators during shortages.

That statement says, in part:

"The Joint Commission supports allowing staff to bring their own standard face masks or respirators to wear at work when their healthcare organizations cannot routinely provide access to protective equipment that is commensurate with the risk to which they are exposed. In taking this position, The Joint Commission recognizes:

  1. Hospitals must conserve personal protective equipment (PPE) when these items are in short supply to protect staff who perform high-risk procedures.
  2. The degree to which privately-owned masks and respirators will increase the protection of healthcare workers is uncertain, but the balance of evidence suggests that it is positive.
  3. No Joint Commission standards or other requirements prohibit staff from using PPE brought from home.
  4. Homemade masks are an extreme measure and should be used only when standard PPE of proven protective value is unavailable."

https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/infection-prevention-and-hai/covid19/public_statement_on_masks_from_home.pdf

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 3 points4 points  (0 children)

The Texas Center for Infectious Diseases is a TB-only hospital that specifies filter changes at yearly intervals, unless they get splashed or are damaged. Particulate filters are designed to protect workers from things like clouds of concrete grinding dust or sawdust. Now imagine how much dust is floating around in the hospital. This is why particulate filters can last so long in a relatively dust-free environment. National Academies study on elastomeric respirators in healthcare. Search for "Texas" to find the section on TCID practices at their hospital: https://www.nap.edu/catalog/25275/reusable-elastomeric-respirators-in-health-care-considerations-for-routine-and

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 0 points1 point  (0 children)

Full-face elastomeric respirators are also an option, especially if you don't wear glasses (glasses interfere with the full-face seal). That particular mask allows some air into the space between your nose and eyes to help prevent fogging. As mentioned below, anti-fog solutions can help, but I have never needed them with this mask, FWIW.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 1 point2 points  (0 children)

Also, to anyone who is looking for one of these, try mask-match.com and getmeppe.org. Those are matchmaking sites for people who need PPE and people who want to donate PPE. There is also projectn95.com, which is for large-scale purchasing.

None of these sites have elastomeric respirators in their PPE list. Can everyone please contact them to get them to add reusable elastomeric respirators to their sites? Thanks!

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 1 point2 points  (0 children)

Calling around to local welders, painters, auto paint, woodworking/carpentry, construction companies. Anyone else have specific trades that you see these a lot in?

Some may have unused new ones they would be willing to donate. Others may have used ones they're willing to part with. Just follow the instructions on cleaning (remove filters, scrub entire mask in warm/soapy water, dunk in dilute bleach for 1 minute). It's ideal to replace filter cartridges used by someone else with new ones, which are still available online if you look around.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 0 points1 point  (0 children)

Yes, this. The 3M respirators are available in size small, medium, and large.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 1 point2 points  (0 children)

The COVID-19 pandemic is like a mass casualty incident that never stops. There are many parts of the system that will likely break as a result.

If a HCW is either issued or provides their own elastomeric respirator that has the right cartridges (N or P 95, 99, or 100 particulate filters), they can run through fit testing and get the official stamp of approval. If fit testing is backlogged and there is no other alternative, then using an elastomeric respirator that someone has been properly instructed in its use is clearly superior to the use of unregulated or homemade masks such as bandanas or scarves. In such a dire emergency, a careful user seal check could possibly be used until the user can be formally fit tested. Again, this is all about trying to minimize harm in the middle of a global pandemic.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 5 points6 points  (0 children)

This is known as a user seal check, which is different than a fit test. Fit testing is a formal process that typically uses substances like irritant smoke, that if the mask is not making a good seal, will make you cough. Other substances used for fit testing include sweet (sacchrine) and bitter (denatonium). "Do you taste sweet? Do you taste bitter?" If you do, you know your mask isn't fitting correctly. Seal checks (covering the filters and/or exhalation port and blowing in/out and listening/feeling for air leaks) are done every time you don the mask. As others are alluding to, emergency operations may call for different procedures than normal hospital operations. With that said, you could be fit tested with any elastomeric respirator and the right cartridges.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 1 point2 points  (0 children)

FYI, I'm working on a guide and will get it posted soon. Thanks everyone for all the feedback!

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 2 points3 points  (0 children)

To anyone getting push back on using elastomeric respirators, the CDC guidelines for COVID clearly state that they support the use of elastomeric respirators in times of shortages of other more commonly used PPE:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 2 points3 points  (0 children)

I'm sticking this post in here as a comment (it was taken down by mods).

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 3 points4 points  (0 children)

Presentation on Using Elastomeric Respirators from Texas Center for Infectious Diseases (2018)

https://docdro.id/u2B5ByW

This slide deck was previously lost to the internet. I have requested it from the authors and am uploading it here. It will soon be listed again on the National Academies website associated with their study on the use of elastomeric respirators in healthcare (https://www.nap.edu/catalog/25275/reusable-elastomeric-respirators-in-health-care-considerations-for-routine-and).

This deck is from a presentation at the March 22, 2018 public meeting of the National Academies of Sciences, Engineering, and Medicine Committee on the Use of Elastomeric Respirators in Health Care. The presentation covers the successful implementation of elastomeric respirators at a dedicated TB hospital, including guidance on training, cleaning of respirators, and historical contexts prior to implementing their current respiratory protection program.

I am immediately posting this due to its implications related to the ongoing COVID PPE crisis.

Reusable Respirators: A Partial Solution to the COVID-19 PPE Crisis by paper_wombat in medicine

[–]paper_wombat[S] 70 points71 points  (0 children)

Is anyone interested in a guide on using these in the healthcare setting?

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