National Nurses United today rebuked new federal guidance encouraging hospitals and other health systems to allow multiple reuse and/or decontamination of N95 respiratory masks that nurses say will put thousands of health care workers at grave risk.

Guidance last week from the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety and Health (NIOSH), provided healthcare employers a green light for those practices, under the pretext of a shortage of the masks.

The CDC recommendation was promptly embraced by OSHA which handed assurance to employers that they won’t be cited for violating respiratory protection rules if they reuse N95 respirators or take other measures as long as they adhere to CDC guidance.

“In the midst of the worst global pandemic in a century, and growing numbers of nurses and other healthcare workers becoming, infected, relying on ventilators to breathe, and dying, the message from the federal government could not send a worse message,” said NNU Executive Director Bonnie Castillo, RN.

There is no validated, scientific evidence that multiple re-use or decontamination of N95 respiratory masks is safe, and will protect a health care worker from being infected when exposed to a patient with the virus, says NNU.

To date, at least 15 registered nurses in the U.S. have died of COVID-19, according to reports NNU has surveyed. The total number of deaths and infections of all health care workers have not been tallied but is certainly in the thousands, given global trends. According to the University of Washington's Center for Health Workforce Studies, the projected number of RN infected cases and deaths in the U.S. is in the range of "400,000 positive cases and 6,809 to 19,125 deaths" and it projects up to 2.5 million health care worker infections and 120,000 deaths.

 “Instead of relaxing protective standards that will lead to further decimation of the frontline caregiver workforce, leave fewer nurses at the bedside to care for patients, and prolong the crisis,” Castillo said, “the federal government should expand mass production and distribution of the only proven effective protective equipment – single use N95 respirator masks or re-usable powered air purifying respirators (PAPRs).”

In a letter Friday to the CDC and NIOSH (available upon request), Castillo warned that the agencies’ new guidance on decontaminating and reusing N95 filtering facepiece respirators “endangers nurses’ lives” at a time when “many employers have turned to decontaminating and reusing disposable N95 filtering facepiece respirators multiple times and for multiple shifts.

Previous moves by the CDC to weaken protective standards have already encouraged the erosion of safety practices in hospitals, warns NNU.

Castillo cited a March 6 letter signed by 14 labor unions “expressing our concerns about CDC’s intention—now guidance—to allow employers to (unsafely) use surgical masks, and now scarves and bandanas, when N95 filtering facepiece respirators are not available.” 

Each CDC substandard recommendation, Castillo wrote, “enables and emboldens hospitals and other healthcare employers to race to the lowest possible level of protection.”

The new guidelines come as many employers “have implemented practices that endanger the health and safety of nurses and other healthcare workers--including locking up N95 filtering facepiece respirators, restricting nurses’ access, and rationing the use of N95 filtering facepiece respirators--leaving nurses unprotected.

“NNU expressed our concerns about the danger of employers locking up, hoarding, and rationing PPE in a letter sent to the CDC on March 4, 2020,” Castillo noted. CDC has failed to respond to any of these concerns.

In the new letter Castillo cited substantial NNU research that “has determined that no decontamination method is both safe and effective.”

Those include such practices as use of ultraviolet germicidal irradiation, bleach, ethylene oxide, vaporized hydrogen peroxide, ionizing radiation, most/steam heat and microwaving masks.

Several of these methods can degrade the integrity of the respirators, melt them, and harm the health of workers who reuse them by causing, lung damage, upper airway irritation, hoarseness, shortness of breath, and a sensation of burning or tightness in the chest.

Additionally, NNU found consistent problems in the available evidence on decontamination methods for N95 filtering facepiece respirators. Many studies did not evaluate the ability of the decontamination method to inactivate pathogens, evaluate the effectiveness of the decontamination method on all surfaces, or examine the impact on outside of respirator only.

Many studies also failed to evaluate the impact of decontamination on all aspects important to respirator function- filtration, structural integrity, and face seal.

To make matters worse, the letter notes, the U.S. Food and Drug Administration (FDA) granted emergency use authorization to Battelle Memorial Institute on March 29, 2020 to use hydrogen peroxide vapor to decontaminate N95 filtering facepiece respirators. “Despite the FDA’s approval, the safety and effectiveness of this method (to the wearer) have not been adequately demonstrated. Additionally, there were no evaluations of the method’s effectiveness in decontamination the SARS-CoV-2 virus specifically.

“It is distressing that users of decontaminated N95 filtering facepiece respirators are not informed adequately of the potential risks and the investigative nature of the use of FDA-approved decontamination methods… we remain opposed to any guideline issued by any federal authority that condones the use of this method.”

“NNU urges the CDC and NIOSH to strengthen their guidance,” the letter concludes “to protect the nurses and other healthcare workers who are on the frontlines of this pandemic. “