Information on the safe reuse of N95 masks is in flux with different groups making different recommendations. The Registered Nursing Organization recommends that nurses wear one N95 mask for a shift and store it where air can circulate around it for 24 hours before using it again. They suggest that the surfaces of the mask are treated as contraindicated at all times and that nurses pay attention to cleaning their hands properly after putting on or taking off the mask and avoid touching the mask while it is worn.1
Hospitals are moving towards sanitation of N95 masks through ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist or dry heat application. These methods require specialized equipment not available to massage professionals.2
Originally many hospitals recommended that health care professionals rotate masks every 24 hours by placing masks to “air” in a breathable paper sack. The idea was that SARS-CoV-2 would dry up and die on the surface of the mask within 24 hours. Research that has since been discredited suggested that COVID lives on mask surfaces for 17 hours.
Current research recently published in the New England Journal of Medicine suggests SARS-CoV-2 remains on surfaces longer than first reported and that differences in environmental conditions like temperature and humidity contribute to variations in the length of time COVID remains viable. Researchers in this study showed that the virus is stable on plastic and stainless steel and detectable on such surfaces for 72 hours. On copper SARS-CoV-2 lasted 4 hours and on cardboard, no viable virus was detected after 24 hours.3
Another study showed that detectable levels of infectious virus could still be present on the outer layer of a surgical mask after 7 days.4
However, just because viral culture can be detected on a surface it doesn’t necessarily mean that the surface is highly infectious. Although SARS-CoV-2 droplets remain active while airborne for up to three hours, it becomes increasingly less infectious with every passing minute.4
The updated recommendation by the CDC is that each health care professional is issued five N95 masks. A mask is placed in a paper sack at the end of a shift and left where air can circulate around the mask for five days before it is worn again.5
As massage professionals we must reconcile a number of factors as we contemplate managing our personal safety and the realities of N95 facemask availability.
- Are N95 masks available? Perhaps we can get hold of five N95 masks and reuse them applying the CDC recommendations and feel a high level of protection. It is more likely that N95 masks will not be available or we are only able to get hold of one or two masks. In this case, we could opt to rotate the use of our N95 masks with surgical masks. However, we must understand that surgical masks will not protect us from small particle respiratory droplets.
- How high is the COVID caseload in the community? If the caseload is lower than we are at less risk of encountering an asymptomatic client and we may feel safe enough in a surgical mask. If the caseload is higher than our chances of encountering an asymptomatic client are higher and we must decide if we feel safe enough in a surgical mask.
- Do we have underlaying conditions that place us at high risk of a serious case of COVID if we are exposed? If yes, we’ll want to be in N95 masks if we decide to open our practices.
- What’s your level of compliance with guidelines? Maybe we are willing to practice exceptional PPE safety, putting on and taking off masks properly as well as cleaning our hands if we absentmindedly touch the surface of the mask. Maybe we feel safe enough simply treating the outer surface of the mask as contaminated and handling it with a high level of caution.
With so many variables left undetermined, it’s advisable to err on the side of caution.
Remember, when your mask shows wear or remains damp inside and no longer conforms to your face, or if you start to have difficulty breathing in the mask, it should be replaced.
- Burger, C. How to reuse PPE. Registered Nursing Organization. April 2020. Available at https://www.registerednursing.org/how-reuse-ppe.
- Cheney, C. How to Conserve Your PPE During the Coronavirus Pandemic. Health Leaders Media. April 03, 2020. Available at https://www.healthleadersmedia.com/clinical-care/how-conserve-your-ppe-during-coronavirus-pandemic.
- Van Doremalen, N., et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1.J New England Journal of Medicine, 2020.
- Chin, AH., Chu, JT., Perera, MRA., et al. Stability of SARS-CoV-2 in different environmental conditions. The Lancet. April 2020. Available at https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30003-3/fulltext
- Coronavirus Disease 2019. Decontamination and Reuse of Filtering Facepiece Respirators. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
Original research – now missing from the CDC website: “COVID-19 Decontamination and Reuse of Filtering Facepiece Respirators.” Centers for Disease Control and Prevention, 11 Feb. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html. Accessed 25 Apr. 2020.