Pittsburgh-based Allegheny Health Network (AHN) announced that a novel process that sterilizes N95 respiratory masks after their initial use can extend the lifespan of these critical devices, allowing them to be worn multiple times by caregivers and helping to alleviate the stress that mask supply shortages have had on healthcare providers across the country.
AHN recently began sterilizing masks for reuse at its nine surgical hospitals. The new process, recently approved by the Centers for Disease Control and Prevention (CDC), enables AHN to sterilize thousands of masks per day and increases AHN's supply of available N95 respirators for caregivers.
According to AHN, it is the first healthcare organization in the region to implement an N95 recycling program as part of its novel coronavirus (COVID-19) pandemic response efforts.
"With masks and other kinds of personal protective equipment in short supply, AHN and Highmark Health have been working tirelessly to ensure that our patients are safe and that our clinical employees always have the protective equipment they need," said Sricharan Chalikonda, MD, chief medical operations officer at AHN, in a statement. "Sometimes, that means finding new sources for those products. In this case, we have developed an outside-of-the-box approach to make more efficient use of the products we already have on hand."
Normally, disposable masks such as N-95s are not permitted to be reused. But because of an ongoing supply shortage driven by the worldwide COVID-19 pandemic, the Food and Drug Administration is temporarily authorizing healthcare providers to sterilize masks for reuse with in-house sterilization equipment that is typically used to sterilize and decontaminate surgical tools and other healthcare instrumentation.
But with AHN and most other health systems postponing elective surgeries, those machines are now available for other uses. AHN's perioperative surgical team and its nursing staff spent the last week designing and implementing a system that would allow the masks to be collected, brought to the hospitals' central sterilization departments and redistributed.
"Reusing the N95 respirators produces a number of benefits," said Hope Waltenbaugh, MSN, RN, AHN's vice president of surgical services, in a statement. "First and foremost, it prolongs the life of our masks and helps to ensure that our frontline caregivers are always protected. It also cuts down on hospital waste and potentially opens the door to sterilizing and reprocessing other types of masks, or other forms of personal protective equipment."
N95 respirator masks are different than surgical earloop masks; they are tight-fitting devices that reduce the wearer's exposure to airborne particles, including large droplets and aerosolized particles. They are used in environments where there is high risk of exposure to airborne agents and are critical resources for healthcare workers who are treating or collecting samples from COVID-19 patients.
Once used masks have been delivered to the hospital's central sterilization department, they'll be inspected for wear and tear, elastic damage, stains, makeup or any other imperfection. Damaged masks will be discarded.
Masks that are selected for reuse will then be sealed into sterilizing peel-pack envelopes and loaded into the sterilization machine, which can accommodate up to 40 masks per load. Before the masks are sterilized, they will be tagged with a tape strip to mark it as a recycled mask.
The N95 masks can be recycled twice before being discarded. AHN hopes that it will eventually be able to recycle more than 80 percent of its N95 masks.
Each load takes about 45 minutes to complete, and each machine can sterilize about 15 loads per day using hydrogen peroxide vapor. Previous studies conducted by Duke University and others have demonstrated that N95 respirators still meet performance requirements even after 50 decontaminations with this process.
Allegheny General Hospital and West Penn Hospital will have two mask-sterilizing machines onsite; the rest of AHN's hospitals will have one. At full capacity, machines across the network could collectively recycle more than 6,000 masks per day, with the help of AHN's central sterilization technicians.
"In our fight against COVID-19, nurses and doctors are getting much of the credit, and deservedly so," said Waltenbaugh. "But central sterilization technicians and environmental services employees work extremely hard to keep our facilities, equipment and instruments clean, and they can be exposed to the same pathogens as our clinical caregivers. They are healthcare's unsung heroes."
AHN collaborated with Pittsburgh-based MSA Safety to test the performance of the respirators following the sterilization process. Last month, MSA helped secure a shipment of N95 masks for the Pittsburgh region that were donated to various healthcare providers and first responders in the community.