Mask crusaders: The force behind critical PPE conservation efforts
Since the early days of the COVID-19 pandemic, news media across the country have been reporting a worldwide shortage of personal protective equipment. Through careful planning and preparation, Michigan Medicine has been able to maintain a steady supply to help protect front-line workers. And, with COVID-19 likely to persist for many months to come, important steps have been taken to ensure that the organization has a plentiful supply throughout the remainder of the pandemic.
“The hospital command center tasked us with developing a solution for reuse and recycling of N95 masks that involves disinfection,” said William W. Roberts, M.D., professor of urology and biomedical engineering and chief of the Division of Endourology at Michigan Medicine.
N95 respirators are masks approved by the National Institute for Occupational Safety and Health (NIOSH) to reduce exposure to small particle aerosols and large droplets. N95s fit tightly to the face of the wearer, and fit-testing is required to ensure a proper fit and effective seal to protect front-line workers from potential exposure to COVID-19.
Roberts, who assumed the role of facilitating a partnership between the U-M College of Engineering and Michigan Medicine to create innovative solutions to challenges caused by the pandemic, gathered a team of virologists, clinical biologists, decontamination and infection prevention experts, and other colleagues from the College of Engineering, U-M Medical School and health system.
The team worked together for weeks to conduct research and test options for safely and effectively reprocessing N95 masks.
“After reviewing available literature, we settled on ultraviolet light and heat, two tried and true methodologies studied and recommended by the CDC,” said Keith S. Kaye, M.D., M.P.H., professor of internal medicine and director of research for the Division of Infectious Diseases.
“We brought in folks from our Central Sterile Processing Department who are experts and have been invaluable in this process,” said Kaye. “We figured out that we had the ability to combine UV light and heat for the most effective results, and we learned that there was a spot in CSPD where this work could be done safely and effectively.”
CSPD worked with the Facilities Department to transform space for the reprocessing work. At the same time, the research team designed viral and bacterial studies necessary to assure that the identified process would achieve the desired results.
“In order to keep our employees safe and have confidence in this process,” said Roberts, “it was necessary to test the integrity of the masks in terms of filtration, ensure that the process kills bacteria and viruses, and make sure the fit of the mask is maintained.”
Roberts and Kaye worked closely with Occupational Health to test N95 masks that were treated with the combination of UV light and heat. They found that treated masks retained their shape through multiple rounds of reprocessing.
“Individuals who tried the masks on before reprocessing and passed fit-testing also passed fit-testing after treatment, even when masks had been reprocessed as many as 10 times,” said Kaye.
Once the team agreed on a method for reprocessing and tested the method for effectiveness, CSPD began its work to put the plan into action.
“We went live with reprocessing on April 3,” said Jania Torreblanca, systems manager for CSPD and Sterilization. “We now have 55 active units across the institution, including ambulatory sites of care, and we continue adding units every day.”
Torreblanca reports an average daily volume of 400 masks reprocessed, with an average turnaround time of six to eight hours.
Participating units have a collection bin where used masks labeled with each employee’s name are placed in brown paper bags at the end of every shift. CSPD runners pick up the used masks and transport them to the reprocessing area.
From there, CSPD staff perform a visual inspection of each mask, disposing of any that are soiled, damaged or compromised, or have been reprocessed more than five times (tally marks on each mask indicate the number of times they have been through the UV light and heat treatment).
Once the masks are disinfected, they are placed into individual white paper bags and then inside a clean bin for return to the unit before employees arrive for their next shift.
“The impact of this has been huge,” said Torreblanca. “We have seen our burn rate of N95s reduced greatly.”
A meaningful milestone
The CSPD team recently celebrated an impressive milestone – reprocessing 10,000 masks. This achievement would not have been possible without the collaboration of numerous departments and professionals across the organization.
“Countless people have been involved in this work,” said Shawn Murphy, corporate director of Perioperative Services for Michigan Medicine. “We had our entire CSPD team, including leaders, staff and educators. We had leaders from the high-level disinfection team, the surgical team, the OR project manager, facilities, plus researchers, scientists, engineers, physicians, nurses and others.”
Murphy said many members of the collaborative team hadn’t met prior to this project and the way people came together was something to behold.
“There was such an esprit de corps among the team,” she said. “It was awesome and such an honor to be part of that work.”
Murphy said when the project began, it was a 24/7 endeavor with people in constant communication, making sure that every step of the way, the work was safe and following all of the process controls. She is grateful for the many hours devoted by all, and the time people spent away from their families to make reprocessing possible.
“This has truly been a multidisciplinary team effort involving experts and hard-working individuals from Michigan Medicine and the engineering school,” Kaye said. “This work could not have been done without the outstanding dedication of these people, and it’s really made me proud to work at Michigan Medicine and the University of Michigan in general.”