What We’re Seeing in the Field
The American Hospital Association and our partners continue to work to make sure that every health care provider can have access to much-need personal protective equipment (PPE) especially during this health care crisis. Information, policies, procedures and best practices around PPE are evolving quickly as the overall situation evolves. Here is a quick review of what we’re seeing in the field today with links, as available, for more information.
PPE Best Practices
The CDC, NIOSH, the FDA and OSHA all provide resources regarding PPEs online. The CDC has issued new strategies to optimize the supply of PPE, and information on decontamination and reuse of filtering facepiece respirators. The National Institute for Occupational Safety and Health (NIOSH) also issued guidance on extended use and limited reuse of N95 respirators. The FDA has issued a new guidance document regarding the enforcement policy for face masks and respirators during the crisis, and is continuing to monitor and update to address needs in the health care field. OSHA has expanded temporary guidance for respirator fit-testing.
PPE manufacturers, distributors and other health care industry partners provide resources related to PPE during this crisis.
- 3M PPE Considerations shares resources comparing masks and alternatives.
- stockd shares guidelines, alternative production methodologies and covid-19 testing resources on their coronavirus update page.
- ECRI offers a covid-19 resource page including information related to PPE equivalents, disinfecting N95 masks, and practical guidance on the potential risks and benefits to consider regarding N95 use and reuse.
Decontamination of N95 Masks
As the health care industry works to adapt and adjust to the shortages of PPE, many organizations are exploring different avenues for decontamination.
To help address the critical shortage of N95 masks, Duke Health researchers and clinical teams confirmed that N95 masks can be decontaminated for reuse without degrading the quality of the masks. The teams used existing decontamination methods utilizing vaporized hydrogen peroxide. Local news shared the story.
Nebraska Medicine and the University of Nebraska Medical Center use ultraviolet germicidal irradiation to surface decontaminate N95 masks. Detailed documentation and key points are available online. They also share exact specifications and processes used. National news shared the story.
Battelle’s system can decontaminate thousands of N95 masks per day using concentrated vapor phase hydrogen peroxide, without degrading N95 performance. The American Hospital Association released a product advisory with more information. Battelle provides detail documentation available for facilities and health care providers.
STERIS Healthcare Decontamination Solutions for compatible N95 or N95-equivalent Respirators
STERIS has received an Emergency Use Authorization (EUA) from the FDA to temporarily provide an option to decontaminate compatible N95 or N95-equivalent respirators up to ten times. Instructions for healthcare facilities and healthcare personnel and other documentation are available online.
Guidance on Reuse of PPE
As the health care industry works to adapt and adjust to shortages of PPE, many organizations have adopted different strategies for reusing PPE. While it is important to recognize viable techniques for reuse, it is equally important to know what does NOT work. We share information on both below.
University of Washington made comprehensive policies and procedures available publicly online. Included are PPE guidelines for limited reuse.
The current, evidence-based answer provided is to NOT use anything in your home to attempt to sterilize or sanitize N95 masks or other PPE. Stanford Medicine's detailed report (not peer-reviewed) shares the evidence gathered regarding the general efficiency of the filtration following disinfection. This does not specifically look at effectiveness against COVID-19. The commentary includes reference to research from prior studies with different viruses.
Tips and Current Practices from the Field
Oregon Health & Science University works to be transparent with staff about supplies and needs with updates posted daily and shared at huddles with all staff. Researchers have mapped out the covid-19 trajectory and aligned it with OHSU’s PPE supply to ensure they can meet the increased needs. OHSU also has a public-facing resource site.
Atlantic Health System implemented a UV sterilization process to prolong the life of N95 respirators and shared this process map detailing the path from clinician through delivery to cleaning. Atlantic Health also offers a public-facing COVID-19 resource site.
Healthcare Laundry Accreditation Council (HLAC) advises on methods to reduce transmission of coronavirus in this press release. HLAC board members also advise that health care organizations work closely with Infection Prevention teams when considering PPE sanitization, sterilization, reuse, or using PPE from new sources and partnerships. They also recommend that organizations keep linens, scrubs and other textiles in the system for laundering; do not take home, and to work with laundry partners to help manage supplies and needs. Local news in New York featured an HLAC accredited facility and what they do to help reduce virus transmission.
The American Hospital Association (AHA) is not responsible for any errors or omissions, or for the results obtained from the use of the specifications and guidance provided above (the Information). The Information was obtained from hospitals, health systems and other third parties, and was not developed by the AHA. The AHA is providing the Information for informational purposes and has not independently, tested, confirmed or verified the Information. Any use of the Information is at the user’s own risk. The AHA is not a health care provider, and it does not actively monitor or approve any Information on this site and are not responsible or liable for verifying the accuracy of the Information. The AHA provides this Information and these materials on an “as is” basis, with no representations or warranties of any kind, express or implied, including with respect to accuracy, completeness, quality, non-infringement, merchantability or fitness for a particular purpose. AHA and its affiliates, will not be liable for any damages of any kind arising from the use of, or reliance on, any Information made available to you by AHA.