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Mercy health system workers wear N95 mask three shifts in a row, defying crisis guidelines

SLU Hopital and Cardinal Glennon sterilize, reuse masks

Medical masks hang in a trailer outside Cardinal Glennon and SLU Hospital on Wednesday, April 22, 2020, for sterilization via direct UV light. Local robotic packaging developer PASCO designed and donated the trailer that zaps 180 masks at once. With personal protective equipment scarce in the coronavirus pandemic, making masks available for reuse is critical for hospitals. Photo by Christian Gooden,


ST. LOUIS — Front-line health care workers at Mercy hospitals, including nurses and doctors, are having to wear their N95 masks — designed for one-time use to protect against viruses — for three shifts in a row.

An anonymous whistleblower tipped off the St. Louis Post-Dispatch that workers at Mercy Hospital South — the former St. Anthony’s Medical Center in south St. Louis County — are expected to wear their masks for three days. That goes against federal crisis guidelines, which recommend storing masks for at least five days in between shifts.

Mercy, in response to the newspaper, confirmed Thursday that in order to preserve its supply of the critically needed masks, the three-time reuse policy was instituted across its hospitals in early April. The Chesterfield-based hospital system has more than two dozen hospitals in Missouri, Arkansas, Oklahoma and Kansas.

“As part of Mercy’s PPE (personal protective equipment) conservation efforts, it is our policy to have co-workers who use N95 masks wear the same mask for up to three shifts with proper, safe storage between shifts,” Mercy spokesman Joe Poelker said in an email.

Mercy’s statement on Thursday appears to contradict a press release it issued on April 23, when it assured the public its “current supply of new PPE is sufficient.” It touted having a decontamination system at the ready that is capable of reprocessing as many as 2,500 masks per day.

The N95 masks are tight-fitting with filtration materials capable of blocking 95% of the very small particles transmitted in the air by coughs, sneezes and medical procedures.

They are regulated and approved for one-time use, which has resulted in a shortage as the worldwide coronavirus pandemic increased demand.

With hospitals running low on their protective equipment, they have been forced to come up with ways to stretch their supplies.

Many health care systems, including SSM Health and BJC HealthCare in the St. Louis area, have relied on ways to decontaminate masks after each shift in an effort to keep workers safe.

While the U.S. Centers for Disease Control and Prevention does not recommend reusing the masks, because it can reduce their filtration capacity, the federal agency has developed guidelines, based on the results of early studies, to help hospitals do so in the safest manner during a crisis.

The CDC reports that prolonged use of an N95 mask can be safe for up to eight hours, and encourages the additional use of a face shield over the mask.

Mercy workers also use face shields along with their masks, officials said.

The CDC suggests that each worker have five N95 masks, with each mask safely stored for five days until it is worn again. If five masks are unavailable for each worker who needs them, then decontamination may be necessary.

According to the CDC, decontamination methods have been shown to destroy the coronavirus and not damage the integrity of the mask up to a certain number of times depending on the method.

Any mask, however, that has been soiled or no longer fits tightly should be thrown out.

Fran Hixson, Mercy’s director of clinical quality, told the Post-Dispatch in an email that administration examined the available evidence from the CDC and institutions such as Emory University and found they “do not provide any data on the length of extended use or reuse of N95 masks.”

“Using the information available to us … we set three shifts as a maximum for the extended use of N95 masks,” Hixson said.

Mercy workers are encouraged to discard any mask that is visibly soiled, difficult to breathe through or no longer has a proper seal, she said. After three shifts, workers turn in the masks for sanitation and possible reuse.

“The crisis management of a limited national supply of N95 masks during a pandemic requires some difficult decisions, and we look forward to a time where the supply of PPE allows to return to the standard policies that were in place prior to the pandemic,” Hixson said.

SSM hospitals as well as BJC hospitals ask workers to turn in masks after each shift for sterilization. The hospitals rely on a process known as hydrogen peroxide gas sterilization, a low-temperature process commonly used in hospitals to sterilize surgical tools that could be damaged by heat, as well as UV-C light.

The state of Missouri also used emergency federal funds to bring in a decontamination system developed by nonprofit Battelle of Columbus, Ohio, that uses hydrogen peroxide vapor.

The system was set up in Jefferson City on April 30 and has sanitized over 1,000 mask so far, a Battelle spokesman said. Health care workers and first responders are able to drop off masks at 13 locations throughout the state, including Bridgeton in the St. Louis area. The masks spend 72 hours at the facility.

Battelle’s system has been approved for emergency use by the federal Food and Drug Administration. Battelle’s research shows the masks can be reused 20 times after cleaning and still function properly.

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