Melissa Mattola-Kiatos has seen a great deal in nearly 11 years as a nurse at Massachusetts General Hospital. But on Monday, she experienced a first: Rather than getting a new respirator mask as she started her shift, she was given one she had worn before — decontaminated in a cutting-edge process meant to help address the dangerous equipment shortages that have plagued hospitals in the battle against the coronavirus.
There was, Mattola-Kiatos acknowledged, “a little bit of uncertainty not knowing how the whole process was going to work. Was it going to smell differently, was it going to feel differently? It’s actually better for me than taking a brand new one out of the box because I’ve already molded it to my face. It’s like it was custom-made for me.”
As part of a bold initiative involving hospitals across the state, MGH on Monday began distributing thousands of freshly decontaminated N95 masks to health care workers after the equipment went through an elaborate cleaning process at a site now up and running in Somerville. The treatment takes place inside a giant decontamination machine owned and operated by the Ohio nonprofit Battelle. Hospitals plan to use the machine to alleviate critical shortages of respirator masks for workers battling the coronavirus pandemic. At its peak, the system will be able to treat up to 80,000 masks per day — a prospect hailed as a “game-changer” for the region.
Inside the loading bay of a former Kmart store in Assembly Row over the weekend, scores of white and teal-blue masks lined the metal racks inside shipping containers. Signs read “DANGER: VHP decontamination in progress.” A nearby container held protective suits and rubber boots ready to be worn by a team of 11 technicians.
MGH couriered about 3,000 of its N95 masks on Friday morning to Battelle, which uses concentrated hydrogen peroxide vapor for decontamination. Boston Medical Center, Brigham and Women’s Hospital, Faulkner Hospital, and Tufts Medical Center also sent masks for decontamination, according to Matt Vaughan, Battelle’s contract research president.
On Saturday and Sunday, the system ramped up. “On the first day we did 1,800 masks, and on the second day it was 2,900,” Vaughan said.
At MGH, where doctors and nurses got their own individual masks back, anxieties about the system quickly dissipated.
“I feel confident using it, said Mattola-Kiatos. “I wear glasses, and for me this is my biggest test. If my glasses fog up, that means I’m not wearing the mask correctly. I put it right on my face, and I knew it fit.”
Battelle announced on Friday that the service will be offered for free to health care providers, thanks to a new six-month federal contract. The cost for Massachusetts hospitals was initially announced as about $3.25 per mask.
Partners HealthCare did incur some costs as part of the arrangement that brought Battelle to the area. “We were prepared to do whatever we needed to get them here,” said Chris Coburn, chief innovation officer at Partners, in an e-mail. “To get the deal done with Battelle, we committed to the immediate site prep, which included making a deposit to Federal Realty [Investment Trust] to cover utilities, etc., as well as the electrical and other contractors to get appropriate power to the site.” Federal Realty, which owns the property, is not seeking compensation, according to Somerville Mayor Joseph Curtatone.
The need for N95 masks has surged as the pandemic has spread through Massachusetts. According to Coburn, the Partners system, which includes MGH, the Brigham, and Faulkner, is currently using about 25,000 masks per week. “We expect that it will go to 45,000," he said at a press briefing on Saturday. At the Brigham alone, the hospital has gone from using 100 to 150 respirator masks each day before the pandemic to 900 to 1,000 each day last week, according to Kevin Giordano, senior vice president of clinical services at Brigham Health.
Hospitals have been working to replenish their stores of personal protective equipment through their normal suppliers, donations, and state and federal shipments, but shortages remain a top concern as Massachusetts approaches an anticipated surge of coronavirus cases. State officials expect the number of people ill with the virus to peak between now and April 20, further straining hospitals.
"PPE remains our best tool," said Steve Walsh, president of the Massachusetts Health & Hospital Association. "There has been some relief in that regard, but it continues to be one thing that keeps our providers up at night."
Walsh called the new Battelle machine "a huge boost for the state."
“We’re hoping nobody throws away an N95 mask again while it has useful life,” he said
Beth Israel Lahey Health is carefully tracking the use of supplies across its many hospitals, said spokeswoman Jennifer Kritz. “We continue to see significant PPE shortages, but we are holding our own through a combination of conservation and efforts to scour the earth to find sources of supply, as well as innovative uses and reuses of equipment,” she said.
Hundreds of health care workers at Boston’s biggest hospitals have been infected with the coronavirus, though hospital officials believe many of them became ill through community spread, not interactions with sick patients. Still, PPE is critical for keeping health care workers safe when they’re around contagious patients, and N95 respirator masks are considered particularly effective at guarding against the droplets that spread the virus.
The Massachusetts Nurses Association is urging that all hospital nurses be given N95 masks, because even asymptomatic patients may be carrying the virus. “It’s still a daily battle for many nurses across the state to get what they need,” said David Schildmeier, a union spokesman.
Each hospital that participates in the Battelle process will receive its own decontaminated masks back. At MGH, in an extra step to help each doctor and nurse get his or her own personal mask returned, staff use a Sharpie to write their name, plus a five-digit code for their hospital unit, on their masks, according to Danielle Le Hals, executive director of radiation oncology at MGH, who oversees the hospital’s logistics for the decontamination process.
The Battelle hydrogen peroxide process kills 99.99999 percent of all contaminants, Vaughan said. Afterward, HEPA filters capture any particles with an efficiency of 99.97 percent. Each mask is then inspected, and the number of times it has been treated is marked on it.
Masks can be decontaminated safely up to 20 times, according to Battelle, but MGH anticipates it may not use them more than four or five times, Le Hals said.
At MGH on Monday, the processed masks were unpacked and distributed in cardboard boxes that look like Big Mac containers, featuring stickers with each user’s name.
Brigham staff are waiting to see how the MGH system works before deciding whether to adopt something similar, Giordano said.
The new system may take some getting used to for hospital staff, who once discarded respirator masks after each use. “Moving from a traditional system to one where they’re decontaminated, there’s an emotional element to this, it’s something different,” Giordano said.
“There’s interest and excitement in the new technology,” he said, along with “some uncertainty and anxieties that we’re going to do our best to address. What’s important is that we have the science on our side.”
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