Many infection preventionists working at hospitals and other healthcare organizations claim frontline workers are reusing personal protective equipment as surges of COVID-19 occur across the U.S.
A survey released Thursday by the Association for Professionals in Infection Control and Epidemiology found of the 1,083 infection preventionists who responded, 68.7% reported extended use or reuse was being applied to surgical masks while 73% said the policy was used for respirators. Additionally, 43.8% said isolation gowns and 10% said gloves were being worn more than once or for an extended time period.
The reuse of respirators, surgical masks, gloves and isolation gowns is concerning because they were intended to be used only one time, said Terri Rebmann, a member of APIC's COVID-19 task force and professor of epidemiology at St. Louis University College.
"We don't have a lot of data (about the safety of reusing PPE) and that is where it's a little concerning," she said. "We don't have definitive evidence that reusing that equipment isn't harmful."
There has been some research since the pandemic about the effectiveness of N95 respirators after more than one use and after decontamination processes, but Rebmann said she isn't aware of research exploring the safety of using surgical masks more than once. "We have zero scientific evidence that it's safe and effective to do that," she said.
The survey shows 56.8% of respondents are at healthcare organizations where using the surgical or medical mask as many times as possible is the practice.
Additionally, 38.6% of respondents said frontline caregivers are asked to wear a respirator mask as many times as possible while 37.3% said caregivers are told to use it for five days and 13% responded staff are told to use it for three days.
The patient safety organization ECRI and others have criticized the reuse of N95 respirators at healthcare organizations throughout the pandemic. Healthcare organizations have responded to a shortage of N95 masks by telling caregivers to wear the respirator more than once, usually using a decontamination process such as ultraviolet light or hydrogen peroxide.
The Centers for Disease Control and Prevention have released guidance on extended use of PPE such as N95 respirators and isolation gowns. Healthcare organizations must follow that guidance to ensure its not putting frontline workers in harm's way, said Connie Steed, APIC president.
"Our providers are going through PPE fatigue so we can't let our guard down and we have to continue to communicate with professionals about proper use (of PPE) and safety," she said.
There is some evidence from APIC that supply of PPE has improved in general. In a March survey, APIC found 20.5% infection preventionists reported their organization had no respirators and nearly 28% said their organization was almost out. In the most recent survey, 60.2% responded there was a sufficient amount of respirators.
Rebmann said the findings from both surveys aren't entirely comparable because the exact same people didn't respond to the survey, but she said there is likely improvements in supply because reuse is much more commonplace now than it was in March.
Steed said PPE reuse is still occurring so widely because healthcare organizations are anticipating the next three months will only bring more spikes in COVID-19 as flu season carries on along with upcoming holidays that encourage social gatherings.
"Part of the strategy for some of the reuse is to ensure that you don't completely run out of PPE," she said.
The survey also found that many infection preventionists are worried about patient safety. Fifty-four percent of respondents said they are somewhat or strongly concerned about safety of care during this surge.
Rebmann said that may be because of workforce exhaustion and fuller hospital beds.
"They are concerned about many aspects that could potentially lead to issues with providing adequate healthcare," she said.
APIC conducted the survey from Oct. 22 to Nov. 5. Most of the respondents — 59% — work in hospitals. Twenty-seven percent work in the ambulatory space. APIC represents 11,922 infection preventionists in the U.S.