Throughout much of the coronavirus pandemic, hospitals have been reusing medical masks that were designed to be disposable as a way to continue operating amid widespread supply shortages.
To help keep hospitals from running out of supplies, the federal government purchased for states decontamination systems that allow masks to be reused. But an analysis by KCUR shows the systems, for which the federal government allocated nearly $500 million, have seen little use in Kansas and Missouri.
Hospitals say they welcome the option the system provides, but critics say it has not lived up to the hype.
“We’re far under the daily estimate for how much these decontamination units would be used and the benefit they would provide to those that have them,” says Scott Amey, general counsel for the Project On Government Oversight, a nonprofit based in Washington, D.C..
Missouri Gov. Mike Parson announced in late April that a Battelle CCDS Critical Care Decontamination System had been provided to Missouri for at least six months. Hospitals, health care providers and first responders would be able to ship or take masks to dropoff centers, where they would be decontaminated at the unit in Jefferson City and returned in about 72 hours.
The decontamination system, which can be used for free, can process up to 80,000 N95 masks per day. Funding comes entirely from the Federal Emergency Management Agency, or FEMA, according to Missouri health department spokeswoman Lisa Cox.
But so far, the system as of July 1 had decontaminated only 4,555 masks in Missouri, according to Cox. And in Kansas, it had decontaminated only about 6,000 masks as of the end of June, according to Kansas Department of Health and Environment spokesperson Ashley Jones-Wisner.
By way of comparison, AdventHealth Shawnee Mission, a single hospital location in Merriam, Kansas, had decontaminated nearly 10,000 masks in-house as of late June.
Many hospitals developed their own in-house decontamination systems early in the pandemic, as shortages quickly threatened supplies of basic protective gear.
“We needed to reuse them,” says Andrew Pierce, supply chain director at Barnes-Jewish Hospital in Saint Louis. “Because if we had discarded them according to the way we normally use them, there would have been nothing.”
Similarly, all of the Kansas City area hospitals contacted by KCUR for this story, including The University of Kansas Health System, Children’s Mercy Hospital, AdventHealth Shawnee Mission and Truman Medical Centers, said that they used their own ultraviolet decontamination systems or other methods.
Many hospitals in Missouri haven’t needed the Battelle system, according to Missouri Hospital Association spokesman Dave Dillon.
“A majority of the larger hospitals and systems have their own decontamination systems which can expedite turnaround,” Dillon said in an email.
Dillon, however, said the Battelle system was “an important resource.”
The Battelle contamination system was developed earlier this year by the Battelle, a private, nonprofit applied science company based in Columbus, Ohio, in response to widespread mask shortages.
The units look like large shipping containers filled with wire shelves, where masks can be placed and treated with vapor phase hydrogen peroxide.
Despite their low-tech appearance, the Battelle systems carry a high price tag.
In April, the Department of Defense awarded Battelle a $415 million contract for 60 Battelle units, including maintenance and operation for six months.
A press release issued by the Department of Defense stated the units could sterilize up to 4.8 million masks per day.
Battelle was then awarded a separate $78 million contract by the Defense Logistics Agency, the Department of Health and Human Services and FEMA to fund the building of the units, according to company spokeswoman Katy Delaney.
The units have since been deployed throughout the country.
Meanwhile, a number of recent studies conducted around the world suggest that other decontamination methods are also effective and may have advantages over the Battelle system.
While the Battelle system has a turnaround time of three days, the ultraviolet light systems used in many Kansas City hospitals can decontaminate several hundred masks in as few as three to four hours, according to University of Oklahoma researcher Evan Floyd, who specializes in personal protective equipment safety.
Other methods, such as steam cleaning or baking, may be simple and inexpensive enough for someone to undertake in their home, a recent research review shows.
Floyd says that a number of decontamination methods appear to be effective, although some questions remain on how they affect the quality of the masks, especially after repeated decontaminations.
But Floyd notes that any decontamination system, including Battelle’s, which requires masks to be shipped, sorted and returned inevitably creates challenges.
“The Battelle vapor phase hydrogen peroxide system – it seems great,” Floyd says. “It’s just the logistics of it is difficult.”
In fact, the Battelle system’s turnaround time has proved too long for some Missouri hospitals that are running short on masks.
“Their limited supply makes the downtime for shipping, sanitizing and return a challenge,” said Dillon, of the Missouri Hospital Association.
The experience of one Missouri dentist suggests that the Battelle system may be getting more use from smaller scale providers.
Travis Shearer, a dentist in West Plains, Missouri, in the southern part of the state, started using N95 masks in his practice for the first time during the pandemic.
He says he's had 200 masks decontaminated with the system.
"If it was not for Battelle we would not have been able to provide dental services other than emergent care," Shearer wrote in an email.
Battelle spokesperson Delaney acknowledges that using the Battelle system requires health care providers to operate differently, but she says she has not heard that hospitals have struggled with the logistics of using it.
The Battelle units have decontaminated a total of 1.2 million masks nationally since being deployed, far below the 4.8 million mask per day capacity, Delaney says.
Delaney, however, defends the system’s cost.
“Putting a price on protecting health care worker during a pandemic – it’s not something you can do,” she says.
Delaney explains that the $415 million award represents a maximum that Battelle can bill the government for services, rather than a grant awarded in full. However, she would not provide information on the amount the company had billed or the costs of maintenance and operation.
Although usage has been low, Delaney insists the Battelle units will serve as a critical safety net system for health care providers to use as coronavirus infections ebb and flow.
“Until the supply chain reestablishes itself as a resource that can be counted on, these systems are definitely in place and ready to be used when they are needed at whatever level,” Delaney says.
Amey, of the Project On Government Oversight, acknowledges that early in the pandemic, the possibility of hospitals running out of mask was concerning enough to warrant the government’s purchase of the Battelle units, which appeared to offer a way to avoid worst-case scenarios.
“At that point, to decontaminate these masks – it was certainly a need and a requirement that we had,” Amey says. “So, I don’t think there’s a problem with buying them.”
But the low use of the units raises questions for Amey about the system’s value.
“There are a lot of questions about, did we need 60 of these? How they were going to [be] used? How were the masks going to hold up?” he asks.
Supplies of masks have been increasing in recent weeks, and supply chain experts generally expect the availability of personal protective equipment will continue to improve.
However, now that hospitals and health care providers have been returning to normal operations and providing more non-urgent care, the demand for masks will continue to be far higher than before the pandemic.
As of late June, 94% of Missouri hospitals were reusing N95 masks, including all hospitals in the Kansas City area, according to the Missouri Hospital Association.
While the methods and practices are changing, Pierce, of Barnes Jewish Hospital, says health care providers will need to continue reusing and decontaminating masks for the foreseeable future.
“The reuse will need to continue,” Pierce says. “There is not enough product in our land to support the current need for taking care of the patients across our land.”
