Shortages of personal protective equipment (PPE) have plagued the U.S., on and off, since the start of the coronavirus epidemic. As the nation faces an alarming increase in new COVID-19 cases and hospitalizations, concerns about the safety of heath care workers are top of mind once more.
One nurse on the front lines, Rick Lucas, told TODAY, that he's worried about the number of times he's required to wear the same N95 mask at work. At Lucas' Ohio hospital and across the country, these life-saving respirators are being decontaminated with chemicals or UV light and returned to medical professionals, despite previous guidance from the Food and Drug Administration that they not be reused or shared. Due to COVID-19, the FDA is now permitting decontaminated N95s to be reused when no other N95s or other FDA-approved respirators are available.
"After months and months and months of wearing decontaminated reused PPE, it’s just so unsettling and so disheartening," Lucas said.
He's not alone in his feeling, either. Roughly 58% of nurses in the U.S. are being required to reuse their N95 masks, and 53% say reusing a decontaminated mask makes them feel unsafe, according to a September survey by the American Nurses Association.
At Lucas' hospital, health care workers usually wear an N95 five times before it's decontaminated, he explained, adding that by the time the mask is returned, it's not always in the best shape.
"There's two elastic bands on the back, so a lot of times those are worn," he said. "They sometimes break really easily. They will just snap. They come back stained with oil on the inside where it's up against somebody’s face."
Lucas' hospital told NBC News in a statement that any masks that are dirty or damaged after reprocessing can be thrown out.
The research into whether N95s can be reused and decontaminated without hurting their effectiveness is ongoing, but it appears that some methods do damage masks and others don't, Richard Peltier, Ph.D., who studies exposure science at University of Massachusetts Amherst, told TODAY.
He added that some decontamination processes can break down a mask when they're repeated, even if the difference is not immediately noticeable.
"It's dangerous," he said. "Health care workers who are grabbing these off the shelf don't have the time or ability to evaluate whether the mask is functional or not."
Peltier and National Nurses United, the largest nurses union in the country, are especially concerned by one of the more prevalent decontamination strategies invented by a company called Battelle. It uses vaporized hydrogen peroxide to decontaminate hundreds of masks at a time and is one of 12 methods given emergency use authorization by the FDA. What's more, Batelle is the only company that has a contract with the federal government, worth $400 million, so it can offer its services to hospitals for free.
Peltier asked Battelle for samples of decontaminated masks to study, but the company declined. He's gathered a few from individual health care workers, but it's not enough to come to any meaningful conclusion about the effectiveness of the method, he said.
"We don't know if they're gonna fail right away or fail over time," he told TODAY. "As scientists, we have to protect those who are putting themselves in harm's way."
Health care workers have already been expressing concerns about Battelle's methods, according to Jane Thomason, an industrial hygienist with National Nurses United who's reviewed multiple public studies on decontamination methods, including Battelle's.
"(Health care workers) report respiratory impacts. They report skin irritation, even approaching the level of chemical burns," she told TODAY.
Earlier this month the FDA sent Battelle a warning letter saying the company hasn't been properly reporting adverse events. Battle declined to be interviewed on camera for TODAY and sent a statement explaining that the complaints they've received are a "fraction of a percent" of the 3.2 million masks they've decontaminated so far. It added that the company's conducted numerous studies of decontaminated masks and found no issue with fit or performance and that the masks can be decontaminated more than 50 times and still be safe.
Some nurses say that decontamination gives them more confidence in their safety, not less. Yvonne Hoppes in El Paso, Texas, told TODAY that Battelle decontaminates about 200 N95s a week at her hospital and she hasn't had any issues.
"Doing the decontamination with Battelle is extremely beneficial to not only maintain appropriate levels of PPE, but (it) also gives a level of confidence for your workforce," she said.