A cost-effective strategy for healthcare systems to offset N95 mask shortages due to the COVID-19 pandemic is to switch to reusable elastomeric respirator masks, according to a new study. These long-lasting masks, often used in industry and construction, cost at least 10 times less per month than disinfecting and reusing N95 masks meant for a single use, say authors of the study, published ahead of print in the Journal of the American College of Surgeons.

The study is one of the first to evaluate the cost-effectiveness of using elastomeric masks in a healthcare setting during the COVID-19 pandemic, says Sricharan Chalikonda, MD, MHA, FACS, lead study author and chief medical operations officer for Pittsburgh-based Allegheny Health Network (AHN), where the study took place.

Disposable N95 masks are the standard face covering when healthcare providers require high-level respiratory protection, but during the pandemic, providers experienced widespread supply chain shortages and price increases, Chalikonda says. He says hospitals need a long-term solution.

“We don’t know if there will be a shortage of N95s again. We don’t know how long the pandemic will last and how often there will be virus surges,” he says. “We believe now is the time to invest in an elastomeric mask program.” Chalikonda says an immediate supply of elastomeric masks in a healthcare system’s stockpile of personal protective equipment is “game-changing,” given the advantages.

Benefits of Elastomeric Masks

Elastomeric masks are made of a tight-fitting, flexible, rubber-like material that can adjust to nearly all individuals’ faces and can withstand multiple cleanings, Chalikonda says. These devices, which resemble gas masks, use a replaceable filter. According to the Centers for Disease Control and Prevention (CDC), elastomeric masks offer healthcare workers equal or better protection from airborne infectious substances compared with N95 masks.

Like many hospitals during the COVID-19 crisis, AHN was disinfecting and reusing N95 masks for a limited number of uses. However, Chalikonda says, “Many caregivers felt the N95 masks didn’t fit quite as well after disinfection.” At the end of March, AHN began a one-month trial of a half-facepiece elastomeric mask covering the nose and mouth. The mask holds a P100-rated cartridge filter, meaning it filters out almost 100% of airborne particles.

Until AHN could procure more elastomeric masks, the system began its program for P100 elastomeric mask “super-users”: those providers who have the most frequent contact with COVID-19 patients. At each of AHN’s nine hospitals in Pennsylvania and Western New York, the first providers to receive the new masks were respiratory therapists, anesthesia providers, and emergency department and intensive care unit (ICU) doctors and nurses. 

Initially, providers shared the reusable masks with workers on other shifts, and the masks underwent decontamination between shifts using vaporized hydrogen peroxide similar to the technique used to sterilize disposable N95 masks. As more masks became available, workers kept their own mask and disinfected it themselves according to the manufacturer’s guidelines. Gradually, AHN provided more staff with the new masks. 

Among nearly 2,000 healthcare providers receiving fit testing for an elastomeric mask (as required for any mask to make sure no unfiltered air penetrates it), 94% could wear one, the investigators report. The small number of workers without a proper fit received an alternate type of respirator mask.

After a month of use, no one wearing an elastomeric mask chose to return to an N95 mask, according to the authors. Regarding the elastomeric masks, Chalikonda says, “Our clinicians were very comfortable with the fit, knowing it was an equivalent if not superior amount of protection, and that these masks were intended to be reused.”