N95s, Elastomeric Respirators and the Future of PPE during Pandemics

As Americans are struggling to prevent the spread of infections across the country, there are numerous PPE options available to keep them safe from hours to years. Most Americans are familiar with N95 disposable masks, which continue to be the most requested PPE by health care workers since the start of the pandemic. N95 respirators have been used since the 1970s to help miners avoid black lung.

N95s were initially used to protect health care workers from deadly viruses in the 1990s when drug-resistant tuberculosis started infecting health care workers. N95 standards were updated for health care workers, and doctors began wearing them when helping tuberculosis patients. N95 masks work better than a surgical mask because they can filter out large and small particles when they inhale. N95s also have electrostatic charges that can attract virus particles and trap them in the mask's fibers. In comparison to standard surgical masks, N95 masks seal better to one's face; therefore, making it significantly less likely to let contaminated air in or out of the mask. It is also important to note that health care workers need to be fit tested to know which size N95 they should wear to have a proper seal.

Historically, N95s were used to successfully protect health care workers during the SARS and H1N1 pandemics and have been in widespread use for Covid-19. N95s are made to be disposed of after each use to prevent contamination and infection of health care workers. Up until 2020 and the Covid-19 pandemic, N95s were not considered a reusable form of PPE; however, due to severe PPE shortages, reusing N95s for days to weeks has become a prevalent and dangerous practice among health care workers. The CDC, NIOSH, OSHA, and other top health agencies researched ways to prevent needing to reuse N95s, and they are recommending health care workers use elastomeric respirators to extend the stockpile of N95s and prevent the need to reuse disposable PPE. Additionally, in 2018, the CDC recommended that elastomeric respirators be stockpiled in the National PPE stockpile for health care workers to use in case of an eventual pandemic.

Like N95s, elastomeric respirators were created and used in mining and other industries before being used in health care settings. Elastomeric respirators were first used by health care workers in 1996 at the Texas Center for Infectious Diseases (TCID) to protect doctors against drug-resistant tuberculosis and other deadly viruses. Health care workers used elastomeric respirators during SARS and H1N1, but it wasn't until Covid-19 that these respirators started being put into widespread use during pandemics.

Similar to an N95, health care workers need to be fit tested to find the right size of the elastomeric respirator to ensure a proper seal. Elastomeric respirators can filter out more airborne particles than an N95. Because they are made of a rubber-like material, they can also be exposed to liquids without losing their seal, making them ideal for droplet and airborne protection. Elastomeric respirators will soon become the gold standard of respiratory protection because they can protect equally or better than an N95 depending on the filter used, but unlike an N95, elastomeric respirators are not disposable and can be safely reused for years.

Elastomeric respirators can use N95/P95 filters, which filter over 95% of airborne particles similar to an N95 mask, or they can use N100/P100 filters, which can filter out 99.97% of airborne particles. Some elastomeric respirators have one-way valves which only filter the air going in but not the air going out, so for health care workers that use elastomeric respirators with one-way valves, the CDC recommends they place a surgical mask, cloth mask, or procedural mask over the valve so it can be used as source control. Another way to use elastomeric respirators with one-way valves as source control is to give the patient a cloth, procedural or surgical mask, which has the same effect.

While N95s continue to be in short supply, elastomeric respirators are readily available and make a sustainable option for any hospital or long-term care home. By combining elastomeric respirators with N95s, health care workers would no longer need to reuse N95s and can dispose of them after a single use, as recommended. Not all elastomeric respirators are created equal, and some elastomeric respirators have features built into the respirator that can help with communication and comfort. Depending on a healthcare worker's situation, they should choose an elastomeric respirator that works best for their work environment.

While widespread use of elastomeric respirators can prevent outbreaks at long-term care homes and hospitals, they can also be used to protect workers in places where outbreaks occur, such as food plants, which would also prevent the community spread that follow those outbreaks. With proper training and increased use of elastomeric respirators in areas where attacks or large clusters occur, the need to shut down the economy to contain the virus's spread would be significantly reduced. Therefore, hospitals like those in Utah would not have to choose between whom they can save with the limited supply of medical equipment and those who may not survive due to this tragic shortage of equipment.

Due to the sustainability of elastomeric respirators, they could not only help our front-line workers during the current pandemic, but they could also be stored and used the next time a deadly virus should surface. They are thereby stopping the spread of these viruses early and eliminating the threat of another fatal pandemic.

Dan Izhaky · October 29, 2020 · Originally published on LinkedIn · All writing