Interim Measures to Conserve Supply of N95 Respirators

April 6, 2020 - Amber Bitters

This document replaces the previous version published 03/17/2020.

It is imperative that departments with essential workers requiring scarce personal protective equipment implement measures to conserve our extremely limited supply of N95 respirators.  Extended use and limited reuse of N95 respirators is a legitimate strategy for extending scarce personal protective equipment in view of the current COVID-19 crisis. 

Extended Use of N95 Respirators

Extended use refers to wearing the same N95 for repeated encounters with several patients without removing the respirator between patient encounters.

  • Discard N95 respirators after use during aerosol generating procedures
  • Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients
  • Discard N95 respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions
  • Wear a face shield over an N95 respirator to reduce surface contamination
  • Wash hands with soap and water or use an alcohol-based hand sanitizer before and after touching or adjusting the respirator
  • Discard any respirator that is obviously damaged
  • Discard any respirator that becomes hard to breathe through
  • Discard respirator after 8 hours of continuous or intermittent use

Limited Reuse of N95 Respirators

Reuse refers to the practice of using the same N95 for multiple encounters with patients but removing it after each encounter. The respirator is stored in between encounters to be put on again.

  • Discard N95 respirators after use during aerosol generating procedures
  • Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients
  • Discard N95 respirators following close contact with any patient co-infected with an infectious disease requiring contact precautions
  • Discard N95 respirators after a maximum of 5 reuses
  • Do Not Share: N95 respirators can only be used by a single wearer
  • Wear a face shield over an N95 respirator to reduce surface contamination
  • Store respirators in a clean zip top bag between uses. To minimize potential cross-contamination, store respirators individually and label the bag with the name of the person using the respirator. Storage containers should be disposed of or disinfected regularly.
  • Wash hands with soap and water or use an alcohol-based hand sanitizer before and after touching or adjusting the respirator
  • Avoid touching the inside of the respirator. If inadvertent contact is made with the inside of the respirator, wash hands with soap and water or use an alcohol-based hand sanitizer
  • Use a pair of clean gloves when donning a used N95 respirator and performing a user seal check. Discard gloves after the N95 respirator is donned and any adjustments are made.
  • Inspect N95 respirators for physical damage before reuse

Risks of Extended Use and Limited Reuse of N95 Respirators

  • Most significant risk is of contact transmission from touching the surface of the contaminated respirator
  • Some devices have not been FDA-cleared for reuse
  • Some manufacturers’ product user instructions recommend discard after each use (i.e., “for single use only”), while others allow reuse if permitted by infection control policy of the facility

Alternatives to N95 Respirators

  • Half-mask air purifying respirators
  • Full facepiece air purifying respirators
  • Powered air purifying respirators (PAPRs)

Use of these alternatives require enrollment in the MSU Respiratory Protection Program; which includes medical evaluation; training and fit testing.

Annual Fit Testing Requirements

MSU is temporarily suspending the annual fit testing of N95 filtering facepiece respirators to preserve and prioritize the supply of respirators for use in situations where they are required to be worn.  This is in accordance with the Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak recently released by the Occupational Safety and Health Administration (OSHA).  

An initial fit test is still required for anyone wearing a respirator to protect against COVID-19.  Annual re-fitting can be temporarily suspended if the employee has already been fit tested to that respirator.

Reminders for those postponing annual fit testing:

  • Workers must perform a user seal check (i.e., a fit check) each time a respirator is put on to make sure they are getting an adequate seal
  • Workers must schedule an annual re-fitting if they observe visual changes in their physical conditions that could affect respirator fit (e.g., facial scarring, dental changes, cosmetic surgery, or obvious changes in body weight). This must be done because if the face shape has changed since the last fit test, the user may no longer be getting a good facial seal with the respirator, and would not be adequately protected
  • Workers should inform their supervisor if the integrity and/or fit of their N95 respirator is compromised

Information in this guidance document is based on the following:

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare

Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak

Enforcement Guidance for Respiratory Protection and the N95 Shortage Due to the Coronavirus Disease 2019 (COVID-19) Pandemic

Additional Resources:

MSU N95 Fact Sheet (PDF)

Donning/Doffing Guide (PDF, 5.57MB)