N95s Should Be Standard Use for All Inpatient COVID Care, Say Investigators

June 30, 2020

Investigators argue in the Annals of Internal Medicine that all healthcare workers in inpatient settings caring for COVID-19 patients should be equipped with N95s.

Infection preventionists and other healthcare workers caring for patients in a healthcare setting who have, or may have, coronavirus disease 2019 (COVID-19), should be equipped with N95 respirators and not just surgical masks, argues an opinion piece published in the Annals of Internal Medicine. N95s and medical or surgical masks have been shown to offer equal protection in some recent studies, and that’s the point being disputed by investigators with the Marshall B. Ketchum University College of Pharmacy, Fullerton, Calif., and the Providence-St. Jude Medical Center, Fullerton, Calif.

The meta-analyses that the investigators cite mix outpatient and inpatient data, they say, and therefore underestimate the benefit of N95s, as opposed to surgical masks. “It poses a danger to HCWs [healthcare workers] for inpatient COVID-19 guidelines to rely on meta-analysis of randomized controlled trials that mix different methods, settings, and outcomes,” the authors state. “On the basis of recent data, aerosol transmission is possible.”

N95 respirators are better at filtering out aerosol generating particles. The investigators want guidelines for use of N95s to be re-evaluated.

“It is apparent that the risk for HCW infection is related to duration and magnitude of exposure,” the investigators state. “A COVID-19 inpatient unit with multiple patients coughing and breathing will have far higher exposure to droplets, resuspended droplets, and aerosols than an outpatient setting. The data the guidelines referenced do not support the conclusion that medical masks are equivalent to N95 respirators in reducing risk for infection.”

They directly appeal to healthcare administrators who have been struggling with inadequate supplies of N95s and other personal protective equipment during the COVID-19 pandemic. The investigators are concerned that studies suggesting protective equivalency between the two types of masks might tamper administrators’ efforts to ensure enough N95s for healthcare workers working with COVID patients in inpatient settings.

“Because various organizations have claimed that medical masks are acceptable, health system administrators may believe that they have a valid reason to deny N95 respirators to HCWs on COVID-19 units and reserve them for AGPs [aerosol-generating procedures] even when other guidelines do recommend their use,” the investigators write.

Yes, there are shortages of N95s, but “instead of allowing our HCWs to work in substandard protection, countries should focus on allocating resources to increase production of … N95 respirators.”

In the end, say the investigators, N95s are more cost-effective. “Use of N95 respirators to protect HCWs should not merely be a preference or a recommendation based on availability,” the study states. “The data indicate that it should be the standard for all inpatient COVID-19 management.”

They conclude that “use of N95 respirators to protect HCWs should not merely be a preference or a recommendation based on availability. The data indicate that it should be the standard for all inpatient COVID-19 management.”