N95 mask supply running low: new guidelines on PPE for health care workers
With supply of N95 masks running low, Ministry of Health directs shift to alternative PPE guidelines
The Ministry of Health (MOH) has advised the union that over the coming days, current supplies of N95 masks will likely be depleted to the point where non-traditional and reprocessed N95s may begin to enter the supply stream. There are reports from members that this may already be happening in some areas.
Medical grade N95 respirators are one of the most critical pieces of personal protective equipment available to protect health care workers from exposure to pathogens, including COVID 19. The surge in demand for N95s over the past several months has put so much pressure on traditional global manufacturing and distribution systems that the global supply is not keeping up with the demand. Measures have been introduced around the world to increase the available supply, including: finding new manufacturing sources, using N95s past their expiry dates and repurposing single use N95s for reuse.
The Ministry of Health Allocation Framework provides direction on the steps to follow when traditional supplies of N95s have been depleted. Each of these steps is described in more detail below:
1. Use alternative PPE that has been assessed and meets National Institute for Occupational Safety and Health (NIOSH) equivalency;
- Large shipments of N95 and KN95 respirators have been received in BC, but most have come from alternative, non-traditional sources, therefore requiring extensive validation and testing before they can be used. Any N95 or KN95 to be used in a healthcare setting must either meet the NIOSH standard or an equivalency endorsed by both the MOH and WorkSafeBC. Once that ongoing validation is completed, the approved N95s/KN95s are then permitted to enter the supply stream.
2. Use N95 respirators and/or surgical masks beyond manufacturer’s stated expiry date;
- All N95s come with a manufacturer’s expiry date and depending on the methods used for storage and the brand of N95, some may be eligible to be brought back into the BC supply chain. Currently it is unknown how many of these may be available for use.
3. Use reprocessed N95 respirators; and/or extend use of reusable respirators.
- The STERRAD Sterilization System, used previously for sterilizing medical instruments has been introduced for the sterilization and repurposing of N95 respirators. STERRAD uses vaporized hydrogen peroxide to sterilize previously used N95s which have not been soiled or damaged.
Reprocessed respirators are to be marked as reprocessed. A sample of each reprocessed lot is inspected before it is stockpiled. The MOH has stated that reprocessed masks will only be used in circumstances where new N95s or equivalent respirators are not available.
Standard Operating Procedures (SOPs) have been provided to all regional health authorities to provide guidance on how to safely collect and handle used N95 respirators. All repurposed N95s are to be clearly marked as such and the SOP allows for N95s to go through the STERRAD system twice. After the third use, the mask is to be discarded. The SOP requires one stripe to be placed on an N95 each time it is sterilized, so an N95 with 1 stripe can be reused once more. An N95 with 2 stripes is to be discarded after use.
The measures described above should be implemented in the order presented, but as the validation and testing of alternative source N95s/KN95s is taking a considerable amount of time, it is conceivable that the health authorities may introduce repurposed N95s before other alternative source N95s/KN95s are available.
Once they come into the system, you may notice that some of the new N95s and especially the KN95s are different from what you are used to. You should follow the steps of the PPE training you have received and conduct a proper seal and fit check before you begin any procedure. If you are not able to do that for some reason, then you should stop and ask for training or assistance. Do not engage in any work activity requiring an N95 unless you are confident that your mask fits and works properly.
HSA has studied the repurposing plan and SOP in detail and has presented the Ministry of Health with a number of questions and recommendations to ensure the highest possible priority is placed on protecting the health and safety of health care workers using any PPE.
Within the hierarchy of controls for workplace hazards, PPE is the last line of defence. Employers must use all available resources to find ways of eliminating hazards or implementing engineering or administrative control measures before PPE is required. However when the PPE is required, it must fit properly and do the work it is supposed to do.
Any time you have concerns over the efficacy of your N95, KN95 or any other PPE, raise it with your supervisor for resolution. If that doesn’t help, involve your OHS Steward or joint occupational health and safety committee rep.
If the matter is still not resolved, contact the HSA COVID Hotline at @email or by phone 1-604-549-5168 for assistance.
And remember, you have a right and obligation to refuse any work process that you consider poses an undue hazard to your health and safety or the health and safety of others.