FFP3 reusable respirators for COVID-19; adequate and suitable in the healthcare setting

Dear Sir/Madam,

in response to critical Personal Protective Equipment (PPE) shortages during the COVID-19 pandemic, MedsupplydriveUK was established by ENT trainee Ms. Jasmine Ho, and MedsupplydriveUK Scotland by two Plastic Surgery trainees (Ms. Gillian Higgins and Mrs. Eleanor Robertson). We applied the principles of creative problem solving and multidisciplinary collaboration instilled by our specialty. Since March 2020, we have recruited over 400 volunteers to mobilise over 200,000 pieces of high quality PPE donated from industry to the NHS and social care. We have partnered with academics and leaders of industry to manufacture: surgical gowns, scrubs and visors using techniques including laser cutting, injection molding, and 3D printing. We have engaged with NHS Boards and Trusts and politicians at local, regional and national level to advocate for healthcare worker protection in accordance with Health and Safety Executive and COSHH legislation including: engineering controls and PPE that is adequate for the hazard and suitable for task, user and environment.

Public Health England (PHE) currently advise FFP3 level of protection only in the context of a list of aerosol generating procedures¹. A surgical mask confers 6x (63%) protection, FFP2/N95 100x (92-98%) and FFP3 100-10,000x (>99%) protection (Figure 1 ). As SARS-CoV-2 is a novel pathogen, evidence is naïve and evolving, and since transmission occurs via aerosol, droplets and fomites from the aerodigestive tract, all 10 UK Surgical Associations have issued guidance to use higher levels of PPE for procedures that are not included in the PHE list(2). CBS, ENTUK and BAOMS have issued statements supporting the use of reusable respirators and power air-purifying respirators, and their use is approved by PHE, Health Protection Scotland, Public Health Agency, Public Health Wales, NHS and the Academy of Medical Royal Collages¹. The first author has experienced the need to quote BAPRAS guidance² in defense of their use of PPE².

Figure 1.

(a) Full face FFP3 reusable respirator conferring ∼10,000x (>99%) protection. (b) Surgical mask conferring 6x (63%) protection.

MedSupplyDrive (UK and Scotland) hope to empower all healthcare workers to demand provision of adequate (i.e. will protect from SARS-CoV-2) and suitable (for the task, user and environment) PPE by engaging with their employers directly or through Unions, Royal Colleges and Associations. As a nation we must learn from other countries who successfully protected their workforce. Data suggests that staff death is avoidable with the use of occupational health measures and FFP3 grade PPE³, despite which at least 245 UK health care workers have died of COVID-19⁴.

The strain placed on systems by SARS-CoV-2, with reduced access to operating theatres, beds, equipment and staff has the potential for serious detrimental consequences for surgical training⁵. PPE shortages and the subsequent necessity for rationing is causing additional harm. Due to global demand and supply chain failures, FFP3 disposable masks for people with small faces are in particularly short supply. The majority of these individuals are female, and they are currently provided with no solution apart from avoiding “high risk” operating if/when this resource runs out; further depriving them of training opportunities.

Reusable respirators provide superior respiratory protection over disposable FFP3 masks due to design characteristics. They are more likely to provide reliable fit due to increased seal surface area (half face 10mm, full face 20mm). As they are designed to be decontaminated between patients and after each shift they are both economically and ecologically advantageous whilst also reducing fit testing burden and negating reliance upon precarious supply chains. There are factories in the UK which already make reusable respirators and MedSupplyDrive have been contacted by UK manufacturers looking to retool to meet this demand. Although some NHS Trusts remain reluctant to use reusable respirators, others have already adopted them routinely, using manufacturer decontamination and filter change advice. One NHS Trust has supplied every member of their workforce with a reusable respirator as a sustainable plan for ongoing pandemic waves.

It is apparent that healthcare workers are unable to access sufficient quantities of high quality respiratory protection. Reusable respirators provide adequate protection from SARS-CoV-2 as well as being eminently suitable for a wide range of users, tasks and environment. We call on those reviewing decontamination and filter policy for reusable respirators to appreciate the urgency of the situation and expedite the process to enable all health and social care workers to access the respiratory protection that they need.