Shortages of PPE Continue as Workarounds Are Found

Author: Michael Vlessides

Anesthesiology News

As COVID-19 continues to challenge health care systems around the world, clinicians are struggling to find a way to deal with growing shortages of personal protective equipment (PPE), particularly face masks. Yet reuse strategies and ingenuity are combining to help physician anesthesiologists confront the issue head-on.

In a conversation with Anesthesiology News, Mary Dale Peterson, MD, MSHCA, the president of the American Society of Anesthesiologists (ASA), explained the roots of the PPE shortage, how institutions and clinicians are trying to address the problem, and the prospects for future relief.

Nevertheless, PPE is vital in the fight against a virus that has proven to be extraordinarily transmissible, and anesthesiologists are at particular risk for cross infection due to aerosolizing airway procedures.

In light of such risks, COVID-19 testing assumes even greater importance. “There are patients coming into our facilities, and we don’t know if they are COVID-19-positive, given the limited testing that’s being done,” Dr. Peterson explained. “This is especially worrisome, given the period of infectivity where patients may not be symptomatic.”

And yet, shortages continue. Perhaps most worrisome to anesthesiologists is the lack of N95 masks, which has led many to face the uncomfortable reality of reusing PPE that is normally meant to be discarded. “We are distributing masks by providers,” Dr. Peterson said. “So, if I have 20 anesthesiologists in my department, each gets one and a paper sack to keep it in.

“We’re having to make the difficult choice of reusing the N95 or trying to protect it with a face shield and a regular surgical mask.”

Bake Your Masks?

This grim reality has led health care practitioners to explore different ways of disinfecting N95 masks for safe reuse. In a recent—and yet unpublished—document (utrf.tennessee.edu/information-faqs-performance-protection-sterilization-of-masks-against-covid-19/), Peter P. Tsai, PhD, who invented the electrostatic charging technology in the filter media of N95 masks, offered suggestions for effective sterilization methods.

In the document, Dr. Tsai explained that alcohol should not be used to sterilize N95 masks. Radiation and ultraviolet light might prove effective, he noted, but also may degrade the masks’ vital polypropylene material.

As Dr. Peterson noted, the best way to sterilize N95 masks for reuse is by baking them at 70° C for 30 minutes, a process that can be repeated several times without a noticeable loss of efficiency. Yet as Dr. Tsai noted in his document, practitioners who choose this route of disinfection must make sure to suspend the masks in the oven without contacting a metal surface. This can be done by using a clothespin, or placing the mask on a wooden grill at least 6 inches away from a metal surface.

Hospitals also may find supplies of masks from otherwise overlooked sources. Indeed, other industries often use protective face equipment with filtering capabilities that are as good, or better, than N95 masks. “At a local level, I think people should have a callout to other industries in their areas that could either donate or sell some of their supplies,” Dr. Peterson said. “For example, a manufacturer of offshore oil platforms in my area just donated 500 N95 or better masks to us.” She also stressed that homemade masks have no place in the hospital environment.

Although these are clearly stopgap measures, they will have to do until domestic industry can ramp up its production of PPE, a development Dr. Peterson hopes to see very soon. “I’m hearing from the federal government that manufacturing is rapidly ramping up production of these masks,” she said. “In the meantime, we’ve got to balance out the risk of the procedure and protecting our health care workers with a limited supply of PPE.”

For its part, the ASA is doing its best to help anesthesiology providers across the country secure access to the PPE they need. On March 22, the society issued a joint statement in conjunction with the Anesthesia Patient Safety Foundation, American Academy of Anesthesiologist Assistants, and American Association of Nurse Anesthetists. In that statement, the societies stressed the importance of PPE for anesthesiology professionals, including properly fitted N95 masks or powered air-purifying respirators.

The ASA is also updating its website regularly, particularly the COVID-19 FAQ section (asahq.org/in-the-spotlight/coronavirus-covid-19-information). “We’ve got an entire committee that’s dedicated to getting all of this information out as it’s coming in to us,” Dr. Peterson said, “and that includes information on PPE.”