U.S. Pandemic Could Severely Strain Face Mask, Other PPE Supply Pipeline

Currently, medical masks are recommended by the CDC for use in healthcare settings for routine patient care, while the National Institute for Occupational Safety and Health (NIOSH) recommends certified N95 respirators be used in high-risk activities such as aerosol-generating procedures in healthcare settings where SARS and tuberculosis could lurk. However, most medical masks and disposable N95 filtering face-piece respirators have a limited effective life span, according to the CDC: “Once worn, they can become damaged or deformed or develop intolerable levels of breathing resistance from moisture buildup. If worn in an environment with high probability of exposure to infectious agents, they can become contaminated.”²

The reuse of RPDs was the subject of scrutiny in January 2006 when DHHS asked the Institute of Medicine (IOM) to convene the IOM Committee on the Development of Reusable Facemasks for Use During an Influenza Pandemic to conduct a 90-day assessment of measures that can be taken that would permit the reuse of disposable N95 respirators in healthcare settings, as well as the need for and development of reusable face masks for healthcare providers and the public. The committee met in January and March 2006 to convene public workshops and develop a report, available through the National Academies Press, on an analysis of the potential for respirator and medical mask reuse.²

The first issue addressed in the report concerns measures taken to permit the reuse of disposable N95 respirators, and issues such as what modifications can be made in the manufacturing process that would permit these respirators to be reused without increasing the likelihood of infection with the flu virus, and what practices in caring for, wearing, and cleaning could be implemented to safely extend the effective lifetime of disposable N95 respirators. Another issue is the need for reusable masks for healthcare providers and the general public. The IOM committee report states, “In the event of an extended pandemic, there will be the inevitable increasing demand by the public for masks, which cannot be met by the current, or even ramped-up U.S. production of disposable masks. Examples of the types of questions related to design of reusable masks that will be considered include: what materials would be effective; what would be an acceptable level of fluid resistance and filtration efficiency (e.g., individual to prevent respiratory droplets from being dispersed, and to reduce exposure to potentially infectious material, that is, to ensure that reusable masks for non-infected individuals filter inflowing air to minimize exposure to the flu virus, and reusable masks for compliance with existing standards and legal requirements, but the committee acknowledges that there may be difficulty in meeting such standards during a pandemic situation.”²