#GetMePPE/ #medtwitter: what does your hospital say re: elastomeric respirators?

Used mainly in industry, filters have same/comparable standards but unlike N95 masks, they are designed for reuse

CDC approves but wondering why there doesn't seem to be a big effort to gather these
Approval from @CDCgov:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html
Everywhere on the chart there's N95, elastomeric respirator (presumably w/ comparable filters) is listed as an alternative.
Here's a 2017 blog post from the CDC, subtitled "The Overlooked Elastomeric," which says that elastomeric respirators' potential for reuse "makes [them] valuable...during a pandemic."

So... right now? #COVID19 #GetMePPE #GetUsPPE
https://blogs.cdc.gov/niosh-science-blog/2017/07/06/elastomerics/
I understand they're a bit more complicated to use, but given the shortage, I have NO IDEA why our governments aren't clamoring for these.
THEY'RE REUSABLE. THE FILTERS (which probably last longer bc they're less exposed to elements) ARE SMALLER/SIMPLER/PROB EASIER TO MANUFACTURE
Which disposable piece of equipment looks easier to manufacture, the N95 respirator (with multiple parts) on the left, or the R95 (equivalent protection to N95) filter insert for an elastomeric on the right?
Which disposable piece of equipment looks easier to manufacture, the N95 respirator (with multiple parts) on the left, or the R95 (equivalent protection to N95) filter insert for an elastomeric on the right?
Which disposable piece of equipment looks easier to manufacture, the N95 respirator (with multiple parts) on the left, or the R95 (equivalent protection to N95) filter insert for an elastomeric on the right?
GOVERNORS: you're prob not going to get the # of N95 masks that you need so FIND OUT which industries in your state use elastomeric respirators.
You need multi-pronged approach to PPE shortage; these are CDC-approved & REUSABLE @NYGovCuomo @JohnBelforLA @GavinNewsom @PhilMurphyNJ
On Friday @usnews/ @WebMD ran an article on this (same article) about a recent study on these (already CDC-approved before that but testing how fast it takes health care workers to learn.)

It didn't take healthcare workers longer to learn how to use them!

https://www.webmd.com/lung/news/20200327/respirator_masks_-_in_short_supply
So it looks like a stumbling block is that there isn't a protocol in place for "how best to disinfect" them in a healthcare setting.

You know what else isn't according to protocol? Re-using disposable N95s!
In the meantime, THERE ARE INSTRUCTIONS ON HOW TO DISINFECT THEM in the package.
Disconnect the cartridge/filters. Dunk the plastic part in a bleach solution.
EVEN THE CDC says if there's not time for that, wipe the exterior w/ alcohol.
https://blogs.cdc.gov/niosh-science-blog/2017/07/06/elastomerics/
Don't get me wrong, really glad @bcmhouston has a group studying elastomeric half-face respirators. It's useful info to know how quickly healthcare workers can learn how to use what is (for most of them) an unfamiliar piece of equipment.
But to hospitals & state governments-- you didn't need to wait for this study on elastomerics.
There is a pandemic RIGHT NOW.
Established protocol for disposable N95s aren't feasible RIGHT NOW.
Existing CDC guidelines allow for this equipment. WHY IS IT NOT BEING USED? #COVID19
Would you look at that? @OSHA_DOL put out a statement on March 14 clarifying that "reusable elastomeric respirators with appropriate filters or cartridges" can be used in a healthcare setting.

https://twitter.com/OSHA_DOL/status/1238880092337684487
(Also, OSHA is generally relaxing enforcement of safety standards given the shortage, in case that was a barrier for any reason. Though given the existing CDC approval of elastomeric respirators, I'd assume it shouldn't have been an issue?) https://www.dol.gov/newsroom/releases/osha/osha20200314
FDA is also on board (though maybe just in the last few days?) https://twitter.com/SteveFDA/status/1244285952929005569
Letter (from Sat.) from FDA Chief Scientist RADM Denise Hinton to @CDCDirector
(Unclear to me why this letter was necessary when CDC had already recommended elastomeric respirators as an alternative to N95s, at least by mid-last week when I checked.)

https://www.fda.gov/media/135763/download
From what I can tell, this FDA letter (March 28) was issued as a follow-up to an original letter (March 2) because people wanted more specifics as to which types of respirators were included.
A former director of the CDC tweeted about elastomeric respirators + the study mentioned above. He got some retweets but not that many.

What. The. HECK??? I don't understand why people aren't all over this as a response to #GetMePPE https://twitter.com/DrTomFrieden/status/1242972789860118528
A doctor did tweet this nice CDC graphic in response. Also reminded us that they were used during H1N1. But this message seems to be gaining only limited traction. https://twitter.com/JamesLiadis/status/1242988450514690051
"Experts" who run hospitals and state/local governments apparently don't listen to people with a more blue collar background who might know a thing or two. 🙃 https://twitter.com/BrianaKarson/status/1243023983127207939
I also found out about elastomeric respirators from my dad who's worked around hazardous chemicals for about 25 years.
During non-pandemic times, being a healthcare worker has occupational hazards, but *generally speaking* they aren't in need of a high level of respiratory protection.
Now that there's a pandemic of a respiratory illness, maybe we should listen to people who have experience working in higher-risk respiratory conditions?
The people who work in construction or manufacturing jobs where if they inhale something by accident, they could suffer serious injury or even death?
Because healthcare workers are now facing *very similar* conditions with #COVID19.
Idk, guys, what am I missing here? How many construction sites, etc. are closed down for the pandemic and have elastomeric respirators lying around?

Is it really just unfamiliarity with this equipment that's standing in the way of adoption in the face of a massive PPE shortage?
Are there just not enough of these to justify the cost/benefit? I don't think I buy that, especially given the reusability and existing regulations permitting them.
I don't have numbers either way but would guess that they could make a significant difference in the shortage.
Meanwhile, @nytimes has story about people 3D printing new PPE, fast-tracking FDA approval, which is great... but what about the equipment that's ALREADY out there and ALREADY FDA/CDC approved? https://www.nytimes.com/2020/03/30/health/coronavirus-innovators.html?smtyp=cur&smid=tw-nytimes
Hive Mind of Makers Rises to Meet Pandemic

Tinkerers, sewers and scientists bring their ideas and 3-D printers to bear on the shortage of medical supplies.

https://www.nytimes.com/2020/03/30/health/coronavirus-innovators.html?smtyp=cur&smid=tw-nytimes
Really, is this it? They make patients anxious. It's a pandemic, we have an acute PPE shortage, we're ALL anxious but especially people in emergency rooms.

As for expense, they aren't expensive if they're donated/ government takes them from industry.

https://www.fastcompany.com/90481370/why-havent-they-designed-reusable-n95-masks
Evidence that elastomeric respirators are WAY more efficient than disposable N95s. This study predicted that during a pandemic, for every 1 million in the population, would need ~6.1 million single-use N95s but only ~10,600 elastomeric respirators
https://www.ncbi.nlm.nih.gov/books/NBK540080/
Also, btw here are CDC guidelines for H1N1 (written 2009-2010) that talk about elastomeric respirators.

https://www.cdc.gov/h1n1flu/guidelines_infection_control_qa.htm#i
👇👇👇 https://twitter.com/meloncholy/status/1245379527263555585
Someone finally wrote an article about this!!!

I don't begrudge the gazillion articles discussing research on how to disinfect single-use N95 masks, but the glaring absence of even any *mention* of existing reusable alternatives made me want to scream. https://twitter.com/DonovanSlack/status/1246078439658008577
Adding to this thread with more updates! https://twitter.com/ChrisFriese_RN/status/1253030108887212033
Also adding this article that came out last week: https://twitter.com/rkhamsi/status/1250765349802426368
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