Replacing N95 Masks With P100 Elastomeric Masks Could Save Money During Pandemic

By Scott Baltic

July 02, 2020

NEW YORK (Reuters Health) - Replacing disposable N95 masks with industrial-style elastomeric masks that use disposable P100 filters is practical and cost-saving, a trial program at a large U.S. academic healthcare system shows.

Like many other healthcare systems, the nine-hospital, 21,000-employee Allegheny Health Network (headquartered in Pittsburgh) faces major demands for personal protective equipment during the COVID-19 pandemic. At the same time, costs for the N95 masks needed for aerosolizing procedures have skyrocketed, and establishing a program to disinfect and reuse N95s created other problems, such as fit testing.

Allegheny began by assigning the P100 half-mask respirators to "super users," that is, emergency departments, intensive-care units, and anesthesia providers, using a train-the-trainer approach. Masks were assigned to units, not individuals, and cleaning was handled by central sterile processing.

Additional supply later allowed masks to be assigned to individual personnel, who each cleaned their own mask by basically just wiping it down with a solution made by the mask manufacturer, Dr. Sricharan Chalikonda, Allegheny's chief medical operations officer, told Reuters Health in a phone interview.

Within a month, the medical system had cut its use of N95s by 95%, Dr. Chalikonda and colleagues found, with 116 P100 respirator and cartridges replacing 2,088 disposable N95s per day.

Conservatively estimated, the team writes, the elastomeric-mask program was 10 times cheaper per month than continuing to rely on N95s, and "the cost benefit continues to increase the longer they are in use."

Dr. Chalikonda said he's looking forward to a next-generation P100 with an exhalation valve filter. Allegheny currently uses a surgical mask on top of the P100 to cover the exhalation valve.

He added that Allegheny will definitely continue with P100s after the pandemic. "There would be zero reason not to continue this program."

"The masks themselves can be used for years and years," Dr. Chalikonda said. By now almost everyone has their own elastomeric mask, though Allegheny keeps an additional supply for occasional users.

The system also keeps a stock of P100 cartridges, but is looking at the possibility of sterilizing and reusing them, in case that's necessary at some point under future pandemic conditions.

Dr. Christopher R. Friese, professor of nursing, health management and policy at the University of Michigan, in Ann Arbor, told Reuters Health by email, "It's important to remember that N95s were never intended for reuse, whereas elastomerics were designed specifically for that purpose."

"We shouldn't get comfortable reusing N95s in the long term," he added. "There are reports that reused N95s are breaking down, and we don't have rigorous data to show they offer identical protection to new N95s."

Reusable elastomerics are not only cost-effective, but more efficient and safer under certain conditions, Dr. Friese continued, including in units or settings where COVID-19 cases are treated.

After the current pandemic, he said, elastomerics will definitely play a role when airborne precautions are needed or when the next airborne respiratory infection outbreak occurs. "It's not a question of if, but when."

The main caveat with elastomeric masks is good training, Dr. Friese emphasized. The Allegheny program addressed key issues, like up-front training, training super users, and making sure healthcare workers are comfortable with the product.

"We learned that lesson from the U.S. response to Ebola, where healthcare workers were not adequately trained on the special PPE needed," he said.

"We've known about the potential for reusable elastomerics for years. They were identified during H1N" - the influenza pandemic in 2009 - "as a potential strategy. It's puzzling why we have relied on N95s for so long, when they have so many limitations," Dr. Friese concluded.

Dr. Friese served on a 2018 National Academy of Medicine committee that considered how to integrate reusable elastomeric respirators for use in healthcare, particularly during a pandemic. He was not involved in the Allegheny project.

The authors declared no outside funding and no conflicts of interest.

SOURCE: Journal of the American College of Surgeons, online June 1, 2020.