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Correlation Between N95 Extended Use and Reuse and Fit Failure in an Emergency Department

Educational Objective
To understand the risks of reusing N95 respirators

Frontline health care workers are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19).1 Personal protective equipment (PPE), including N95 respirators (N95s), is essential for prevention of COVID-19. The Centers for Disease Control and Prevention recommends that health care workers dispose of N95s after a single patient encounter. However, it recommends N95 extended use (wearing the same N95 for multiple patient encounters) and limited reuse (storing an N95 between encounters for use over multiple encounters) during critical PPE shortages.2,3 There are limited data regarding N95 reuse and extended use. Existing studies were conducted in laboratories, not clinical environments.4,5 Inadequate supplies of N95s have forced many emergency departments to implement various N95 reuse and extended use policies but without empirical evidence of their effectiveness. We examined the prevalence of N95 fit test failure while reusing 2 common types of N95 masks.

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Article Information

Corresponding Author: Nida F. Degesys, MD, Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0208 (nida.degesys@ucsf.edu).

Accepted for Publication: May 20, 2020.

Published Online: June 4, 2020. doi:10.1001/jama.2020.9843

Author Contributions: Drs Degesys and Wang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Degesys, Wang, Kwan, Fahimi, Noble.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wang, Fahimi.

Administrative, technical, or material support: Degesys, Kwan, Noble.

Supervision: Degesys, Wang, Noble, Raven.

Conflict of Interest Disclosures: None reported.

References
1.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648PubMedGoogle ScholarCrossref
2.
National Institute for Occupational Safety and Health. Guide to the selection and use of particulate respirators: DHHS (NIOSH) publication 96-101. Centers for Disease Control and Prevention website. Published January 1996. Accessed May 7, 2020. https://www.cdc.gov/niosh/docs/96-101/default.html
3.
National Institute for Occupational Safety and Health. Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Centers for Disease Control and Prevention website. Published March 2020. Accessed May 7, 2020. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html#risksextended
4.
Bergman  MS , Viscusi  DJ , Zhuang  Z , Palmiero  AJ , Powell  JB , Shaffer  RE .  Impact of multiple consecutive donnings on filtering facepiece respirator fit.   Am J Infect Control. 2012;40(4):375-380. doi:10.1016/j.ajic.2011.05.003PubMedGoogle ScholarCrossref
5.
Vuma  CD , Manganyi  J , Wilson  K , Rees  D .  The effect on fit of multiple consecutive donning and doffing of N95 filtering facepiece respirators.   Ann Work Expo Health. 2019;63(8):930-936. doi:10.1093/annweh/wxz060PubMedGoogle ScholarCrossref
6.
Zhuang  Z , Bergman  M , Brochu  E ,  et al.  Temporal changes in filtering-facepiece respirator fit.   J Occup Environ Hyg. 2016;13(4):265-274. doi:10.1080/15459624.2015.1116692PubMedGoogle ScholarCrossref
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