Prolonged Use of Respiratory Protection Equipment

Definitions and Guidelines

The American Academy of Orthopaedic Surgeons defines extended use of respiratory protection equipment as the continuous or intermittent use of the same respirator for repeated close contact encounters with multiple patients, without removing it between encounters 1
The Centers for Disease Control and Prevention (CDC) suggests that extended use or reuse of N95 respirators for 8 hours (continuous or intermittent) may be acceptable under specific conditions, including proper hand hygiene and respirator maintenance 4

Theoretical limits for N95 respirator use are 8 to 12 hours, but in practice, extended use beyond 4 hours is generally impractical in most clinical settings due to provider needs for meal breaks and physiological needs 1
A study found that healthcare workers could tolerate N95 respirators for 89 of 215 (41%) total 8-hour shifts, indicating significant limitations in tolerability 3

Prolonged use of respiratory protection equipment presents physiological risks to workers, including dehydration and heat stress, and requires careful attention to limiting work shifts and using proper decontamination procedures 6
The CDC recommends discarding N95 respirators after close contact with patients under contact precautions or after aerosol-generating procedures 1

Powered Air-Purifying Respirators (PAPRs) are preferred for long operations if available, as they do not require prior fit testing, are more comfortable, and are reusable 2, 1, 4
PAPRs have a higher assigned protection factor (25 to 1,000) compared to N95 respirators (10) 4