Shift to reusable PPE 'an immediate need' for public health — but transition won't be simple, experts say

The combination of several thin layers of fabric, staples, two elastic bands and a malleable metal strip has allowed health-care workers to breathe safely while on the front lines of the COVID-19 pandemic — but the masks have been working overtime.

Disposable personal protective equipment, including the N95 respirator, is only meant to be used once before being thrown out. But the pandemic caused a global supply shortage of disposable PPE, so health-care workers have had to extend the use of what they have.

"Nobody has enough N95 masks to use them in the way that they've been used and were designed to be used, so everyone's trying to extend them one way or the other," said Dr. Anand Kumar, a professor of medicine and microbiology at the University of Manitoba.

But Manitoba health-care workers should soon have a more useful mask at their disposal.

Precision ADM, a manufacturing company in Winnipeg, won a bid to make one million reusable N95 masks for the Manitoba government. The masks, designed by two Manitoba doctors, can be used up to 30 times with disinfecting after each use, says a news release from the province.

When the deal was announced, Lanette Siragusa, chief nursing officer for Manitoba Shared Health, hinted that a possible shift toward locally made reusable PPE could be on the horizon.

Although the number of active COVID-19 cases in Manitoba has been relatively low for weeks, Siragusa later told CBC News through a spokesperson that the shift is "an immediate need" due to the global shortage of disposable PPE and the potential for a second wave of COVID-19.

Risks come with extended use

Landing personal protective equipment has been difficult during the pandemic. Many of the products are made overseas, which creates supply chains so large that suppliers have a tough time tracking orders.

Countries that manufacture PPE are also constantly changing export regulations to ensure their own citizens have enough, which has caused delays elsewhere.

As a result, public health authorities were forced to use their PPE stocks sparingly. Shared Health created a colour-coded zone system for workers that dictates their PPE use per shift, with masks, gowns and associated gear appropriate to each zone.

In April, Kumar discovered ways to clean disposable masks that are accessible to all hospitals. Disposable N95 masks can be used about five times when cleaned, he says, but extended use can still pose risks.

Donning and doffing a disposable mask wears out its structural integrity until it doesn't fit properly, which could expose the wearer to droplets carrying the novel coronavirus that causes COVID-19, Kumar said.

"They'll lack protection when they think they have it, and they'll start getting an increasing number of infections."

That is what some believe happened to health-care workers in COVID-19 epicentres including New York, Italy and Spain, he said.

Wearing the gear for extended periods can also cause "quite a bit of a strain" on the worker, said Dr. Vanessa Meier-Stephenson, an infectious disease expert in Calgary.

Health workers going into areas where COVID-19 is present must wear PPE from head to toe, which makes it harder to function and can leave a mark if worn for long stretches, Meier-Stephenson said.

Taking off the gear to either throw it away or disinfect it at least gives a health-care worker's body a break.

Shift to reusable will take time

Both Meier-Stephenson and Kumar believe reusable PPE would have a significant impact now and in the future, but warn that the switch won't be simple.

"If we could guarantee that we had a way to recycle and reinstitute [PPE], it would certainly provide that little extra degree of confidence that we have that backup plan," Meier-Stephenson said.

Reusable PPE would also "be a great way to be able to ensure that you always have sufficient stock going forward."

But research would have to be done about which models work, and a minimum level of protection has to be established, she said.

Reusable PPE includes gowns and face shields, but of particular concern are reusable masks or respirators, which typically look like gas masks with two air filters. The masks can be cleaned, while the filter cartridges need replacing every few weeks, said Kumar.

"If you had one [each] for your entire workforce, and then some spare cartridges, then you're in pretty good shape," he said. "But nobody has that many."

Reusable items are more complicated to make and require large supply chains for the various pieces, Kumar said. That means an immediate and complete switch to the reusable gear isn't possible right now.

The feasibility of a shift to reusable PPE may come down to the manufacturers of disposable PPE, though, as switching to reusable products could affect their bottom line, said Meier-Stephenson, but "that's a whole other level of complexity."

Kumar expects at least one of two things to happen.

First — and he's sure this will happen — governments are "going to be doubling, tripling, quadrupling" the amount of PPE procured, just in case of emergencies. 

Second, there may be a shift toward stocking up on both disposable and reusable PPE, he said.

Completely replacing disposable PPE with reusable could take three or four years, Kumar said. 

Before a shift to reusable equipment can begin, though, a business analysis needs to be conducted to assess efficiency, Siragusa told CBC News.

How efficiency is measured depends on the particular product, she said, but the analysis would look at associated costs, product quality, how much of a product is needed, how often it can be reused safely and how to disinfect it, among other things.

In the meantime, Precision ADM is ramping up production. A prototype has been made and tested, so the company is tweaking its design to prepare for mass production, CEO Martin Petrak said.

The company has hired 30 people in the last six weeks, and may have to hire 50 to 100 more once mass production starts in about two or three months.

"It's not just a one-time thing," Petrak said, adding the province's decision to invest in local business will pay off, and that Precision ADM will be part of establishing the local supply chain for reusable PPE.

He said it's "a privilege" to work on a project locally. He hopes to make multiple mask designs and eventually help other industries, such as dentistry.