Reusable Elastomeric Respirators in HealthCare

r espiratory protective devices safeguard health care workers (HCWs) from exposure to infectious airborne pathogens and are a critical component of infection control strategies in Healthcare settings. Healthcare settings have experienced significant shortages of the single-use, disposable N95 respirator (herein: N95) during the COVID-19 pandemic. The Centers for Disease Control and Prevention’s (CDC) Strategic National Stockpile (SNS) holds large quantities of respirators for distribution in the event of a public health emergency, which were depleted during this pandemic despite the 92 million N95s distributed to healthcare facilities by the SNS (as of September 2020; U.S. Government Accountability Office, 2020). In recent years, the elastomeric half-mask respirator (EHMR) has been proposed as one alternative to the N95. Elastomeric half-mask respirators are half-face, tight-fitting respirators that are made of synthetic or rubber material and are equipped with replaceable filter cartridges (CDC, 2020a). The EHMR has at least the same assigned protection factor (APF) as the N95. The advantage over the N95 is that the EHMR can be repeatedly disinfected, cleaned, and reused. Elastomeric half-mask respirators were not typically used in healthcare prior to the COVID-19 pandemic, with few exceptions (Hines et al., 2017). While presence of an exhalation valve has previously excluded their use from sterile procedures due to concern for contamination from the wearer’s exhaled air, ongoing studies may clarify whether these concerns are warranted (Fernando et al., 2021). While few studies have examined the use of the EHMR in healthcare, findings from one suggest that workers perceived the EHMR as providing greater protection than the N95 (although the APF is the same) and was the preferred respirator in high-risk exposure scenarios (Hines et al., 2019b). However, workers who wore the EHMR also reported greater difficulty communicating and less comfort, relative to the N95. This same study identified several critical logistical barriers to hospital EHMR use, namely, assuring storage, availability, cleaning, and disinfection (Hines et al., 2019a). Fortunately, solutions to overcome these barriers and others such as high-volume fit testing evolved quickly (Hines et al., 2021). A separate study observed that HCWs could be rapidly fit-tested and trained to use the EHMR (Pompeii et al., 2020). This study observed that workers demonstrated competency in EHMR use (e.g., donning, user seal check) after a brief training. In September 2020, the CDC’s SNS put forth a call for healthcare organizations to volunteer to deploy EHMRs in their setting and to participate in future EHMR demonstration projects (CDC, 2020b). The purpose of the SNS’s efforts is “to diversify the respiratory protection options available to HCWs and emergency responders during the COVID-19 crisis.” Findings from this initiative will provide healthcare organizations with more details about the feasibility of these devices across various types of settings. Occupational health professionals charged with leading their organization’s respiratory protection program should consider EHMRs approved by the National Institute for Occupational Safety and Health as possible alternatives to the disposable N95 in select workgroups and settings. Integrating these types of devices into the workplace could better prepare workplaces for potential shortages in the current and future outbreaks and pandemics.