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Coronavirus (COVID-19)

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

Educational Objective
To understand the risks of reusing N95 respirators

1 Credit CME

JAMA

Published Online: June 4, 2020

Research Letter

Article Information and Disclosures

Nida F. Degesys, MD¹;

Ralph C. Wang, MD, MAS¹;

Elizabeth Kwan, MD¹;

Jahan Fahimi, MD, MPH¹;

Jeanne A. Noble, MD, MA¹;

Maria C. Raven, MD, MPH¹

Author Affiliations

¹Department of Emergency Medicine, University of California, San Francisco

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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

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.2020.2648 PubMed Google Scholar Crossref

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

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

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.2011.05.003 PubMed Google Scholar Crossref

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/wxz060 PubMed Google Scholar Crossref

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:10.1080/15459624.2015.1116692 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.