Health-care workers at St. Michael’s and St. Joseph’s hospitals are being told that due to shortages of personal protective equipment (PPE) during the COVID-19 pandemic they’ll soon need to reuse N95 masks that have been decontaminated.

An undated memo from hospital network Unity Health Toronto obtained by the Star, states that they have been collecting used N95 masks instead of throwing them away. Their vice president of research and innovation, along with a team of scientists and engineers “are finalizing the accepted reprocessing techniques we will use for N95 respirators.”

The hospitals are already asking staff to wear the same N95 masks and face shields “when seeing multiple COVID-19 patients back-to-back, unless they are soiled or contaminated,” the memo adds.

And they “will soon be recommending reuse of N95 respirators during a shift (taking the N95 respirator off when not needed, safely storing, and then putting back on when needed again).”

Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses, said she “was reassured” by the province that at this time, under a Health Canada initiative, they are only testing possible methods to sterilize or decontaminate soiled N95 masks.

Nurses “were asked to put them in a bin because they will collect them to reprocess, and now they’re being told already here in this memo, ‘oh by the way, another memo will come soon saying to you, we will reuse them, and we will tell you how,’” she said.

“That’s the bit that they are totally jumping the gun on, before we even know if this works.”

The RNAO has been receiving emails from nurses worried that doing this wrong would leave them at risk, particularly given they are caring for patients who have a disease with no treatment or vaccine.

“The only vaccine is the PPE and if they’re telling them to use reprocessed ones they will explain to all of us, including to media, including to the nurses, that this was tested,” Grinspun said.

She also reinforced the importance of properly taking N95 masks on and off, a process known as donning and doffing, which the memo “does not stress enough.”

Nurses and other health-care professionals are already under a lot of stress and this makes it worse, she added.

“They get distracted by this type of memo, and I would too,” she said.

“Because if you’re worried about protecting yourself, and other colleagues, and other patients, it distracts you from the important work of taking care of patients.”

Asked about the memo, Unity Health Toronto spokesperson Jennifer Stranges responded echoing language from it in an email about the need for “additional measures to preserve PPE, specifically N95 respirators,” as they “expect to see more COVID-19 cases over the coming weeks and we need to continue to have sufficient supplies.”

“The health and safety of our patients, people and community remains our priority, and these measures are in the interest of keeping everyone well. We are working on reprocessing for N95 masks and don’t have more to share at this time,” she added.

There are currently 20 COVID-19 patients at St. Joseph’s and 20 at St. Michael’s, with six and seven in intensive care respectively, according to the most recent counts posted on Unity Health Toronto’s website.

A second undated memo provides more details to staff, and says there is a “critical shortage of N95 respirators,” telling staff to reuse them during shifts.

The person who provided it to the Star, a nurse, said it was from infection control at St. Mikes.

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It says that “staff should label their N95 respirator prior to donning with their first initial, last name, model and size, and date.

Staff should not change the N95 respirator unless it becomes damaged or soiled — it should last an entire shift,” the memo says.

When leaving for breaks it should be removed and safely stored, on, for example, a clean paper towel.

Vicki McKenna, a registered nurse and president of the Ontario Nurses’ Association (ONA) union, said if staff are being asked to reuse N95 masks they have to train them “to ensure that nurses are safe.”

COVID-19 patients should also be grouped together, and nurses should only be taking care of those patients so they minimize taking masks on and off.

On reprocessing soiled or contaminated masks, “we have said very clearly that unless the science is clear we would in no way endorse this,” she said.

“Manufacturers have not made any clear scientific guidance about this and how it should be done, and even if it should be done.”

ONA is “very concerned” about supplies of PPE, which impact everyone.

“We have to keep our health-care workers safe and if we don’t, more and more of them will become ill, they won’t be able to work. It’s a vicious cycle,” McKenna said.

“It’s a really difficult time right now and everybody is scrambling trying to make sure that we’ve got enough, we’ve got limited stock.The government is bringing stuff in but it’s all backed up.”

An Ontario Health spokesperson said there is a “tremendous group working in partnership with the ministry to keep supplies flowing in the face of travel disruptions and import challenges,” and they “applaud their efforts.”

“For the health of Ontarians and the safety of health-care workers, a number of organizations with support from Ontario Health are exploring various scenarios. This includes a scenario to reprocess N95 masks in case there is ever a need,” they added.

“Everything that we are exploring is being informed by science, is motivated by a deep commitment to safety, and is just to be prepared, if ever needed.”