a doctor's call for help! - n95 and surgical masks

[MTBmonkey]

Reaching out to the Bladeforums Family for help. Many of you know me from buying and selling knives over the years and I am proud to be part of this community. Like most of you, I love knives and have had a passion for knives since I was a little kid. I am a total knife nerd....

But I am also a doctor in my community and our clinic is desperate for N95 masks for emergent or urgent office visits, procedures, surgeries, and other medical care--so I am asking for your help. Most of my days are spent treating disease and managing operative care with older patients.

I AM NOT ASKING FOR DONATIONS. I will be happy to buy them.

I know some of you dabble in woodwork or knife making, or are hobbyists or even work in industry where masks may be available. If you have any, even if just 1 or 2--any help will be greatly appreciated. These n95 masks will definitely save lives. Most of us in clinics and hospitals will be fine even if we get sick. But what is to come in our country is that some of our older patients and even younger patients with underlying conditions will die because medical care is insufficient as medical providers are taken out of the battle due to being contagious themselves because we are so short on masks. And sadly, if doctors or medical staff become contagious, they may actually spread the virus to patients before they even realize or have symptoms, again..greatly in part to not having appropriate masks in the first place.

If you have n95 masks and for some reason, you do not feel comfortable sending masks to me, then please take them to your local providers. I assure you that they will be grateful. And I'm sure they will buy them. We are in need of even just normal surgical masks at this point. Please consider it and I am so appreciate of your help. If you want to help us, send me a PM for more information....and thank you.

I want to add one more thing-- and that is that I have many times seen people step up and I have been so impressed with this family and community of knife makers and collectors and enthusiasts and bush crafters, etc. I have never been burned in all of my knife dealings and have had many transactions and relationships with people that I only wish I could know in person. I have a busy life but I hope to have time to meet more of you someday. When I mentioned to my colleagues that I was going to reach out on the Fiddleback knife forum for help, they looked at me like I was crazy. I think they imagine a bunch of crazy peppers who don't care. On the contrary, this whole Bladeforum group has some of the most stand-up people that I can imagine to be associated with. These are the people that I want to be in the trenches with and who know and appreciate what our country is supposed to stand for. I want you to be healthy and keep your family safe too. Don't give them all away, save some for you and your family. But again, if you have or know of where you can scramble up extra masks, please do and even if you don't send them my way, please help out your medical community and make a difference. This older generation has paid an amazing and terrible price for our freedom and we owe them.

Thanks for hearing me out and letting me use this forum in this way (I apologize if this comes off wrong to anyone in any way)...and God Bless you and your families and keep you safe.
-wade

*If you are interested in helping and would like to look me up, please send a PM and I can give more contact information reference to my clinic website, etc. Thank you!

 

[annr]

I was hoping you’d get some replies—and hope you got some PMs.

I found an old mask I am going to try to recycle for a cancer patient and continue to dig through my drawers and bags.

I spoke with a retired physician today and he said that some manufacturers (pillows?) are retooling to make masks— something you may or may not have time to read about.

I also read a physician-directed story about the dire shortages and how medical staff are being muzzled and penalized for exposing this fact to the public.

Good luck and I hope you remain well. Things shouldn’t be this way…yet they are…

 

[MTBmonkey]

Thanks brother. Yes it is getting crazy and we are desperate in our clinic for gear. We all need it but only the larger hospitals are getting any of the distribution and midsized and smaller hospitals and clinics have a long wait. Its a lose-lose if our hospitals and clinic staff get sick...they will either be unavailable, or they will become part of the problem by spreading it themselves because they don't have protective gear.

It is a big deal, and here's why:

Anyone that unknowingly becomes infected will almost certainly be a link in the chain that leads to someone's suffering or death...its just an unfortunate fact. This is mainly because you are contagious well before you even have symptoms (and well afterwards also), so it is very easy to pass it along and not even know it.

Our average patient is over 65yo. We are only seeing emergencies right now, but we deal with a lot of emergencies that also have heart or respiratory conditions or other risk factors for COVID-19 related morbidity and mortality. This virus is already forcing us to rethink the boundaries of what is truly an "emergency" given the risks, age, health, etc and it could really tie our hands in being able to help people the worse it gets.

Again you all, many thanks!!! All be safe.

We are still asking to buy both n95 masks and even surgical masks. Please PM me if you have or need info.
-wade

 

[gazz98]

MTBmonkey I wish I could help. I don't know what else to say other then "Thanks for all you do", good luck, stay strong, and stay safe.

I've been given one surgical mask from work and told to disinfect it every night.

 

[annr]

gazz98 how do you disinfect?

 

[annr]

MTBmonkey

Here is what is am wondering (reposted from another thread):

What about ventilation systems?

Isolation rooms of CV patients were tested pre- and post- cleaning. Among other places, the virus was found in the ventilation fan.

So, when we go to the supermarket (where possibly 1 or more employee tested positive), and although they practice distancing, cleaning, etc., how do we know that the HVAC system is clean?

Same for hospitals…?

This question applies to all scenarios where we try to wash hands and follow guidelines. The Marriott longwarf (biogen conference CV locus) CLOSED for cleaning, not like overnight cleaning in a supermarket.

ETA: the virus was found 17 days later on the cruise ship (pre-cleaning).

 

[gazz98]

gazz98 how do you disinfect?

I have a hospital disinfectant in a spray bottle. I saturate the mask and let it dry over night. Is it the ideal situation? No but since I don't have a supply of masks, its the best I can do. I also am currently not working and only going out to grocery shop when I have too.

 

[annr]

gazz98 Thanks. I get it, none of this is ideal. Do you know what is in the disinfectant? Active ingredients?
_________________________________________________________________
MTBmonkey Sorry, I didn't want to highjack your thread, just want people to see what is on the table.
_________________________________________________________________
I have heard MDs are putting in paper bags between uses. See CDC on this topic for HEALTHCARE SETTINGS (click on link for references). I had to split in separate posts:
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html#respreuse

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings
CDC or NIOSH website for guidance related to implementing the other recommended approaches for conserving supplies of N95 respirators.

There are also non-emergency situations (e.g., close contact with patients with tuberculosis) where N95 respirator reuse has been recommended in healthcare settings and is commonly practiced.(5-9) This document serves to supplement previous guidance on this topic.

Definitions
Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients, without removing the respirator between patient encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. Extended use has been recommended as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.(10, 11)

Reuse1 refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (‘doffing’) after each encounter. The respirator is stored in between encounters to be put on again (‘donned’) prior to the next encounter with a patient. For pathogens in which contact transmission (e.g., fomites) is not a concern, non-emergency reuse has been practiced for decades.(7) For example, for tuberculosis prevention, CDC recommends that a respirator classified as disposable can be reused by the same worker as long as it remains functional2 and is used in accordance with local infection control procedures.(9) Even when N95 respirator reuse is practiced or recommended, restrictions are in place which limit the number of times the same FFR is reused.Thus, N95 respirator reuse is often referred to as “limited reuse”. Limited reuse has been recommended and widely used as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.(2, 3, 10-12)

Implementation
The decision to implement policies that permit extended use or limited reuse of N95 respirators should be made by the professionals who manage the institution’s respiratory protection program, in in consultation with their occupational health and infection control departments with input from the state/local public health departments. The decision to implement these practices should be made on a case by case basis taking into account respiratory pathogen characteristics (e.g., routes of transmission, prevalence of disease in the region, infection attack rate, and severity of illness) and local conditions (e.g., number of disposable N95 respirators available, current respirator usage rate, success of other respirator conservation strategies, etc.). Some healthcare facilities may wish to implement extended use and/or limited reuse before respirator shortages are observed, so that adequate supplies are available during times of peak demand. For non-emergency (routine) situations, current CDC recommendations (6, 9) specific to that pathogen should also be consulted.

 

[annr]

Continued: The following sections outline specific steps to guide implementation of these recommendations, minimize the challenges caused by extended use and reuse, and to limit risks that could result from these practices.

Respirator Extended Use Recommendations
Extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission. Please see the section on Risks of Extended Use and Reuse of Respirators for more information about contact transmission and other risks involved in these practices.

A key consideration for safe extended use is that the respirator must maintain its fit and function. Workers in other industries routinely use N95 respirators for several hours uninterrupted. Experience in these settings indicates that respirators can function within their design specifications for 8 hours of continuous or intermittent use. Some research studies (14, 15) have recruited healthcare workers as test subjects and many of those subjects have successfully worn an N95 respirator at work for several hours before they needed to remove them. Thus, the maximum length of continuous use in non-dusty healthcare workplaces is typically dictated by hygienic concerns (e.g., the respirator was discarded because it became contaminated) or practical considerations (e.g., need to use the restroom, meal breaks, etc.), rather than a pre-determined number of hours.

If extended use of N95 respirators is permitted, respiratory protection program administrators should ensure adherence to administrative and engineering controls to limit potential N95 respirator surface contamination (e.g., use of barriers to prevent droplet spray contamination) and consider additional training and reminders (e.g., posters) for staff to reinforce the need to minimize unnecessary contact with the respirator surface, strict adherence to hand hygiene practices, and proper Personal Protective Equipment (PPE) donning and doffing technique.(16) Healthcare facilities should develop clearly written procedures to advise staff to take the following steps to reduce contact transmission after donning:

• Discard N95 respirators following 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.
• Consider use of a cleanable face shield (preferred3) over an N95 respirator and/or other steps (e.g., masking patients, use of engineering controls) to reduce surface contamination.
• Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

Extended use alone is unlikely to degrade respiratory protection. However, healthcare facilities should develop clearly written procedures to advise staff to:

• Discard any respirator that is obviously damaged or becomes hard to breathe through.

 

[annr]

Continued:
Respirator Reuse Recommendations
There is no way of determining the maximum possible number of safe reuses for an N95 respirator as a generic number to be applied in all cases. Safe N95 reuse is affected by a number of variables that impact respirator function and contamination over time.(18, 19) However, manufacturers of N95 respirators may have specific guidance regarding reuse of their product.The recommendations below are designed to provide practical advice so that N95 respirators are discarded before they become a significant risk for contact transmission or their functionality is reduced.

If reuse of N95 respirators is permitted, respiratory protection program administrators should ensure adherence to administrative and engineering controls to limit potential N95 respirator surface contamination (e.g., use of barriers to prevent droplet spray contamination) and consider additional training and/or reminders (e.g., posters) for staff to reinforce the need to minimize unnecessary contact with the respirator surface, strict adherence to hand hygiene practices, and proper PPE donning and doffing technique, including physical inspection and performing a user seal check.(16) Healthcare facilities should develop clearly written procedures to advise staff to take the following steps to reduce contact transmission:

• Discard N95 respirators following 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.
• Consider use of a cleanable face shield (preferred3) over an N95 respirator and/or other steps (e.g., masking patients, use of engineering controls), when feasible to reduce surface contamination of the respirator.
• Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses. To minimize potential cross-contamination, store respirators so that they do not touch each other and the person using the respirator is clearly identified. Storage containers should be disposed of or cleaned regularly.
• Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).
• Avoid touching the inside of the respirator. If inadvertent contact is made with the inside of the respirator, discard the respirator and perform hand hygiene as described above.
• Use a pair of clean (non-sterile) 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 to ensure the respirator is sitting comfortably on your face with a good seal.

To reduce the chances of decreased protection caused by a loss of respirator functionality, respiratory protection program managers should consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model(s) used in that facility. If no manufacturer guidance is available, preliminary data(19, 20) suggests limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin. Management should consider additional training and/or reminders for users to reinforce the need for proper respirator donning techniques including inspection of the device for physical damage (e.g., Are the straps stretched out so much that they no longer provide enough tension for the respirator to seal to the face?, Is the nosepiece or other fit enhancements broken?, etc.). Healthcare facilities should provide staff clearly written procedures to:

• Follow the manufacturer’s user instructions, including conducting a user seal check.
• Follow the employer’s maximum number of donnings (or up to five if the manufacturer does not provide a recommendation) and recommended inspection procedures.
• Discard any respirator that is obviously damaged or becomes hard to breathe through.
• Pack or store respirators between uses so that they do not become damaged or deformed.

Secondary exposures can occur from respirator reuse if respirators are shared among users and at least one of the users is infectious (symptomatic or asymptomatic). Thus, N95 respirators must only be used by a single wearer. To prevent inadvertent sharing of respirators, healthcare facilities should develop clearly written procedures to inform users to:

• Label containers used for storing respirators or label the respirator itself (e.g., on the straps(11)) between uses with the user’s name to reduce accidental usage of another person’s respirator.

Risks of Extended Use and Reuse of Respirators
Although extended use and reuse of respirators have the potential benefit of conserving limited supplies of disposable N95 respirators, concerns about these practices have been raised. Some devices have not been FDA-cleared for reuse(21). 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.(19) The most significant risk is of contact transmission from touching the surface of the contaminated respirator. One study found that nurses averaged 25 touches per shift to their face, eyes, or N95 respirator during extended use.(15)Contact transmission occurs through direct contact with others as well as through indirect contact by touching and contaminating surfaces that are then touched by other people.

Respiratory pathogens on the respirator surface can potentially be transferred by touch to the wearer’s hands and thus risk causing infection through subsequent touching of the mucous membranes of the face (i.e., self-inoculation). While studies have shown that some respiratory pathogens (22-24) remain infectious on respirator surfaces for extended periods of time, in microbial transfer (25-27) and reaerosolization studies (28-32) more than ~99.8% have remained trapped on the respirator after handling or following simulated cough or sneeze.

Respirators might also become contaminated with other pathogens acquired from patients who are co-infected with common healthcare pathogens that have prolonged environmental survival (e.g., methicillin-resistant Staphylococcus aureas, vancomycin-resistant enterococci, Clostridium difficile, norovirus, etc.). These organisms could then contaminate the hands of the wearer, and in turn be transmitted via self-inoculation or to others via direct or indirect contact transmission.

The risks of contact transmission when implementing extended use and reuse can be affected by the types of medical procedures being performed and the use of effective engineering and administrative controls, which affect how much a respirator becomes contaminated by droplet sprays or deposition of aerosolized particles. For example, aerosol generating medical procedures such as bronchoscopies, sputum induction, or endotracheal intubation, are likely to cause higher levels of respirator surface contamination, while source control of patients (e.g. asking patients to wear facemasks), use of a face shield over the disposable N95 respirator, or use of engineering controls such as local exhaust ventilation are likely to reduce the levels of respirator surface contamination.(18)

While contact transmission caused by touching a contaminated respirator has been identified as the primary hazard of extended use and reuse of respirators, other concerns have been assessed, such as a reduction in the respirator’s ability to protect the wearer caused by rough handling or excessive reuse.(19, 20) Extended use can cause additional discomfort to wearers from wearing the respirator longer than usual.(14, 15) However, this practice should be tolerable and should not be a health risk to medically cleared respirator users.(19)

 

[Eversion]

Mini thread resurrection here, apologies.

If you'd find it interesting, I've recently designed a 3D filament printable mask which takes an N95 circular insert about an inch in diameter. It's not ideal, but it'll perhaps help you stretch your available resources a bit.

If you want the files and can print it on your end, feel free to distribute the masks and the print files to anyone and everyone you wish.

I can send the files to anyone else that's interested, just send me a message.

 

[MTBmonkey]

Sure...message sent!