OLMSTED ENVIRONMENTAL SERVICES, INC

1992 Route 9 Garrison NY 10524

Report Date: November 27, 2020

To: Claire Tuck – Legal Director

Email: claire.tuck@nysna.org
david.pratt@nysna.org

Prepared by: Edward Olmsted, CIH, CSP

Re: Employee Safety and Health During COVID-19 Epidemic

At the request of the New York State Nurses Association (NYSNA) I have reviewed the
complaints submitted by Nurses represented by NYSNA regarding infection prevention
with SARs-CoV-2 at Albany Medical Center located in Albany, NY. Based on the review
of those papers, it is my professional opinion that the nurses at Albany Medical Center
(AMC) have been placed at unreasonable risk of exposure to COVID-19 while
performing their jobs. I base my opinion on the following:

1. Reuse of N95 Filtering Facepiece Masks - N95 respirators are not designed or intended for
reuse, however nurses at Albany Medical are required to reuse N95 respirators over an
extended period of time. It was reported that masks are collected after use and treated using
a Bioquell process, which involves large scale disinfection using aerosolized hydrogen
peroxide. The National Institute for Occupational Safety and Health (“NIOSH”) and the
Occupational Safety and Health Administration (“OSHA”) guidelines, and the standard in
the field of safety and health, all instruct that disposable or “single-use” N95 respirators
are not intended for reuse.1 In fact, the major manufacturer of N95 respirators in the United

1
OSHA/NIOSH, Hospital Respiratory Protection Toolkit, page 16, 2015 Occupational
Safety and Health Administration (OSHA), available at
https://www.osha.gov/Publications/OSHA3767.pdf.
 New York State Nurses Association
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SARs-CoV-2 Albany Medical Center

States, 3M, does not recommend reuse or cleaning of disposable N95 respirators. 3M
warns that filtering facepiece N95 respirators are not intended to be decontaminated.2 The
treatment with hydrogen peroxide has been shown to disinfect the mask, however,
hydrogen peroxide (H202) is a strong oxidizer and will degrade the straps on the mask and
mask material as well. H202 reacts with most organic compounds including polyethylene,
which is the principal component of masks and straps. As the straps are oxidized by the
hydrogen peroxide they can stretch out affecting the fit of the N95. Albany Medical does
not have a policy of refit-testing employees on masks that have been worn by the nurse and
treated with hydrogen peroxide over multiple cycles. It is more than likely as the mask and
straps are weathered by repeated H202 treatments, the fit of the mask is impacted. This
results in a mask that may have fit a nurse when new, but no longer fits after multiple
sterilization events. In fact it was reported that when employees were fitted on recycled
masks, the hospital found a high fit test failure rate and has not acted upon this.
2. Masks Are not discarded even when visibly soiled or damaged - It was reported that N95
face pieces are often observed to have visible contamination or are misshapen due to
folding when returned after disinfection treatment. OSHA mandates that users should
discard respirators when they become damaged, misshapen, soiled or become unsuitable
for further use due to excessive breathing resistance (for example, particulates clogging the
filter).3 Re-using damaged soiled masks is a health hazard and will not protect the worker.
Additionally, it was reported that disposable N95 masks are being cleaned up to 20 times.
The Centers for Disease Control advise that limited cleaning and reuse of N95 masks may
be possible, but there are many warnings. These include disposal after use around aerosol
generating procedures, disposal if misshapen or stained or obviously damaged. CDC warns

2.
3M Technical Bulletin, Decontamination of 3M Filtering Facepiece Respirators, such
as N95 Respirators, in the United States - Considerations – September 2020 Revision 11
3
OSHA/NIOSH, Hospital Respiratory Protection Toolkit, page 27, 2015 Occupational
Safety and Health Administration (OSHA), available at
https://www.osha.gov/Publications/OSHA3767.pdf.

2
 New York State Nurses Association
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SARs-CoV-2 Albany Medical Center

that reuse of filtering facepiece masks (disposable masks) should be limited to no more that
5 donnings of the mask due to the impact on the fit.4
3. Cleanable Respirators are Available to AMC and not Used – If Albany Medical wants to
reuse respirators, it can do so safely by purchasing respirators that are intended for cleaning
and reuse -- tight-fitting elastomeric respirators with replaceable and disposable filters. A
nurse could safely wear an elastomeric respirator into a COVID-19 patient area and then
sanitize the respirator using wipes designed by the manufacturer. Furthermore, these masks
can be worn with a surgical mask over the exhalation valve to filter exhaled air and thereby
prevent infection. These elastomeric masks have a long track record of over 50 years and
have been demonstrated to be easily cleaned and sanitized and to maintain good fit after
cleaning. Instead, Albany Med has chosen to issue disposable, single use N95s, which are
not designed to be reused or cleaned.
4. Standard infection prevention controls are not used - It was reported that patients are often
in the emergency department waiting areas and are not distanced by 6 feet. In some case
patients who may have tested positive for SARs-CoV-2 are waiting to be admitted or
treated and are seated with other patients. Patients are transported and moved into and out
of elevators comingling COVID patients and other patients and visitors. It should be
required that all patients wear masks when indoors and follow 6 foot distancing between
patients. Elevator occupancy should be strictly limited to provide distancing. This is
standard practice for reducing exposure and controlling infection. One nurse reported that
a training seminar was done with over 20 nurses in the room and the instructor not wearing
a mask. In my recent experience working at three NYC hospitals, employees in seminars,
classroom areas or conference rooms are required to wear a mask and observe social
distancing rules. In fact, a large NYC hospital center has recently instituted a policy that
all meetings and trainings must be done by web based platforms with in-person meetings
forbidden. Albany Medical should be meeting these same standards of care and infection
prevention observed in other hospitals and public places.

4
Centers for Disease Control (CDC) Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after
Decontamination, When There Are Known Shortages of N95 Respirators; October 2020.

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 New York State Nurses Association
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SARs-CoV-2 Albany Medical Center

5. Failure to Provide Negative Pressure Isolation Rooms for COVID-19 Patients - Nurses
report that COVID-19 patients are sometimes placed in rooms that are not negative
pressure isolation rooms. One way that ventilation can be used to contain infectious disease
is through differential pressure. Exhausting more air from a room than is supplied will
create negative pressure, which prevents airborne contaminants from escaping from the
room. Isolation rooms are specially designed to have negative pressure. But it is also
possible to adjust the supply and exhaust ventilation to a room to convert it to a negative
pressure room. Portable air filtration devices can be equipped with a flexible duct that is
discharged outside in order to quickly and temporarily establish negative pressure in a
standard patient room used for COVID patients. The use of engineering controls is the first
level of exposure control for employees and takes precedence over use of personal
protective equipment such as masks in the hierarchy of controls.
6. Nurses Have not been adequately trained in the use of PPE including respirators – Nurses
report that they are issued powered air purifying respirators (PAPRs), but have not been
trained in the use of the respirator. The report that the use of N95s in the operating room is
not mandated and no clear direction is given when specific PPE is required and must be
worn. The OSHA personal protective equipment standard (1910.132(f)(1) requires
employee PPE training to include the following:
• When PPE is necessary
• What PPE is necessary
• How to properly don, doff, adjust and wear PPE;
• The limitations of the PPE;
• The proper care, maintenance, useful life, and disposal of the PPE.
Re-training is required when the requirements for PPE change, when employees
demonstrate inadequate knowledge or use of the assigned PPE or have not retained the
requisite skill, or there are changes in the workplace. The employer must perform a
hazard assessment with documentation and certification of the assessment including the
person making the assessment and the date.