Woman examining mask
Each N95 respirator goes through a series of inspections. Here, a member of UHN's Medical Devices Reprocessing Department marks the elastic strap to indicate the respirator will be reprocessed. (Photo: UHN)

COVID-19 has put enormous pressure on healthcare systems and sharpened focus on emergency preparedness.

At UHN, that has led to development of an unprecedented process to ensure a healthy stockpile of a key piece of personal protective equipment – N95 respirators, which are being reprocessed and stored for possible use if a second wave of the coronavirus leads to supply shortages.

"We need to be prepared for any future shortages that may arise," says AnnMarie Tyson, Director of UHN's Medical Devices Reprocessing Department (MDRD).

"This system, as novel as it is, is something we can all feel confident in, and proud of."

The reprocessed respirators are not being used now, explains AnnMarie, "but are being processed and then stored away by size and manufacturer type should we need to access them."

N95 respirators are high-level facial protection for the nose and mouth, which should only be worn in healthcare settings. When used properly, they filter more than 95 per cent of particles that may be present in the air, protecting the healthcare worker from potential infections.

The demand for N95 respirators grew exponentially in earlier stages of the COVID-19 pandemic, creating uncertainty of supply in many countries, including Canada.

UHN procurement efforts have guaranteed there's a minimum 30-day supply on hand. Still, leadership decided it was important to be prepared.

"As a leading academic hospital, we have to think ahead and prepare for every scenario," says Dr. Fayez Quereshy, Interim Vice-President and Site Lead at Toronto General Hospital (TGH).

"Among the many lessons to be learned during this pandemic, a very important one is that emergency preparedness is absolutely critical."

Developing the program

N95 respirators were originally designed for single use, so reprocessing them was entirely new territory.

"It's something that has never been done before," says AnnMarie.

"We've developed best practices in setting up our respirator reprocessing labs and continue to apply scientific rigour through testing and investigation as we build our program. 

"We are also collaborating with governing and regulatory bodies to guide our work, so we can be confident we have a safe process in place for storage and retrieval, if we need to."

With the greenlight from Health Canada and Ontario Health, and in consultation with suppliers, UHN has already reprocessed and stockpiled more than 2,300 N95 respirators of various sizes.

Given the unprecedented nature of this work, there's no set shelf life for the reprocessed respirators. Frequent tests are done to assess their efficacy in case they are needed.

Behind the scenes

Staff wearing an N95 respirator have been instructed to examine it when they take it off. If there are missing parts, broken bands, makeup residues or any signs of bodily fluids, it's thrown out.

UHN has two N95 respirator reprocessing labs, one at TGH and one at Toronto Western Hospital.

Once the respirator arrives at a lab, it goes through three inspection tables where it is further checked under a magnifying glass and light for visible gross soils and damage.  If the respirator passes these inspections, it's considered a candidate for reprocessing.

The N95 respirator is then packaged, sealed and processed in the same machine used to sterilize delicate medical instruments.

After the process is completed, the N95s pouch is cracked open and allowed to aerate, resealed, labeled, stamped for quality control, and safely stored away.

Watch the video from UHN's MDRD detailing the N95 Respirator Reprocessing Program. 


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