Proper Use of N95 Respirators

Authors and Disclosures

Beth Clarke, RN, MSc(A), MBA, CWOCN, Nanci Haze RN, MSN, CPNP, Jacqueline Sly, RN, MSN, NP-C, Allan Thomas, MSN, CRNA, Patricia Reid Ponte, DNSc, RN, FAAN, NEA-BC and Corrine Y. Jurgens, PhD, RN, ANP, FAHA, FHFSA, FAAN

The authors work at the Boston College Connell School of Nursing in Chestnut Hill, Massachusetts. Beth Clarke is a clinical instructor, Nanci Haze is a clinical assistant professor, Jacqueline Sly is a clinical instructor, Allan Thomas is a clinical instructor, Patricia Reid Ponte is an associate clinical professor, and Corrine Y. Jurgens is associate professor.

Sidebar 1

N95 Decontamination

Decontamination should not be standard practice; however, If personal protective equipment shortages force you to reuse your N95 respirator, the Centers for Disease Control and Prevention recommends three decontamination methods:

• ultraviolet light

• vaporized hydrogen peroxide

• moist heat.

Currently, limited research is available for these measures, and their efficacy may vary depending on the N95 manufacturer and model. All decontamination methods result in some degree of N95 degradation, which may reduce respirator effectiveness and frequency of safe reuse. More research and guidance is needed to determine how decontamination might impact a respirator's straps, filtration, fit, structural integrity, and performance.

If decontamination is used, carefully assess the respirator's seal:

• Inhale and exhale quickly to check for collapsing and puckering, which indicates a good seal.

• Hold your bare hands around the respirator (don't touch it) and exhale forcefully to check if you can feel your breath, which indicates air leak.

Sidebar 2

N95 Reuse Best Practices

Boston College Connell School of Nursing has established these best practices when reusing N95 respirators. (Note: Reuse should be avoided.)

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Suggested best practice techniques to doff and re-don an N95 respirator*

• Before using a respirator, check with your primary care provider to determine if you have a chronic respiratory, cardiac, or similar medical condition; a respirator may make breathing more difficult.

• All styles of N95 respirators require fit testing.

• A fit test and inspection for structural integrity don't ensure a proper seal, so perform a seal test each time you don the N95.

• Always assume the exterior of a used N95 respirator is contaminated. Don gloves if touching the N95.

• Extended use of an N95 respirator, when worn appropriately, is preferred to repeated doffing and re-donning to reduce the risk of contamination.

• Ask a trained peer to assist in doffing and re-donning.

• Inspect the N95 for damage before donning (label the respirator per institution policy).

• Oil-based makeup and facial hair will reduce N95 effectiveness.

• Consider wearing a hairnet or placing hair in an elastic band to limit interference with respirator fit.

• Use a wriggling motion to guide straps over glasses and hair.

• Gently shape the respirator around the bridge of the nose, then test the seal by inhaling briskly to verify collapse and puckering.

• Discard N95 if breathing becomes difficult or the respirator lacks structural integrity.

• If wearing a face shield, ensure it doesn't interfere with the N95 seal.

• Decontamination processes alter the integrity of duckbill N95 respirators, so reuse them with caution.

*Reusing N95 respirators should be avoided, and the evidence supporting reuse continues to evolve.

Click here for an illustration to remind nurses of the proper steps for doffing and re-donning used N95 respirators.

Artwork by Nicole Sly, BS, MA candidate, Teachers College, Columbia University