As Coronavirus Looms, Mask Shortage Gives Rise to Promising Approach
Surgical masks are supposed to be used just once. But doctors in Nebraska are attempting a novel experiment as gear shortages arise.
Facing a dire shortage of protective face masks for health care workers, administrators at the University of Nebraska Medical Center decided they had no choice.
Masks are certified for one-time use only. But on Thursday, the center began an experimental procedure to decontaminate its masks with ultraviolet light and reuse them. Administrators plan to use each mask for a week or longer.
To the knowledge of the program’s administrators, the medical center is the first to disinfect and reuse masks.
“We have talked with a lot of others around the country who are going after a similar approach,” said John Lowe, the medical center’s assistant vice chancellor for health security training and education, who designed the program.
When administrators made the decision, they knew the procedure violated regulations promulgated by the Centers for Disease Control and Prevention, which said that if masks were decontaminated they could no longer be certified for use.
But late Thursday night, the agency issued new guidance, saying that “as a last resort, it may be necessary” for hospitals to use masks that were not approved by the National Institute for Occupational Safety and Health.
That change would seem to mean it is now acceptable for hospitals to decontaminate and reuse masks during the coronavirus pandemic, said Shawn Gibbs, a professor of environmental health at Indiana University.
If that were not the case, he added, then many hospitals would find themselves in a tightening bind as gear shortages spread: “What is preferred — not using respirator protection equipment, or using a decontaminated respirator whose certification is voided?”
No one thinks reuse of face masks is ideal, and the practice may raise legal liability issues. But there seemed to be little choice.
Doctors and administrators at the University of Nebraska Medical Center calculated that if they continued to use masks only once, they would run out of masks in just weeks.
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“We are making the best of bad choices,” said Dr. Mark Rupp, the medical center’s chief of infectious diseases.
He feels confident that the masks will still protect health care workers. “The data is very clear that you can kill and inactivate viruses with UV germicidal irradiation,” he said. “It is also very clear that you will not damage the respirators.”
The alternative, Dr. Lowe said, would be to ask health care workers to carefully store their masks and reuse them without cleaning them. Handling a mask repeatedly also increases the chances that it will be contaminated.
“Health care workers are very apprehensive about that,” he said.
Decontamination and reuse of masks is not a new idea. Researchers have tested a variety of methods — ultraviolet light, bleach, ethylene oxide gas, moist heat — and have concluded in published papers that decontamination can work.
But the studies were small, and scientific interest in decontamination has been sporadic and fleeting.
“People get interested around the time of a SARS epidemic or an H1N1 flu epidemic, and then they forget,” said Dr. Lynn Goldman, dean of George Washington University’s Milken Institute School of Public Health.
“When you have an epidemic, it’s very cool,” she added. “When you don’t have an epidemic, it’s not cool.”
“If you are talking about cures, you can get very large grants” to study decontamination, Dr. Goldman added. “But if you are doing studies on prevention and protection, it’s very hard. It’s not clear whose job in the federal government it is to fund it.”
UV light was the Nebraska hospital’s choice because it is effective and convenient. Hospitals already use UV light to decontaminate rooms after patients with dangerous infections, like C. difficile, are moved.
The medical center also used UV light to disinfect rooms when it was treating Ebola patients a few years ago. Patients were sent there because the center has a sophisticated biocontainment area.
“We bring in large UV lamps, hit ‘start’ and leave the room,” Dr. Lowe said. “We let it shine for three to five minutes. It disinfects anywhere it can shine.”
As for N95 masks, the kind used by health care workers, “there are really good data that it can decontaminate and that it doesn’t degrade the masks a significant amount,” Dr. Lowe said.
But, he added, “we inspect the masks before every use.” And the protocol Dr. Lowe designed uses three times the concentration of UV light needed to kill coronaviruses.
Masks conform somewhat to the health care worker’s face, and a tight seal is necessary. So each health care worker’s mask is returned to its user after decontamination.
Health care workers write their names on their masks before they first use them. After they remove the masks for decontamination, they are placed in brown bags labeled with their names.
The bags are transported to a special room covered in a beige paint that reflects UV light. After the masks are treated, each one goes into a white bag with the health care worker’s name on it.
The procedure is experimental, and there are uncertainties.
For instance: How many times can a mask be reused? For now, staff members will use each mask for a week before disposing of it. But the medical center may decide to keep using the masks for 10 days, or even two weeks, Dr. Rupp said.
“Hopefully, that will at least buy us enough time to offer protection through this epidemic,” he added.
He knows there may be risks, but he believes the medical center has made the right choice.
“I sleep very well,” he said. “If we get sued, I still think we are doing the right thing.”