Challenges of limited reuse and extended use of N95 filtering facepiece respirators: Lesson learnt from COVID-19 pandemic in Mumbai, India

Abstract

Introduction: Usage of personal protective equipment, which includes N95 filtering face piece respirators (FFRs), was the major preventive measure for healthcare workers to control COVID-19 transmission. However, a global shortage of N95 FFRs was observed worldwide during initial phase of pandemic. Reusing mask was the only strategy and various decontamination methods were suggested. The main objective of the study was to evaluate the compliance rate of limited reuse and extended use policy implemented in hospital.
 Methods: Limited reuse and extended use policy of N95 FFRs was implemented for one month in lower risk areas. Compliance to policy was checked by questionnaires asked to 100 healthcare workers verbally and challenges faced by them were noted.
 Results: It was observed that overall compliance to policy was 80%. Major reasons of non-compliance were suffocation, followed by smell from mask and loosened strips.
 Conclusion: Limited reuse and extended use method was successfully used as a bridge until sufficient N95 FFRs were not available although effective decontamination method must be established in hospitals to prepare ourselves for the future pandemics.

Reuse of N95/PFF2 masks in clinical practice: morphological and structural analysis

“…When evaluating the integrity of the N95/PFF2 masks reused for seven and fifteen days, several signs of wear on the straps and degradation on the nose clips were identified through visual inspection. These damages corroborate the findings of studies carried out in both clinical and laboratory environments, highlighting the fragility of this equipment under reuse conditions ( 9 , 25 ) . A clinical study, carried out in a tertiary hospital in India during the COVID-19 pandemic, indicated that 9% of health professionals reported the loosening of straps, generally after five reuses in eight-hour shifts, as one of the main reasons for early disposal of N95/PFF2 masks ( 25 ) .…”

“…These damages corroborate the findings of studies carried out in both clinical and laboratory environments, highlighting the fragility of this equipment under reuse conditions ( 9 , 25 ) . A clinical study, carried out in a tertiary hospital in India during the COVID-19 pandemic, indicated that 9% of health professionals reported the loosening of straps, generally after five reuses in eight-hour shifts, as one of the main reasons for early disposal of N95/PFF2 masks ( 25 ) . In a laboratory context, simulating a ten-hour shift, it was found that the rupture of five nose clips and eight fixation items, which occurred over 20 episodes of donning and doffing, resulted in the failure of sealing tests for all participants who used such devices ( 9 ) .…”

“…However, after the seven- and fifteen-day protocols, folds and marks made by a professional with ballpoint pens were observed in the samples, suggesting possible improper packaging of the N95/PFF2 masks in clothing pockets or in personal items, such as bags. This condition is also observed in other studies, drawing attention to the cruciality of implementing awareness actions to discourage inappropriate storage of these devices ( 25 , 27 ) .…”

“…Al evaluar la integridad de las mascarillas N95/PFF2 reutilizadas durante siete y quince días, se identificaron, mediante inspección visual, varios signos de desgaste en las correas de sujeción y degradación en los clips nasales. Estos daños corroboran los hallazgos de estudios realizados tanto en ambiente clínico como de laboratorio, destacando la fragilidad de estos equipos en condiciones de reutilización ( 9 , 25 ) . Una investigación clínica, realizada en un hospital terciario de la India durante la pandemia de COVID-19, indicó que el 9% de los profesionales de la salud informaron que el aflojamiento de las correas de sujeción, generalmente después de cinco reutilizaciones en turnos de ocho horas, era una de las razones principales para la eliminación temprana de mascarillas N95/PFF2 ( 25 ) .…”

Post-Covid Workplace Scenario – Employer and Employee Health and Safety

“…Self-quarantine for several weeks, confusion about the symptoms of the disease will last even after getting cured. 17,18 In such cases, the organization should come forward to address the problems of such people rather than just ignoring them. Strategies that are devised to isolate people from getting the infection, may sometimes affect their mental health leading to stress.…”