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Massachusetts General Hospital Shares Details of Its N95 Respirator Reuse Program

By: Julie E. Williamson

May 6, 2020

The COVID-19 pandemic has created a myriad of challenges for healthcare facilities, not the least of which includes shortages of N95 respirators and other types of personal protective equipment (PPE). In the face of such difficulties, however, some facilities are tapping innovative solutions and thinking outside the proverbial box to support patient care and meet the needs of frontline caregivers.

Massachusetts General Hospital (MGH), a Partners Healthcare facility in Boston, is a prime example. With the current daily demand for N95 respirators continuing to skyrocket and MGH consuming a week’s worth of N95 respirators in a single day, finding a solution to sustainably meet the new demand became critical. The MGH Innovation team, in partnership with its research community, began internal testing of various methods to effectively decontaminate N95 respirators, and vaporized hydrogen peroxide (VHP) showed promising results from the start, explained Meaghan Gray, Sr. Director of Central Sterile Processing and Supplies, at MGH. Through those internal efforts, the organization became aware of the Battelle VPH decontamination solution, which was then under review by the US Food and Drug Administration (FDA).

The FDA issued Battelle an Emergency Use Authorization (EUA) on March 29, 2020, and Partners Healthcare immediately began negotiations with the company. “MGH received its first batch of decontaminated N95 respirators on April 13, 2020 – just two weeks after partnering with Battelle,” said Gray.

With Battelle’s own technicians performing the VHP decontamination offsite in a vacant retail building, and MGH’s own team of technicians working hard at the hospital to sort, label, package and deliver the decontaminated N95 respirators to their original owners, it’s a shining example of teamwork – all rooted in a sincere desire to lend a hand where its needed most.

In the following Q&A, Gray shares more details about MGH’s/Partners Healthcare’s N95 reuse program through Battelle, including some the many steps involved to keep safety at the forefront, and how the program is giving clinicians a much-needed morale boost.

IAHCSMM: What sort of demand increase for N95 masks has MGH seen since dealing with COVID-19, and roughly how many masks are currently being decontaminated for your facility by Battelle each day?

Gray: The current daily demand for N95 respirators is unprecedented and continues to increase. Our weekly consumption of these devices is up by more than 500%. Imagine going through an entire week's worth of supply – in one day. This is our new reality, and this is every hospital's new reality.

The Battelle partnership has positively impacted our N95 respirator inventory, as more than 8,000 masks are decontaminated, packaged and returned to their original owners each week. It's hard to say how long the N95 shortage will go on, but until the supply chain is restored, I expect the Battelle facility will be busy.

IAHCSMM: Can you explain how the process workflow was established at MGH and what takes place once the decontaminated masks arrive from the offsite Battelle facility?

Gray: The Innovation team quickly identified that the Central Sterile Processing and Supply Department (CSPS) was equipped to operationalize this new high-volume process. One might say that the department was built for this type of work.

With music setting the pace, a small army of Sterile Processing, Endoscopy, and service line technicians work alongside administrative specialists, supervisors and managers to sort, label, package and deliver more than 4,500 masks in one day. It is truly a herculean effort.

The leadership team developed detailed workflows, standard operating procedures, and staffing projections to support this effort. Teams are organized by process function and all work together to return N95 respirators to their owners. Data is entered into our tracking software at each stage, providing real-time production metrics and enhanced process traceability.

Incoming work is segregated into unit batches, which are then further sorted by mask type. Those performing the 'sort' process function verify masks are labeled with MGH and an approved 2-digit unit code and indexed username; those that are not are discarded. Sorted masks move to the 'label' process function, and the team enters the indexed user's name and 2-digit unit code into the tracking system. This generates a unique label. The label is placed inside the mask and both are transported to the packaging station.

At the packaging station, the first team places masks into breathable containers that are pre-labeled with mask type and size, if applicable. The second team verifies that all labeling is accurate and applies the index user unique label, sealing the box. Once a unit batch is complete, the masks are transported in bulk to their home unit using surgical case carts.

I cannot stress enough the value of creating complete process documents before undertaking any large and complicated process.

IAHCSMM: Overall, has the program been well received by clinicians?

Gray: From the beginning, the MGH N95 respirator reuse program placed staff safety first. This commitment to safety drove the decision to return decontaminated N95s to their original owner. Also, the MGH is committed to monitoring the safety of this new and innovative process, and we routinely test the fit and filtration efficacy of masks decontaminated using the Battelle system.

A collaborative team took into consideration things like our current supply chain, staff comfort, mask strap fatigue, and the potential for wear and tear – and after much discussion, the decision to decontaminate the masks a maximum of five times was made. We, of course, agreed to revisit this in the future if necessary.

The attention to staff safety has paid off, and the feedback from our clinical colleagues is overwhelmingly positive. One user shared, "When I first learned of this process, it was such an enormous feeling of 'PPE relief.’ I felt like it was all going to be okay.” Since our initial roll-out, the process has expanded to include over 50 hospital units spanning inpatient and ambulatory settings.

IAHCSMM: At this time of reduced surgical case volume, has the Sterile Processing team at MGH taken on any other new roles/responsibilities, aside from what’s involved with the N95 reuse program?

Gray: The CSPS team at MGH, like many others across the nation, is experiencing a significant decline in surgical instrument reprocessing due to the reduced surgical caseload. This pause allowed our team to focus on cleaning up ‘old business' items such as completing incomplete instrument trays and completing a much-needed culling of our excess instrument back stock.

As for new responsibilities, the Battelle process is our new book of business and I'm delighted that our team can support the hospital's COVID-19 response in this way.